Correlation of Carotid Plaque Neovascularization Detected by Using Contrast-enhanced US with Clinical Symptoms

Xiong, Li; Deng, Yansha; Zhu, Ying; Liu, Yani; Bi, Xiaojun

doi:10.1148/radiol.2512081829

Cited by 156 publications

(132 citation statements)

References 27 publications

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“…Further, a different pattern of plaque vascularization was observed in the acute symptomatic patients, represented by a major and more diffuse contrast enhancement, completely different from the pattern of the majority of the asymptomatic plaques. These data have been confirmed by other Authors (Xiong, 2009;, Chowdhury ,2010, Cosgrove, 2009). Histological specimens with immunostaining obtained from CEA confirmed a relevant angiogenesis in symptomatic plaques when compared to asymptomatic ones.…”

Section: Contrast Ultrasound Findingssupporting

confidence: 86%

Contrast Enhanced Ultrasonography and Carotid Plaque Imaging: from the Hemodynamic Evaluation to the Detection of Neoangiogenesis - The New Approach to the Identification of the Unstable Plaque: from Morphology to Patophysiology

Giannoni¹,

Vicenzini²,

Monaco³

et al. 2011

Ultrasound Imaging

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Section: Contrast Ultrasound Findingssupporting

confidence: 86%

Contrast Enhanced Ultrasonography and Carotid Plaque Imaging: from the Hemodynamic Evaluation to the Detection of Neoangiogenesis - The New Approach to the Identification of the Unstable Plaque: from Morphology to Patophysiology

Giannoni¹,

Vicenzini²,

Monaco³

et al. 2011

Ultrasound Imaging

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“…Systematic histopathological validation revealed a direct positive correlation between contrast enhancement using this semi-quantitative grading scale and histology [44,45]. Furthermore, wholly consistent with the concept that more vulner- able plaque contains a higher degree of neovascularization, recent retrospective studies revealed the association between plaque enhancement on contrast-enhanced ultrasound imaging and clinical symptoms including cerebrovascular events in patients with carotid atherosclerosis [19,46,47]. Therefore, contrast-enhanced ultrasound examination of the carotid artery may provide a novel, noninvasive clinical tool to identify and quantify the presence and the extent of arterial plaque neovascularization in patients at risk for developing symptomatic atherosclerosis, thus permitting more reliable assessment of cardiovascular risk.…”

Section: Plaque Neovascularization On Contrast-enhanced Ultrasound Imsupporting

confidence: 59%

Current Strategies and Possible Perspectives of Ultrasonic Risk Stratification of Ischemic Stroke in Internal Carotid Artery Disease

Eyding

Geier

Staub³

2010

Ultraschall in Med

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“…50,91 Studies comparing plaque enhancement in asymptomatic and symptomatic plaques have demonstrated that plaque enhancement is markedly increased in patients with symptomatic plaque and is associated with a higher rate of cardiovascular events in general. 102,122,130 Retention of microbubbles on the plaque surface on delayed images has been shown to correlate with plaque disruption and inflammation as macrophages are known to phagocytose this contrast agent. 56 When combined with B-mode ultrasonography, CEUS provides further details in plaque characterization.…”

Section: Ceusmentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

291

172

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abbreviatioNs AHA = American Heart Association; CAS = carotid artery stenting; CEA = carotid endarterectomy; CEUS = contrast-enhanced ultrasonography; CTA = CT angiography; DCE = dynamic contrast-enhanced; DSCT = dual-source CT; FDG = fluorodeoxyglucose; FSE = fast spin echo; Gd = gadolinium; HU = Hounsfield units; IPH = intraplaque hemorrhage; LRNC = lipid-rich necrotic core; MDCT = multidetector-row CT; MDCTA = MDCT angiography; MES = microembolic signal; MMP-9 = matrix metalloproteinase-9; MRA = MR angiography; PDW = proton density-weighted; SUV = standardized uptake value; SUVmax = maximal SUV; TBR = target-to-background ratio; TCD = transcranial Doppler ultrasonography; TIA = transient ischemic attack; TOF = time of flight; USPIO = ultrasmall superparamagnetic iron oxide. Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis....

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Correlation of Carotid Plaque Neovascularization Detected by Using Contrast-enhanced US with Clinical Symptoms

Abstract: Symptomatic patients had more intense contrast agent enhancement in the plaque than asymptomatic patients, suggesting that contrast-enhanced carotid US may be used for plaque risk stratification.

Cited by 156 publications

References 27 publications

Contrast Enhanced Ultrasonography and Carotid Plaque Imaging: from the Hemodynamic Evaluation to the Detection of Neoangiogenesis - The New Approach to the Identification of the Unstable Plaque: from Morphology to Patophysiology

Contrast Enhanced Ultrasonography and Carotid Plaque Imaging: from the Hemodynamic Evaluation to the Detection of Neoangiogenesis - The New Approach to the Identification of the Unstable Plaque: from Morphology to Patophysiology

Current Strategies and Possible Perspectives of Ultrasonic Risk Stratification of Ischemic Stroke in Internal Carotid Artery Disease

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

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