Evaluation of the Time-Dependent Changes and the Vulnerability of Carotid Plaques Using Contrast-Enhanced Carotid Ultrasonography

Shimada, Hirofumi; Ogata, Toshiyasu; Takano, Koichi; Abe, Hiroshi; Higashi, Toshio; Yamashita, T.; Matsunaga, Akira; Inoue, Tatsuo

doi:10.1016/j.jstrokecerebrovasdis.2017.09.010

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…Furthermore, the association between carotid plaque enhancement on CEUS and plaque vulnerability evaluated by MRI has been reported recently, which warrants further investigations on CEUS. 42 Whether identification of vulnerable plaque features may actually translate into a clinical benefit for patients remains a matter of debate. In the coronary setting, the most common cause of lumen thrombosis is plaque rupture, with the thin cap fibroatheroma (TCFA) being postulated as its precursor lesion.…”

Section: Discussionmentioning

confidence: 99%

Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease

D’Oria

Chiarandini

Pipitone

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease

D’Oria

Chiarandini

Pipitone

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…3 Additionally, in a recent study on the correlation between MRI and CEUS evaluation of carotid plaques, Shimada and colleagues compared the plaque-tomuscle ratio calculated via MRI and the median brightness of plaque enhancement found using CEUS, which both independently correlate to plaque vulnerability. 28 They identified a significant association between these values, which suggested diagnostic and prognostic agreement between the two techniques.…”

Section: Carotid Visualizationmentioning

confidence: 93%

“…2,5,7,21 The metabolic products of the contrast agent used in this modality are expelled through the lungs rather than the kidneys, as happens with MRI and CT, and can be safely used in patients with chronic kidney disease. 28 CEUS allows for the visualization of both superficial and deep vascular structures, reducing the need for invasive surgical exposure while also decreasing the overall time of surgery. 23,24,33 Particularly when guided by prior B-mode ultrasound, CEUS provides a broader view of the anatomical relationship among the lesion of interest, the surrounding parenchyma, and vessels of any diameter and flow velocity.…”

Section: Advantagesmentioning

confidence: 99%

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The role of contrast-enhanced ultrasound in neurosurgical disease

Kearns

Sokolowski

Chadwell

et al. 2019

Neurosurgical Focus

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Contrast-enhanced ultrasound (CEUS) is a relatively new imaging modality in the realm of neurosurgical disease. CEUS permits the examination of blood flow through arteries, veins, and capillaries via intravascular contrast agents and allows vascular architectural mapping with extreme sensitivity and specificity. While it has established utility in other organ systems such as the liver and kidneys, CEUS has not been studied extensively in the brain. This report presents a review of the literature on the neurosurgical applications of CEUS and provides an outline of the imaging modality’s role in the diagnosis, evaluation, and treatment of neurosurgical disease.

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“…Furthermore, a meta-analysis reported that CEUS is a useful, noninvasive modality for the diagnosis of intraplaque neovascularization [6]. We previously reported that the enhancement and its attenuation with time inside a carotid plaque on CEUS study was significantly associated with its vulnerability evaluated with magnetic resonance imaging [7]. The enhancement was highly suggestive of the presence of intra-plaque neovascularization.…”

Section: Doi: 101159/000495299mentioning

confidence: 97%

Intra-Plaque Vessels on Contrast-Enhanced Ultrasound Sonography Predict Carotid Plaque Histology

et al. 2018

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Background and Purpose: Although the echogenicity of carotid plaques on carotid enhanced ultrasound (CEUS) was reported to correlate with the historological density of intra-plaque neovessels, it is unclear whether the intra-plaque vessel size is associated with carotid plaque vulnerability. We evaluated the relationship of size of intra-plaque vessels on CEUS with carotid plaque histology. Methods: We prospectively registered patients with carotid stenosis who were hospitalized to receive carotid endarterectomy between 2012 and 2016. CEUS was performed by ultrasound specialists using a 7-MHz linear transducer (GE LOGIQ7; GE Healthcare, Milwaukee, WN, USA). Sonazoid® was used for conducting CEUS. The sizes of microbubbles inside the plaques were scored at 0, 1, 3, and 5 min after the injection of contrast agent, and were categorized according to our defined vascular score (Vas-S; 0: the effect of contrast was not recognized; 1: the microbubbles were visible, but so blurred and vague that their shape could not be recognized; 2: dot or string-like microbubbles with movement, localized in part or the whole site of the plaque). At histological examination, we simplified the modified American Heart Association classification and defined as an atherosclerotic category (Ath-cat; 1: unruptured plaque; 2: ruptured plaque; 3: healed plaque). We then assessed the correlation of Vas-S with Ath-cat, which describes the process of rupture and restoration of carotid plaques. Results: A total of 97 patients were included in this study. A higher Ath-cat was significantly associated with higher Vas-S at any time. Spearman signed-rank test indicated that Vas-S at 1 min was most strongly correlated with Ath-cat (ρ = 0.43, p = 0.001). Receiver operating curve analysis indicated that a Vas-S of 0 at 1 min was significantly associated with an unruptured plaque (area under curve [AUC] 0.72, p = 0.006), while a Vas-S of 2 at 1 min was significantly associated with a healed plaque (AUC 0.72, p = 0.001). Conclusion: Vas-S values of 0 and 2 at 1 min indicated unruptured and healed plaques respectively. Thus, a Vas-S of 1 at 1 min is an indicator of a ruptured plaque. The intra-plaque vessel size on CEUS was significantly associated with carotid plaque histology, and may predict the process of plaque rupture and restoration.

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Evaluation of the Time-Dependent Changes and the Vulnerability of Carotid Plaques Using Contrast-Enhanced Carotid Ultrasonography

Cited by 9 publications

References 18 publications

Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease

Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease

The role of contrast-enhanced ultrasound in neurosurgical disease

Intra-Plaque Vessels on Contrast-Enhanced Ultrasound Sonography Predict Carotid Plaque Histology

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