Late-Phase Contrast-Enhanced Ultrasound Reflects Biological Features of Instability in Human Carotid Atherosclerosis

Shalhoub, Joseph; Monaco, Claudia; Owen, David R.; Gauthier, Thomas; Thapar, Ankur; Leen, Edward; Davies, Alun H.

doi:10.1161/strokeaha.111.631200

Cited by 44 publications

(26 citation statements)

References 7 publications

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“…19,115 A number of inflammatory markers including matrix metalloproteinase-9 (MMP-9) are highly expressed in enhancing plaques. 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.…”

Section: Ceusmentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

294

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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Section: Ceusmentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

294

172

View full text Add to dashboard Cite

show abstract

“…1 Recently, contrast-enhanced ultrasound (CEUS) has been introduced for the evaluation of carotid atherosclerosis and plaque vulnerability by identifying the presence of intraplaque neovascularization. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The present review provides a brief overview of the commonly used ultrasound techniques for the evaluation of carotid atherosclerosis and subsequently focuses on the role of CEUS for the assessment of carotid atherosclerosis and plaque instability. The promising results of the initial CEUS studies in humans are discussed.…”

mentioning

confidence: 99%

Current status and future developments of contrast-enhanced ultrasound of carotid atherosclerosis

Kate

Oord²,

Sijbrands

et al. 2013

Journal of Vascular Surgery

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B-mode and Doppler ultrasound are commonly used for the evaluation of atherosclerosis in the carotid arteries. Recently, contrast-enhanced ultrasound (CEUS) has been introduced as a technique to improve the detection of carotid atherosclerosis and evaluate the presence of intraplaque neovascularization, which is considered a marker of plaque vulnerability. The present review focuses on the role of CEUS for the assessment of atherosclerosis and plaque instability. Currently available literature and future developments with CEUS are discussed.

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“…2,6,16,17 Thus, it is speculated that correlations may also exist between spatial and temporal parameters. Here, correlations between the two types of parameters are reported for the first time.…”

Section: Discussionmentioning

confidence: 99%