Ultrasound Densitometric Analysis of Carotid Plaque Composition

Beletsky, Vadim; Kelley, Roger E.; Fowler, Marjorie; Phifer, Travis J.

doi:10.1161/01.str.27.12.2173

Cited by 48 publications

(31 citation statements)

References 15 publications

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“…We excluded 17 that were validation studies comparing plaque imaging with histology [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] ; 7 that failed to provide sufficient data for each group 25,26,50 -54 ; 4 that were highly selected studies 19,[55][56][57] ; 2 that included patients with extracranial restenosis 58,59 ; and 8 that were duplicate records. 1,3,5,14,21,60 -62 The group sizes were very different in 1 study.…”

Section: Resultsmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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Background and Purpose-We sought to investigate the association between carotid intraplaque hemorrhage (IPH) and ipsilateral symptoms of cerebral ischemia. Methods-A search was performed for clinical observational studies comparing the incidence of IPH between symptomatic and asymptomatic patients. Odds ratios (ORs) for IPH as a factor in the pathogenesis of neurologic events were calculated and combined by a meta-analysis. Interstudy heterogeneity, estimated effects, and methodologic quality of the studies were assessed. Results-Thirty-one studies were included for analysis. The reported ORs varied widely. Overall, the incidence of IPH in the symptomatic groups was significantly higher than in the asymptomatic group. However, there was an apparent trend for heterogeneity (PϽ0.00001) between studies. The random-effects summary estimator of ORs was 2.25 (95% CI, 1.57 to 3.22; PϽ0.00001). To identify potential sources of heterogeneity, subgroup analyses were performed. The pooled ORs varied greatly by stratification. Major heterogeneity was found among studies with low quality, microscopic methods of examination, significant effects, small sizes, early publication, and unequal severity of carotid stenosis in both groups. Large, recent, macroscopic, or high-quality studies, as well as studies with equal degrees of stenosis, tended to yield insignificant associations. The methods in defining and evaluating hemorrhage were very heterogeneous. Characterizations of the age, size, number, and location of hemorrhages were poorly reported and highly variable. In addition, a lack of control of confounders and selection bias were frequently identified among studies. Conclusions-Statistical inferences have suggested a plausible role in the production of cerebral ischemia; however, reliable interpretation was strongly undermined by poor methodologic quality, substantial heterogeneity, and suspicious publication bias. To preciously estimate the underlying correlation, a well-designed study with uniformity in definition and evaluation for IPH might be warranted.

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Section: Resultsmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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“…Grønholdt et al 17 demonstrated that triglyceride-rich lipoprotein level in the fasting and postprandial state can be used to predict carotid plaque echolucency and that echolucency was associated with a high lipid content of plaque. Beletsky et al 18 performed densitometric analysis of the B-mode images of carotid plaques in patients who underwent endarterectomy. Digital densitometric evaluation in both studies allowed differentiation of the various possible components of carotid plaques, but densitometric analysis was subject to inherent nonlinear transformations in the ultrasound imaging chain that resulted from log compression and postprocessing functions.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Ultrasonic Tissue Characterization Can Identify High-Risk Atherosclerotic Alteration in Human Carotid Arteries

et al. 2000

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Background-Recently, ultrasonic tissue characterization of the composition of plaques has been performed in a quantitative fashion on the basis of integrated backscatter (IBS) analysis, but most of those studies have used high-frequency ultrasound to obtain microscopic images. Methods and Results-We performed B-mode measurement and IBS signal analysis with acoustic densitometry with a 7.5-MHz linear-array transducer in freshly excised human aortas (nϭ58) (normal, atheromatous, and fibrous tissue) obtained at autopsy. Atheromatous and fibrous tissue had a similar intima-media thickness (IMT), but the IBS value in atheromatous specimens was lower than that in fibrous specimens. We further applied this method to human carotid ultrasonography. The subjects were young (80 regions), middle aged with 1 or no coronary risk factors (low risk) (120 regions), middle aged with Ն2 coronary risk factors (high risk) (240 regions), or elderly (80 regions) or were patients with myocardial infarction (MI) with multivessel disease (90 regions). The IMT was similar in middle-aged, elderly, and MI subjects. In contrast, the IBS value was significantly higher in elderly subjects and lower in high-risk middle-aged and MI subjects compared with that in low-risk middle-aged subjects. The percent of regions diagnosed as atheromatous (IBS less than mean minus 2-SD value of IBS in young subjects) was 11% in low-risk middle-aged subjects, 29% in high-risk middle-aged subjects, and 63% in the MI group. Conclusions-In conjunction with conventional B-mode imaging, IBS analysis with carotid ultrasonography appeared to provide prognostic information to identify a high-risk group with systemic atherosclerosis, which could lead to coronary heart disease in individuals with early-stage disease. (Circulation. 2000;102:766-770.)

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“…Four studies provided no information on the sectioning, number or staining of histology slides. 12,56,58,72 Forty-three studies did not state whether the plaques were decalcified before histological analysis, of which 30 studies subsequently drew conclusions about the ability of imaging to detect calcification seen on histology. ** The histological features that were compared with imaging findings included size of lipid core relative to fibrous tissue (56 studies, 77%), calcification (48 studies, 66%), intraplaque hemorrhage (41 studies, 56%), surface-thrombus (27 studies, 37%), rupture (15 studies, 21%), inflammatory cells (9 studies, 12%), cap thickness (7 studies, 10%), and neovascularization (3 studies, 4%).…”

Section: Histological Methodsmentioning

confidence: 99%

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

Lovett¹,

Redgrave²,

Rothwell³

2005

Stroke

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Background and Purpose-Carotid plaque instability is an important determinant of stroke risk. There are now a number of different imaging techniques that provide information on carotid plaque morphology. However, it is unclear how they compare with one another or whether they can reliably assess plaque instability. Studies comparing imaging with pathology have shown highly variable results, even for similar imaging techniques. This may be because of variable pathology techniques rather than differences in imaging. Methods-We performed a systematic review of studies that compared carotid imaging with histology of the excised plaque published between January 1995 and September 2004. We assessed the quality and comparability of these studies. In particular, we determined which histology methods were used and whether observer reproducibility of the histology assessment was reported. Results-Among 73 eligible studies, histological methods were poorly reported and highly variable; 23% reported reproducibility data for imaging and only 12% reported reproducibility data for histology. Of 29 studies that reported quantitative results of blinded comparisons, there were methodological deficiencies and the results were highly variable.No study considered the extent to which the lack of reproducibility influenced the imaging-pathological correlations reported. Conclusions-Pathological correlation in studies of carotid plaque imaging cannot be reliably interpreted or compared because of incomparable and poorly reported histology methods. We make recommendations for the performance, reporting, and interpretation of imaging-pathological correlation studies and highlight the need for consensus guidelines.

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Ultrasound Densitometric Analysis of Carotid Plaque Composition

Abstract: We conclude that densitometric evaluation allows differentiation of the various possible components of carotid plaque. The determination of plaque composition, based on density measurement, may provide information about its potential for thromboembolization.

Cited by 48 publications

References 15 publications

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Quantitative Ultrasonic Tissue Characterization Can Identify High-Risk Atherosclerotic Alteration in Human Carotid Arteries

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

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