Ultrasound Elastography: another piece in the puzzle of carotid plaque vulnerability?

Abstract

Recent literature has shown that various carotid plaque features, other than stenosis, contribute to plaque vulnerability. Features such as surface morphology and plaque composition with distinct components (e.g. intraplaque hemorrhage, lipid core) have been associated with the increased risk of future cerebrovascular events. Ultrasonography constitutes the first line modality for the assessment of carotid disease and has traditionally been used to grade stenosis with high accuracy. Recenttechnological advances such as contrast-enhanced ultrasound and elastography increased the diagnostic yield of ultrasound in assessing the morphology of carotid plaques. The purpose of this review is to present the available literature on ultrasound elastography of the atherosclerotic carotid. Strain and shear wave elastography allow for the characterization of plaque components, thus indicating its nature and importantly, the plaque’s vulnerability. Shear wave elastography indices appear morerobust than Strain indices. Overall, elastography is a feasible method to distinguish vulnerable carotid plaques. There is, however, a need for larger and longer prospective controlled clinical studies in order to validate elastography as an imaging modality used for the detection of unstable carotid plaques.

Peripheral arterial disease treatment planning using noninvasive and invasive imaging methods

“…This technique has mainly been applied in the treatment of carotid artery disease. 20 , 21 Arterial stiffness increases in diseased arteries with thromboembolism, soft plaque, calcified plaque, and inflammatory disease. Because the rate of this progression varies between different vascular pathologies, elastography could be useful for further evaluation.…”

Novel ultrasound techniques in the identification of vulnerable plaques—an updated review of the literature

“…Ultrasound elastography can quantify the mechanical characteristics of plaques, and reveal their composition and vulnerability by analyzing tissue displacement in response to either external (focused acoustic radiation) or internal (variation in blood pressure) mechanical excitations ( 77 , 78 ). Depending on different motivation methods, ultrasound elastography can be classified into two imaging modes: strain elastography (SE) which utilize internal or external stress excitation, and shear-wave elastography (SWE) which utilizes shear wave excited by ultrasound.…”

“…The transducer emits a transverse wave through an acoustic radiation force pulse (ARFI) and measures the speed of the transverse wave propagation through the tissue, expressed as Young's modulus (YM), which reflects the tissue's resistance to elastic deformation and is largely depended on the composition of the tissue. Soft tissues such as lipid cores in plaques tend to show obvious elastic deformation, lower YM and lower transverse wave velocity; whereas harder tissues and lesions show less elastic deformation ( 77 , 84 ) ( Figure 4 ).…”

Elastografia Ultrassonográfica No Diagnóstico De Endometriose

“…Os índices de elastografia por onda de cisalhamento parecem mais robustos do que os índices de tensão. No geral, a elastografia é um método viável para distinguir placas carotídeas vulneráveis (Davidhi, 2022).…”