TY - JOUR
T1 - The role of contrast-enhanced ultrasound (CEUS) in visualizing atherosclerotic carotid plaque vulnerability: Which injection protocol? Which scanning technique?
AU - Iezzi, Roberto
AU - Petrone, Gianluigi
AU - Ferrante, Angela Maria Rosaria
AU - Lauriola, Libero
AU - Vincenzoni, Claudio
AU - La Torre, Michele Fabio
AU - Snider, Francesco
AU - Rindi, Guido
AU - Bonomo, Lorenzo
PY - 2015
Y1 - 2015
N2 - Purpose: To correlate the degree of plaque vulnerability as determined by contrast-enhancedultrasound(CEUS)with histological findings. Secondary objectives were to optimize the CEUS acquisition technique and image evaluation methods.
Materials and methods: Fifty consecutive patients,either symptomatic and asymptomatic referring to
our department in order to perform carotid endarterectomy(TEA),were enrolled.Each patient provided
informed consent before undergoing CEUS.Ultrasound examination was performed using high-frequency
(8–14 MHz)linear probe and a non-linear pulse inversion technique(mechanicalindex:0.09–1.3).A
double contrast media injection(Sonovue,2mLand4mL;Bracco,Italy)was performed.Two video-
tapes were recorded for every injection:early “dynamic” phase and late “flash” phase,performed with
6 high mechanical index impulses.Movies were quantitatively and qualitatively evaluated.Qualitative
and quantitative evaluation were statistically compared to immunohistological diagnosis of vulnerable
plaque, considered as gold standard.
Results: Qualitative CEUS evaluation obtained high statistical results when compared to immunohisto-
logical results,with values of sensitivity,specificity,positive predictive value(PPV),negative predictive
value (NPV),and diagnostic accuracy of 94%,68%,87%,85% and 86%,respectively,which became higher if
considering only asymptomatic patient,with a NPV of 91%.Nevertheless, quantitative software evaluation
proved less effective and could not reach similar results.
Conclusion: Carotid plaque enhancement assessed with CEUS well correlates with histological assessment
of plaque instability.CEUS may provide valuable information for plaque risk stratification and may play
a role in the indication to treatment of patients with carotid stenoses, particularly in asymptomatic
population.
AB - Purpose: To correlate the degree of plaque vulnerability as determined by contrast-enhancedultrasound(CEUS)with histological findings. Secondary objectives were to optimize the CEUS acquisition technique and image evaluation methods.
Materials and methods: Fifty consecutive patients,either symptomatic and asymptomatic referring to
our department in order to perform carotid endarterectomy(TEA),were enrolled.Each patient provided
informed consent before undergoing CEUS.Ultrasound examination was performed using high-frequency
(8–14 MHz)linear probe and a non-linear pulse inversion technique(mechanicalindex:0.09–1.3).A
double contrast media injection(Sonovue,2mLand4mL;Bracco,Italy)was performed.Two video-
tapes were recorded for every injection:early “dynamic” phase and late “flash” phase,performed with
6 high mechanical index impulses.Movies were quantitatively and qualitatively evaluated.Qualitative
and quantitative evaluation were statistically compared to immunohistological diagnosis of vulnerable
plaque, considered as gold standard.
Results: Qualitative CEUS evaluation obtained high statistical results when compared to immunohisto-
logical results,with values of sensitivity,specificity,positive predictive value(PPV),negative predictive
value (NPV),and diagnostic accuracy of 94%,68%,87%,85% and 86%,respectively,which became higher if
considering only asymptomatic patient,with a NPV of 91%.Nevertheless, quantitative software evaluation
proved less effective and could not reach similar results.
Conclusion: Carotid plaque enhancement assessed with CEUS well correlates with histological assessment
of plaque instability.CEUS may provide valuable information for plaque risk stratification and may play
a role in the indication to treatment of patients with carotid stenoses, particularly in asymptomatic
population.
KW - CEUS
KW - carotid plaque
KW - CEUS
KW - carotid plaque
UR - http://hdl.handle.net/10807/70100
U2 - 10.1016/j.ejrad.2015.01.024
DO - 10.1016/j.ejrad.2015.01.024
M3 - Article
SN - 0720-048X
VL - 84
SP - 865
EP - 871
JO - European Journal of Radiology
JF - European Journal of Radiology
ER -