Abstract T MP29: Contrast-Enhanced Ultrasound is Useful for Detection of Vulnerable Plaques

Background and Purpose: Vulnerable plaques of carotid arteries are characterized as the presence of large necrotic core, intraplaque hemorrhage (IPH), intraplaque neovascularization (IPN), and active inflammation with thin fibrous cap. MRI is widely used for the qualitative evaluation of the plaques in vivo and the high-intensity plaques (HIP) on magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images indicate containing necrotic cores with IPH, which indicates vulnerable plaques. However, we encounter the symptomatic cases without the presence of HIP on MPRAGE in clinical practice. Recent studies showed the efficacy for the evaluation of IPN using contrast-enhanced ultrasound (CEUS). We aimed to assess the vulnerability of the plaques without high intensity on MPRAGE images using CEUS. Methods: Between July 2010 and June 2014, we enrolled 69 patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and preoperatively examined CEUS and MRI (MPRAGE). All plaques were evaluated with CEUS and the contrast effects were classified semi-quantitatively (grade 0: absent, 1: small, 2: large, 3: extensive). We also divided the plaques into two groups (HIP group or non-HIP group) based on the signal intensity of the plaques on MPRAGE images. The results of MRI and CEUS were compared with histopathological findings of CEA specimens. Results: Fifty-eight plaques of all 69 patients showed HIP (41 were symptomatic), and eleven plaques were non-HIP (five were symptomatic: amaurosis fugax in three, cerebral infarction in two). In non-HIP group, symptomatic plaques were more enhanced (three in grade 2, two in grade 3) than asymptomatic plaques (one in grade 0, five in grade 1) using CEUS. Histopathological findings of all five CEA specimens from symptomatic patients showed that extensive IPN, large necrotic core, and active inflammation with thin fibrous cap which indicated vulnerable plaques, but small amount of IPH. These histological findings were compatible with the results of CEUS and MRI findings. Conclusion: CEUS may be useful for diagnosis of vulnerable plaques without high intensity on MPRAGE images.

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Stress Concentrations of Vulnerable Plaques With a Composite Variable Core

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19233 ◽

2010 ◽

Author(s):

Eyass Massarwa ◽

Aronis Ze’ev ◽

Rami Eliasy ◽

Rami Haj-Ali ◽

Shmuel Einav

Keyword(s):

Plaque Rupture ◽

Necrotic Core ◽

Intraplaque Hemorrhage ◽

Plaque Morphology ◽

Rapid Progression ◽

Stress Concentrations ◽

Coronary Syndrome ◽

Fibrous Cap ◽

Vulnerable Plaques ◽

Life Threatening

Vulnerable plaques are inflamed, active, and growing lesions which are prone to complications such as rupture, luminal and mural thrombosis, intraplaque hemorrhage, and rapid progression to stenosis. It remains difficult to assess what factors influence the biomechanical stability of vulnerable plaques and promote some of them to rupture while others remain intact. The rupture of thin fibrous cap overlying the necrotic core of a vulnerable plaque is the principal cause of acute coronary syndrome. The mechanism or mechanisms responsible for the sudden conversion of a stable atherosclerotic plaque to a life threatening athero-thrombotic lesion are not fully understood. It has been widely assumed that plaque morphology is the major determinant of clinical outcome [1, 2]. Thin-cap fibroatheroma with a large necrotic core and a fibrous cap of < 65μm was describes as a more specific precursor of plaque rupture due to tissue stress.

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Use of Contrast-Enhanced Ultrasound in Carotid Atherosclerotic Disease: Limits and Perspectives

BioMed Research International ◽

10.1155/2015/293163 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Gianfranco Varetto ◽

Lorenzo Gibello ◽

Claudio Castagno ◽

Simone Quaglino ◽

Matteo Ripepi ◽

...

Keyword(s):

Imaging Study ◽

Intraplaque Hemorrhage ◽

Minor Stroke ◽

Diagnostic Tools ◽

Surgical Removal ◽

Histopathological Analysis ◽

Contrast Enhanced Ultrasound ◽

Fibrous Cap ◽

Contrast Enhanced ◽

Ischemic Attack

Contrast-enhanced ultrasound (CEUS) has recently become one of the most versatile and powerful diagnostic tools in vascular surgery. One of the most interesting fields of application of this technique is the study of the carotid atherosclerotic plaque vascularization and its correlation with neurological symptoms (transient ischemic attack, minor stroke, and major stroke) and with the characteristics of the “vulnerable plaque” (surface ulceration, hypoechoic plaques, intraplaque hemorrhage, thinner fibrous cap, and carotid plaque neovascularization at histopathological analysis of the sample after surgical removal). The purpose of this review is to collect all the original studies available in literature (24 studies with 1356 patients enrolled) and to discuss the state of the art, limits, and future perspectives of CEUS analysis. The results of this work confirm the reliability of this imaging study for the detection of plaques with high risk of embolization; however, a shared, user-friendly protocol of imaging analysis is not available yet. The definition of this operative protocol becomes mandatory in order to compare results from different centers and to validate a cerebrovascular risk stratification of the carotid atherosclerotic lesions evaluated with CEUS.

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Contrast enhanced ultrasound (CEUS) with MRI image fusion for monitoring focal therapy of prostate cancer with high intensity focused ultrasound (HIFU)1

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-189123 ◽

2018 ◽

Vol 69 (1-2) ◽

pp. 93-100 ◽

Cited By ~ 10

Author(s):

M. Apfelbeck ◽

D.-A. Clevert ◽

J. Ricke ◽

C. Stief ◽

B. Schlenker

Keyword(s):

Prostate Cancer ◽

Image Fusion ◽

High Intensity ◽

Focused Ultrasound ◽

Focal Therapy ◽

High Intensity Focused Ultrasound ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Mri Image

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Relation between carotid vulnerable plaques and peripheral leukocyte: a case-control study of comparison utilizing multi-parametric contrast-enhanced ultrasound

BMC Medical Imaging ◽

10.1186/s12880-019-0374-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Xianghong Luo ◽

Wanbin Li ◽

Yun Bai ◽

Lianfang Du ◽

Rong Wu ◽

...

Keyword(s):

Case Control Study ◽

Case Control ◽

Contrast Enhanced Ultrasound ◽

Peripheral Leukocyte ◽

Vulnerable Plaques ◽

Contrast Enhanced ◽

Control Study

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V4-07 CONTRAST-ENHANCED ULTRASOUND (CEUS): EVALUATION OF HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) ABLATION OF THE PROSTATE

The Journal of Urology ◽

10.1016/j.juro.2017.02.906 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Andre Luis Abreu ◽

Daniel Freitas ◽

Daniel Park ◽

Toshitaka Shin ◽

Masakatsu Oishi ◽

...

Keyword(s):

High Intensity ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound ◽

Contrast Enhanced Ultrasound ◽

Hifu Ablation ◽

Contrast Enhanced

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Assessment of Carotid Plaque Stability Using Contrast-Enhanced Ultrasound and Its Correlation With the Expression of CD147 and MMP-9 in the Plaque

Frontiers in Computational Neuroscience ◽

10.3389/fncom.2021.778946 ◽

2021 ◽

Vol 15 ◽

Author(s):

Shanshan Huang ◽

Xinyin Wu ◽

Linlin Zhang ◽

Jianming Wu ◽

Yi He ◽

...

Keyword(s):

Surface Morphology ◽

Positive Predictive Value ◽

Predictive Value ◽

Vulnerable Plaque ◽

Contrast Enhanced Ultrasound ◽

Plaque Vulnerability ◽

Vulnerable Plaques ◽

Contrast Enhanced ◽

2D Ultrasound ◽

Grade Ii

This study aims to investigate the correlation between the enhancement degree of contrast-enhanced ultrasound (CEUS) and the expression of CD147 and MMP-9 in carotid atherosclerotic plaques in patients with carotid endarterectomy and evaluate the diagnostic efficacy of CEUS using pathological results as the gold standard. Thirty-eight patients who underwent carotid endarterectomy (CEA) for carotid stenosis in the Department of Neurovascular Surgery of the Second People’s Hospital of Shenzhen from July 2019 to June 2020 were selected. Preoperatively, two-dimensional (2D) ultrasound scan was performed on all patients to assess the characteristics of the plaque and degree of stenosis, and CEUS was used to evaluate the surface morphology of the plaque and the distribution of neovascularization. Postoperatively, pathological sections and immunohistochemical analysis of CD147 and MMP-9 levels in the plaque were performed on the stripped plaque tissue, and the results were analyzed against the CEUS grading and pathological results. Among the 38 patients, pathological results showed that 10 and 28 were in the stable and vulnerable plaque groups, respectively. There were more smokers in the vulnerable plaque group than in the stable plaque group, with higher intraplaques CD147 and MMP-9. The difference in ultrasound plaque surface morphology grading and CEUS grading between the two groups was statistically significant. There was no significant difference in age, sex, incidence of complications such as hypertension, diabetes, and coronary heart disease between the two groups. CD147 was higher in the CEUS grade IV group than in the grades I (P = 0.040) and II (P = 0.010) groups. MMP-9 was higher in the CEUS grade IV group than in the grade II group (P = 0.017); MMP-9 was higher in the grade III group than in the grade II group (P = 0.015). Intraplaque contrast enhancement intensity was positively correlated with CD147 (r = 0.462, P = 0.003) and MMP-9 (r = 0.382, P = 0.018) levels. There was moderate consistency between the assessment of plaque vulnerability by 2D-ultrasound and by histopathological hematoxylin-eosin (HE) (kappa = 0.457, P > 0.05). 2D diagnosis of vulnerable plaque had a sensitivity of 85.7%, a specificity of 60.0%, a positive predictive value of 85.7%, a negative predictive value of 60.0%, and an accuracy of 78.0%. There was a strong consistency between the assessment of plaque vulnerability by CEUS and histopathological HE (kappa = 0.671, P < 0.01). CEUS had a sensitivity of 89.2%, a specificity of 80.0%, a positive predictive value of 92.6%, a negative predictive value of 72.7%, and an accuracy of 86.8% for the diagnosis of vulnerable plaques; CEUS is a reliable, non-invasive test that can show the distribution of neovascularization within vulnerable plaques, evaluate the vulnerability and risk of intraplaque hemorrhage, with a high consistency with pathological findings. The degree of intraplaque enhancement and the levels of CD147 and MMP-9 in the tissue were positively correlated.

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Follow-up after focal therapy of the prostate with high intensity focused ultrasound (HIFU) using contrast enhanced ultrasound (CEUS) in combination with MRI image fusion

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-199222 ◽

2019 ◽

Vol 73 (1) ◽

pp. 135-143 ◽

Cited By ~ 4

Author(s):

M. Apfelbeck ◽

M. Chaloupka ◽

B. Schlenker ◽

C.G. Stief ◽

D.-A. Clevert

Keyword(s):

Image Fusion ◽

High Intensity ◽

Focused Ultrasound ◽

Focal Therapy ◽

High Intensity Focused Ultrasound ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Mri Image

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A Study on Distribution Features of Neovascularization in Atherosclerotic Carotid Artery Plaques: Comparing Contrast-enhanced Ultrasound with Histopathology

Ultrasonic Imaging ◽

10.1177/0161734618824941 ◽

2019 ◽

Vol 41 (2) ◽

pp. 115-125

Author(s):

Bin Ning ◽

Dong Zhang ◽

Wen He ◽

Li Shu Wang ◽

Zhan Qiang Jin

Keyword(s):

Statistical Difference ◽

Ultrasound Images ◽

Contrast Enhanced Ultrasound ◽

Plaque Vulnerability ◽

Asymptomatic Group ◽

Significant Statistical Difference ◽

Fibrous Cap ◽

Contrast Enhanced ◽

Distribution Features ◽

Histopathological Images

Intraplaque neovascularization (IPNV) is a characteristic feature of the vulnerable plaques. In this study of neovessels of carotid plaques, we assessed intraplaque echogenicity and plaque surface morphology, and performed contrast-enhanced ultrasound (CEUS) to observe the location and grading of neovessels to identify the vulnerability of plaques. The results showed that plaque with a ruptured fibrous cap on the histopathological images presented as a sunken or fissured surface on corresponding ultrasound images. Both in the symptomatic and asymptomatic groups, plaque echogenicity did not correlate with neovessels grading. The neovessels that appeared in the tunica media and base of the plaque in the symptomatic and asymptomatic group on CEUS had no statistical difference ( p > 0.05), but those located in the fibrous cap and shoulders had a significant statistical difference ( p = 0.000). Statistical differences were not found in the locations of IPNV on CEUS and histopathology (all p > 0.05). The sensitivity (82.4%, 56/68) and specificity (77.4%, 24/31) of IPNV location were higher than those (77.9%, 53/68; 45.2%, 14/31) of IPNV grading in the identification of plaque vulnerability. IPNVs located at the fibrous cap and shoulders on CEUS is a reliable indicator for identifying plaque vulnerability.

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Abstract 2559: Reflectance, Fluorescence, and Raman Spectroscopy Identify Features of Vulnerable Atherosclerotic Plaque In Vivo Including a Thin Fibrous Cap, Necrotic Core or Superficial Foam Cells, and Thrombus

Circulation ◽

10.1161/circ.118.suppl_18.s_746-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Obrad R Šćepanović ◽

Maryann Fitzmaurice ◽

Arnold Miller ◽

Chae-Ryon Kong ◽

Ramachandra R Dasari ◽

...

Keyword(s):

Raman Spectroscopy ◽

Early Detection ◽

Ex Vivo ◽

Foam Cells ◽

Necrotic Core ◽

Histopathological Analysis ◽

Artery Wall ◽

Fibrous Cap ◽

Vulnerable Plaques

Early detection and treatment of vulnerable atherosclerotic plaques, the lesions most prone to rupture, is critical to reducing patient mortality associated with cardiovascular disease. The combination of reflectance, fluorescence, and Raman spectroscopy - termed multimodal spectroscopy (MMS) - provides complementary and depth-sensitive information about tissue composition. We assessed the hypothesis that MMS can detect morphological features of vulnerable plaque: thin fibrous cap (TFC), necrotic core (NC), superficial foam cells (SFC), intralesional hemorrhage (IH), and thrombus. Methods. In vivo and ex vivo MMS spectra were collected from 12 patients undergoing peripheral vascular surgeries. The data collection was facilitated by means of a novel MMS probe catheter and a portable clinical instrument developed in our laboratory. During carotid endarterectomies, MMS spectra were collected in vivo from the intimal surface of the plaque with the probe held normal to the artery wall. During femoral bypasses, MMS spectra were collected in vivo either through the proximal anastomosis site from the posterior artery wall or adjacent to the incision. A tissue specimen was excised for additional MMS spectral collection ex vivo. Histopathological analysis was performed by a blinded cardiovascular pathologist to assess the vulnerability of each spectrally evaluated tissue site using a quantitative index based on the dimension or severity of the following: TFC, NC, SFC, IH, and thrombus. Across the total set of 76 evaluated tissue locations, MMS is shown to have the ability to detect vulnerability features including a TFC, NC or SFCs, and thrombus. A TFC is detected by measuring the relative amount of collagen assessed by fluorescence, a large NC or SFCs are detected through the combination of beta-carotene absorption and the Raman spectral signature of lipids, and thrombus is detected through its Raman signature. The results indicate that rupture-prone vulnerable plaques could be detected with a sensitivity of 96% and specificity of 72%. In conclusion, these encouraging results will help bring MMS into the clinical arena as a powerful, catheter-based diagnostic technique for early detection of vulnerable plaques.

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