Contrast-Enhanced Ultrasound Combined With 2D Strain Imaging and Histopathological Multimodal Assessment of Carotid Plaque Vulnerability

Ting Ma; Xuan Shi; Chen Yuan; Yuanyuan Yang; Lina Guan; Yanhong Li; Wei Zhang; Yuming Mu; Xiaojiang Cheng

doi:10.1016/j.ultrasmedbio.2023.03.005

Contrast-Enhanced Ultrasound Combined With 2D Strain Imaging and Histopathological Multimodal Assessment of Carotid Plaque Vulnerability

Ultrasound Med Biol. 2023 Jul;49(7):1595-1601. doi: 10.1016/j.ultrasmedbio.2023.03.005. Epub 2023 Apr 21.

Authors

Ting Ma¹, Xuan Shi¹, Chen Yuan¹, Yuanyuan Yang¹, Lina Guan², Yanhong Li¹, Wei Zhang³, Yuming Mu⁴, Xiaojiang Cheng⁵

Affiliations

¹ Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China.
² Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China; State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
³ Department of Pathology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
⁴ Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China; State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. Electronic address: mym1234@126.com.
⁵ Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.

PMID: 37088605
DOI: 10.1016/j.ultrasmedbio.2023.03.005

Abstract

Objective: The aim of this study was to explore the value of contrast-enhanced ultrasound (CEUS) combined with 2-D strain imaging in evaluating carotid plaque vulnerability and the correlations among CEUS perfusion parameters, strain parameters and histopathological findings in different plaque segments.

Methods: Patients with carotid artery stenosis who underwent carotid endarterectomy (CEA) at the First Affiliated Hospital of Xinjiang Medical University from September 2020 to June 2021 underwent preoperative carotid artery 2-D ultrasonography and CEUS. The plaques were divided into three segments: the proximal end of the shoulder, central cap and distal end of the shoulder. The peak intensity (PI) value and strain rate parameters of the regions of interest were analyzed. Plaques were divided into a stable group (8 cases) and an unstable group (19 cases). The microvascular density (MVD) and vascular endothelial growth factor (VEGF) expression of each patch in the unstable group were analyzed.

Results: The peak strain during the systolic period in each plaque segment in both groups showed the following pattern: proximal end shoulder > distal end shoulder > top (p < 0.05). The PI value for CEUS is also represented. In the unstable group, the PI values of each segment of the plaque were positively correlated with the MVD, near-center PI value and VEGF average optical density value. The average optical density of each segment was positively correlated with the MVD (p < 0.05). There were positive correlations between the PI values of the proximal and distal shoulder and the strain values (p < 0.05), and the MVD value of each segment, VEGF value and strain value were positively correlated (p < 0.05).

Conclusion: PI and the pathological tissue components represented by CEUS were positively correlated with the mechanical parameters of the plaque along the long axis. There may be overlap between the high shear stress area of the plaque and the neovascular aggregation area, and the combination of the two has certain significance for assessing the vulnerability of the plaque.

Keywords: 2-D strain imaging; Carotid artery plaque; Contrast-enhanced ultrasound; Neovascularization; Vulnerability.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carotid Arteries / diagnostic imaging
Carotid Arteries / pathology
Carotid Stenosis* / diagnostic imaging
Carotid Stenosis* / pathology
Contrast Media
Endarterectomy, Carotid*
Humans
Neovascularization, Pathologic
Plaque, Atherosclerotic* / diagnostic imaging
Plaque, Atherosclerotic* / pathology
Ultrasonography
Vascular Endothelial Growth Factor A

Substances

Vascular Endothelial Growth Factor A
Contrast Media