title: Computer analysis of ultrasonic plaque echolucency in identifying high risk carotid bifurcation lesions.
abstract: OBJECTIVE
  to confirm that plaque echogenicity evaluated by computer analysis, as suggested by preliminary studies, can identify plaques associated with a high incidence of strokes.
  
  
  METHODS
  a series of 96 patients with carotid stenosis in the range of 50-99% were studied retrospectively (41 with TIAs and 55 asymptomatic). Carotid plaque echogenicity was evaluated using a computerised measurement of the median grey scale value (GSM). All patients had a CT brain scan to determine the presence of infarction in the carotid territory.
  
  
  RESULTS
  the incidence of ipsilateral brain CT infarctions was 16% in the asymptomatic and 32% in the symptomatic plaques (p =0.076). It was 20% for <70% stenosis and 25% for >70% stenosis (p =0.52). It was 9% for plaques which had a GSM >50 and 40% in those with GSM <50 (p <0.001) with a relative risk of 4.6 (95% CI 1.8 to 11.6).
  
  
  CONCLUSIONS
  the results confirm that computer analysis of plaque echogenicity is better than the degree of stenosis in identifying plaques associated with an increased incidence of CT brain-scan infarction and consequently useful for identifying individuals at high risk of stroke. What is required is a form of image standardisation in order to apply this method to natural history studies with stroke as the endpoint.
authors.affiliation: Division of Vascular Surgery, Bassini Teaching Hospital, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Biasi
authors.forename: A
authors.initials: A
authors.lastname: Sampaolo
authors.forename: P
authors.initials: P
authors.lastname: Mingazzini
authors.forename: P
authors.initials: P
authors.lastname: De Amicis
authors.forename: N
authors.initials: N
authors.lastname: El-Barghouty
authors.forename: A N
authors.initials: AN
authors.lastname: Nicolaides
mesh_terms: D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging; D004453:Echoencephalography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D012307:Risk Factors; D014057:Tomography, X-Ray Computed