title: Significance of sonographic tissue and surface characteristics of carotid plaques.
abstract: OBJECTIVE
  Our hypothesis was that symptomatic and asymptomatic carotid plaques are different. The aim of this study was to identify the sonographic tissue and surface characteristics of plaques and their degree of stenosis that corresponded to these two clinical presentations.
  
  
  METHODS
  We studied 81 symptomatic and 111 asymptomatic plaques (150 patients) having 50% to 99% stenosis on duplex scanning. These plaques were imaged on duplex and captured in a computer. We evaluated the gray-scale median (GSM) to distinguish hypoechoic (low GSM) from hyperechoic (high GSM) plaques, and the bending energy (BE), to distinguish plaques with irregular (high BE) versus smooth (low BE) surfaces.
  
  
  RESULTS
  The symptomatic group corresponded to hypoechoic (median GSM, 4) and severely stenosed (median stenosis, 85%) plaques, whereas the asymptomatic group corresponded to hyperechoic (median GSM, 35) and moderately stenosed (median stenosis, 70%) plaques (P <.05 for both variables). The BE failed to separate the two groups; the mean BEs were 1.63 and 1.68 for the symptomatic and asymptomatic groups, respectively (P =.38).
  
  
  CONCLUSIONS
  Our results suggest that echogenic characteristics and the degree of stenosis are the strongest predictors of carotid plaque behavior. The sonographic surface characteristics failed to qualify as an index of plaque instability.
authors.affiliation: Irvine Laboratory for Cardiovascular Investigation and Research, Department of Vascular Surgery, Imperial College of Science, Technology, and Medicine, St. Mary's Campus, London, United Kingdom.
authors.forename: T J
authors.initials: TJ
authors.lastname: Tegos
authors.forename: K J
authors.initials: KJ
authors.lastname: Kalomiris
authors.forename: M M
authors.initials: MM
authors.lastname: Sabetai
authors.forename: E
authors.initials: E
authors.lastname: Kalodiki
authors.forename: A N
authors.initials: AN
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018616:Ultrasonography, Doppler, Duplex