title: Ultrasound measurement of the fibrous cap in symptomatic and asymptomatic atheromatous carotid plaques.
abstract: BACKGROUND
  Fibrous cap thickness (FCT) is an important determinant of atheroma stability. We evaluated the feasibility and potential clinical implications of measuring the FCT of internal carotid artery plaques with a new ultrasound system based on boundary detection by dynamic programming.
  
  
  RESULTS
  We assessed agreement between ultrasound-obtained FCT values and those measured histologically in 20 patients (symptomatic [S]=9, asymptomatic [AS]=11) who underwent carotid endarterectomy for stenosing (>70%) carotid atheromas. We subsequently measured in vivo the FCT of 58 stenosing internal carotid artery plaques (S=22, AS=36) in 54 patients. The accuracy in discriminating symptomatic from asymptomatic plaques was assessed by receiver operating characteristic curves for the minimal, mean, and maximal FCT. Decision FCT thresholds that provided the best correct classification rates were identified. Agreement between ultrasound and histology was excellent, and interobserver variability was small. Ultrasound showed that symptomatic atheromas had thinner fibrous caps (S versus AS, median [95% CI]: minimal FCT=0.42 [0.34 to 0.48] versus 0.50 [0.44 to 0.53] mm, P=0.024; mean FCT=0.58 [0.52 to 0.63] versus 0.79 [0.69 to 0.85] mm, P<0.0001; maximal FCT=0.73 [0.66 to 0.92] versus 1.04 [0.94 to 1.20] mm, P<0.0001). Mean FCT measurement demonstrated the best discriminatory accuracy (area under the curve [95% CI]: minimal 0.74 [0.61 to 0.87]; mean 0.88 [0.79 to 0.97]; maximal 0.82 [0.71 to 0.93]). The decision threshold of 0.65 mm (mean FTC) demonstrated the best correct classification rate (82.8%; positive predictive value 75%, negative predictive value 88.2%).
  
  
  CONCLUSIONS
  FCT measurement of carotid atheroma with ultrasound is feasible. Discrimination of symptomatic from asymptomatic plaques with mean FCT values is good. Prospective studies should determine whether this ultrasound marker is reliable.
authors.affiliation: Department of Neurology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland. gerald.devuyst@chuv.hospvd.ch
authors.forename: Gérald
authors.initials: G
authors.lastname: Devuyst
authors.forename: Theodoros
authors.initials: T
authors.lastname: Karapanayiotides
authors.forename: Patrik
authors.initials: P
authors.lastname: Ruchat
authors.forename: Marc
authors.initials: M
authors.lastname: Pusztaszeri
authors.forename: Johannes-Alexander
authors.initials: JA
authors.lastname: Lobrinus
authors.forename: Lisa
authors.initials: L
authors.lastname: Jonasson
authors.forename: Olivier
authors.initials: O
authors.lastname: Cuisinaire
authors.forename: Askenadios
authors.initials: A
authors.lastname: Kalangos
authors.forename: Paul-André
authors.initials: PA
authors.lastname: Despland
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Thiran
authors.forename: Julien
authors.initials: J
authors.lastname: Bogousslavsky
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000473:pathology; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D012984:Software; D014463:Ultrasonography / Q000379:methods* / Q000592:standards