Detailed plaque texture analysis as the alternate method of ultrasound image analysis in predicting the risk of intraoperative microembolism and perioperative complications.
BACKGROUND
The aim of the study was to assess the value of an alternative method of carotid plaque ultrasound image analysis in relation to the perioperative complications and the main risk factor: the microembolism (ME).


METHODS
96 plaques were evaluated following carotid endarterectomy. Preoperatively, each plaque was screened by ultrasound and assessed by means of 2 computer assisted methods. All patients were evaluated for ME (measured as hits) intraoperatively. The removed plaques were assessed visually (intraoperative assessement) and histologically. A number of risk factors were included as a final outcome event for the purpose of multivariate regression analysis.


RESULTS
Detailed plaque texture analysis (DPTA) predicts best the risk of perioperative complications and ME (p = 0.029 and p = 0.028 respectively). The results of the standard gray-scale median (GSM) analysis did not reach the statistical significance (p > 0.1). The predictive value of the model (ROC) was 0.88. The multivariate model for ME revealed that from the level of > 5 HITS, a rapid increase in the risk of perioperative complications (rise of 5% by every 1 hit) is seen and correlates well with the DPTA. ROC was 0.77. A direct correlation between the DPTA and perioperative ME was shown.


CONCLUSIONS
DPTA analysis of a carotid plaque is more predictive of the likelihood of microembolism than the GSM analysis. There is a direct correlation between the perioperative ME and plaque morphology, as assessed by DPTA. This supports the need for further refinements in noninvasive analysis of carotid plaques.
Madycki
G
G
Department of Vascular Surgery and Angiology, Centre for Postgraduate Medical Studies Bielany Hospital, Warsaw, Poland. g.madycki@interia.pl
Staszkiewicz
W
W
D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D020766:Intracranial Embolism / Q000209:etiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012307:Risk Factors; D014463:Ultrasonography