Juxtaluminal hypoechoic area in ultrasonic images of carotid plaques and hemispheric symptoms.
OBJECTIVE
The aim was to determine the diagnostic value of a juxtaluminal black (hypoechoic) area without a visible echogenic cap (JBA) in ultrasonic images of internal carotid artery plaques.


METHODS
Ultrasonic images of plaques from 324 patients with asymptomatic (n = 139) and symptomatic (n = 185) internal carotid 50% to 99% stenosis in relation to the bulb (European Carotid Surgery Trial) referred for duplex scanning were studied. The JBA in mm(2) and the gray-scale median (GSM) were obtained after image normalization. Cut-off points for GSM and JBA (combined highest sensitivity with highest specificity) were determined from receiver operator characteristic (ROC) curves.


RESULTS
JBA >or= 8 mm(2) was associated with a high prevalence of symptomatic plaques in all grades of stenosis. In a multiple logistic regression model, increasing stenosis (mild, moderate, severe), GSM <or= 15 and JBA >or= 8 mm(2) were independent predictors of the presence of hemispheric symptoms. This model could identify a high-risk group of 188 plaques that contained 142 (77%) of the 185 symptomatic plaques (odds ratio [OR], 6.7; 95% confidence interval [CI], 4.08-10.91), (P < .001), (sensitivity: 77%; specificity 66%; positive predictive value 75%; negative predictive value 68%).


CONCLUSIONS
The results of this study indicate the diagnostic value and for the first time suggest a cut-off point of 8 mm(2) for JBA. This cut-off point needs to be validated in other groups and then applied to prospective studies of asymptomatic patients.
Griffin
Maura B
MB
Vascular Screening and Diagnostic Centre, London, United Kingdom. maurabgriffin@googlemail.com
Kyriacou
Efthyvoulous
E
Pattichis
Costas
C
Bond
Dawn
D
Kakkos
Stavros K
SK
Sabetai
Michael
M
Geroulakos
George
G
Georgiou
Niki
N
Doré
Caroline J
CJ
Nicolaides
Andrew
A
D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000209:etiology*; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018616:Ultrasonography, Doppler, Duplex