Correlation of carotid artery atherosclerotic lesion echogenicity and severity at standard US with intraplaque neovascularization detected at contrast-enhanced US.
OBJECTIVE
To correlate echogenicity and severity of atherosclerotic carotid artery lesions at standard ultrasonography (US) with the degree of intraplaque neovascularization at contrast material-enhanced (CE) US.


METHODS
This HIPAA-compliant study was approved by the local ethics committee, and all patients provided informed consent. A total of 175 patients (113 [65%] men, 62 [35%] women; mean age, 67 years ± 10 [standard deviation]) underwent standard and CE US of the carotid artery. Lesion echogenicity (class I to IV), degree of stenosis, and maximal lesion thickness were evaluated for each documented atherosclerotic lesion. The degree of intraplaque neovascularization at CE US was categorized as absent (grade 1), moderate (grade 2), or extensive (grade 3). Correlation of neovascularization with echogenicity, degree of stenosis, and maximal lesion thickness was made by using Spearman ρ and χ(2) test for trend.


RESULTS
In a total of 293 atherosclerotic lesions, echogenicity was inversely correlated with grade of intraplaque neovascularization (ρ = -0.199, P < .001). More echolucent lesions had a higher degree of neovascularization compared with more echogenic ones (P < .001). The degree of stenosis was significantly correlated with grade of intraplaque neovascularization (ρ = 0.157, P = .003). Lesions with higher degree of stenosis had higher grade of neovascularization (P = .008), and maximal lesion thickness increased with the grade of neovascularization (P < .001) and was significantly correlated with grade of neovascularization (ρ = 0.233, P < .001).


CONCLUSIONS
Neovascularization visualized with CE US correlates with lesion severity and with morphologic features of plaque instability, contributing to the concept that more vulnerable plaques are more likely to have a greater degree of neovascularization. Therefore, CE US may be a valuable tool for further risk stratification of echolucent atherosclerotic lesions and carotid artery stenosis of different degrees.


BACKGROUND
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10101008/-/DC1.
Staub
Daniel
D
Department of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, Ill, USA. StaubD@uhbs.ch
Partovi
Sasan
S
Schinkel
Arend F L
AF
Coll
Blai
B
Uthoff
Heiko
H
Aschwanden
Markus
M
Jaeger
Kurt A
KA
Feinstein
Steven B
SB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins; D000704:Analysis of Variance; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons