Assessment of subclinical atherosclerosis using contrast-enhanced ultrasound.
OBJECTIVE
The sensitivity of standard carotid ultrasound and colour Doppler for the detection of subclinical atherosclerotic plaques is suboptimal. The aim of this study is to assess whether contrast-enhanced ultrasound (CEUS) added to standard carotid ultrasound improves the detection of subclinical atherosclerosis.


RESULTS
Carotid intima-media thickness (CIMT) measurement, standard carotid ultrasound including colour Doppler imaging, and CEUS were performed in 100 asymptomatic patients with one or more risk factors for atherosclerosis. CEUS was performed using intravenous administration of SonoVue™ contrast agent (Bracco S.p.A., Milan, Italy). CIMT, standard ultrasound, colour Doppler, and CEUS were reviewed by two independent observers. Standard ultrasound, colour Doppler, and CEUS were scored for the presence of atherosclerotic plaques. Subclinical atherosclerosis was diagnosed if patients had a CIMT above their age-corrected threshold value or if atherosclerotic plaques were present on standard carotid ultrasound clips or CEUS clips. McNemar's test was performed to compare between groups. Twenty-one patients (21%) had a thickened CIMT value and were considered to have subclinical atherosclerosis. Standard carotid ultrasound including colour Doppler demonstrated atherosclerotic plaques in 77 patients (77%). The addition of CEUS to the standard ultrasound protocol demonstrated atherosclerotic plaques in 88 patients (88%). The incorporation of CEUS into the standard carotid ultrasound protocol resulted in a significantly improved detection of patients with subclinical atherosclerosis (P < 0.01).


CONCLUSIONS
CEUS has an incremental value for the detection of subclinical atherosclerosis in the carotid arteries. Atherosclerotic plaques which were only detected with CEUS and not with standard carotid ultrasound and colour Doppler imaging were predominantly hypoechoic.
Department of Cardiology,  Thoraxcenter Room Ba 304, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam,  The Netherlands.
Stijn C H
SC
van den Oord
Gerrit L
GL
ten Kate
Zeynettin
Z
Akkus
Guillaume
G
Renaud
Eric J G
EJ
Sijbrands
Folkert J
FJ
ten Cate
Aad
A
van der Lugt
Johan G
JG
Bosch
Nico
N
de Jong
Antonius F W
AF
van der Steen
Arend F L
AF
Schinkel
D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
D003287:Contrast Media