title: An assessment of the vulnerability of carotid plaques: a comparative study between intraplaque neovascularization and plaque echogenicity.
abstract: BACKGROUND
  Carotid plaque echolucency as detected by Color Doppler ultrasonography (CDUS) has been used as a potential marker of plaque vulnerability. However, contrast-enhanced ultrasound (CEUS) has recently been shown to be a valuable method to evaluate the vulnerability and neovascularization within carotid atherosclerotic plaques. The aim of this study was to compare CEUS and CDUS in the assessment of plaque vulnerability using transcranial color Doppler (TCD) monitoring of microembolic signals (MES) as a reference technique.
  
  
  METHODS
  A total of 46 subjects with arterial stenosis (≥ 50%) underwent a carotid duplex ultrasound, TCD monitoring of MES and CEUS (SonoVue doses of 2.0 mL) within a span of 3 days. The agreement between the CEUS, CDUS, and MES findings was assessed with a chi-square test. A p-value less than 0.05 was considered statistically significant.
  
  
  RESULTS
  Neovascularization was observed in 30 lesions (44.4%). The vascular risk factors for stroke were similar and there were no age or gender differences between the 2 groups. Using CEUS, MES were identified in 2 patients (12.5%) within class 1 (non-neovascularization) as opposed to 15 patients (50.0%) within class 2 (neovascularization) (p = 0.023). CDUS revealed no significant differences in the appearance of the MES between the 2 groups (hyperechoic and hypoechoic) (p = 0.237).
  
  
  CONCLUSIONS
  This study provides preliminary evidence to suggest that intraplaque neovascularization detected by CEUS is associated with the presence of MESs, where as plaque echogenicity on traditional CDUS does not. These findings argue that CEUS may better identify high-risk plaques.
authors.affiliation: Department of Neurology, The First Norman Bethune Hospital of Jilin University, Chang Chun, China. yyangyangzhou@gmail.com
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Zhou
authors.forename: Yingqi
authors.initials: Y
authors.lastname: Xing
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Yang
authors.initials: Y
authors.lastname: Bai
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Sun
authors.forename: Yingqiao
authors.initials: Y
authors.lastname: Zhu
authors.forename: Jiang
authors.initials: J
authors.lastname: Wu
mesh_terms: D016893:Carotid Stenosis; D003287:Contrast Media; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren
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