title: Asymptomatic carotid disease--a new tool for assessing neurological risk.
abstract: Active carotid plaques are associated with atheroembolism and neurological events; its identification is crucial for stroke prevention. High-definition ultrasound (HDU) can be used to recognize plaque structure in carotid bifurcation stenosis associated with plaque vulnerability and occurrence of brain ischemic events. A new computer-assisted HDU method to study the echomorphology of the carotid plaque and to determine a risk score for developing appropriate symptoms is proposed in this study. Plaque echomorphology characteristics such as presence of ulceration at the plaque surface, juxta-luminal location of echolucent areas, echoheterogeneity were obtained from B-mode ultrasound scans using several image processing algorithms and were combined with measurement of severity of stenosis to obtain a clinical score--enhanced activity index (EAI)--which was correlated with the presence or absence of ipsilateral appropriate ischemic symptoms. An optimal cutoff value of EAI was determined to obtain the best separation between symptomatic (active) from asymptomatic (inactive) plaques and its diagnostic yield was compared to other 2 reference methods by means of receiver-operating characteristic (ROC) analysis. Classification performance was evaluated by leave-one-patient-out cross-validation applied to a cohort of 146 carotid plaques from 99 patients. The proposed method was benchmarked against (a) degree of stenosis criteria and (b) earlier proposed activity index (AI) and demonstrated that EAI yielded the highest accuracy up to an accuracy of 77% to predict asymptomatic plaques that developed symptoms in a prospective cross-sectional study. Enhanced activity index is a noninvasive, easy to obtain parameter, which provided accurate estimation of neurological risk of carotid plaques.
authors.affiliation: Faculty of Medicine, Lisbon Academic Medical Centre, University of Lisbon and Lisbon Cardiovascular Institute, Lisbon, Portugal.
authors.forename: Luís M
authors.initials: LM
authors.lastname: Pedro
authors.forename: J Miguel
authors.initials: JM
authors.lastname: Sanches
authors.forename: José
authors.initials: J
authors.lastname: Seabra
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Suri
authors.forename: José
authors.initials: J
authors.lastname: Fernandes E Fernandes
mesh_terms: D000368:Aged; D019985:Benchmarking; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
keywords: asymptomatic carotid disease; carotid plaque; enhanced activity index; risk; speckle; stroke; ultrasound