title: Quantitative assessment of carotid plaque surface irregularities and correlation to cerebrovascular symptoms.
abstract: BACKGROUND
  The purpose of this study was to determine whether surface irregularities measured from ultrasound images of carotid artery plaques and quantified using a novel method, correlate with the presence of ipsilateral hemispheric cerebrovascular symptoms.
  
  
  METHODS
  A plaque surface irregularity index (SII) was measured in 47 carotid artery plaques (32 subjects, stenosis range 10% -95%, 49% symptomatic) using ultrasound image sequences spanning several cardiac cycles. The differences in the distribution of SII in plaques with ipsilateral hemispheric symptoms versus those without symptoms and the correlation between the SII of plaques and the degrees of stenosis of the corresponding arteries were assessed. Diagnostic performance of plaque SII was evaluated on its own and in combination with the degree of stenosis.
  
  
  RESULTS
  The mean SII was significantly greater for plaques with ipsilateral hemispheric symptoms (1.89 radians/mm) than for asymptomatic plaques (1.67 radians/mm, p = 0.03). There was no statistically significant association between the SII and the degree of stenosis (p = 0.30). SII predicted the presence of cerebrovascular symptoms with an accuracy of 66% (sensitivity 65%, specificity 67%) on its own and with an accuracy of 83% (sensitivity 96%, specificity 71%) in combination with the degree of stenosis.
  
  
  CONCLUSIONS
  Quantitative assessment of carotid plaque surface irregularities using a novel SII parameter correlates with the presence ipsilateral hemispheric cerebrovascular symptoms and may increase diagnostic performance beyond that provided by the degree of stenosis.
authors.forename: Baris
authors.initials: B
authors.lastname: Kanber
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Hartshorne
authors.forename: Mark A
authors.initials: MA
authors.lastname: Horsfield
authors.forename: A Ross
authors.initials: AR
authors.lastname: Naylor
authors.forename: Thompson G
authors.initials: TG
authors.lastname: Robinson
authors.affiliation: Department of Medical Physics, University Hospitals of Leicester NHS Trust, Sandringham Building, Leicester Royal Infirmary, Infirmary Square, LE1 5WW, Leicester, England, UK. kumar.ramnarine@uhl-tr.nhs.uk.
authors.forename: Kumar V
authors.initials: KV
authors.lastname: Ramnarine
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic; D014463:Ultrasonography / Q000379:methods