title: Assessment of carotid atherosclerosis, intraplaque neovascularization, and plaque ulceration using quantitative contrast-enhanced ultrasound in asymptomatic patients with diabetes mellitus.
abstract: OBJECTIVE
  Patients with diabetes mellitus (DM) are at severely increased risk of developing atherosclerosis. Intraplaque neovascularization (IPN) and plaque ulceration are markers of the vulnerable plaque, which is at an increased risk of rupture and may lead to cardiovascular events. The aim of this study was to assess the prevalence of subclinical carotid atherosclerosis, intraplaque neovascularization (IPN), and plaque ulceration in asymptomatic patients with DM.
  
  
  RESULTS
  A total of 51 asymptomatic patients with DM underwent standard carotid ultrasound in conjunction with contrast-enhanced ultrasound (CEUS) to assess the prevalence of subclinical atherosclerosis, IPN, and plaque ulceration. Subclinical atherosclerosis was defined as the presence of atherosclerotic plaque, according to the Mannheim consensus. Semi-automated quantification software was used to assess IPN in suitable plaques. Plaque ulceration was defined as a disruption of the plaque-lumen border of ≥ 1 × 1 mm. A total of 408 carotid segments in 102 carotid arteries were investigated. Forty-six (90%) patients had subclinical atherosclerotic plaques, with a median plaque thickness of 2.4 mm (inter-quartile range 1.9-3.0). CEUS revealed IPN in 88% of the patients. In 10 carotid segments (8%), the plaque had an ulcerated surface. The presence of IPN could not be predicted by the presence of clinical characteristics including complications of DM (P > 0.05).
  
  
  CONCLUSIONS
  Patients with DM have a high prevalence (90%) of subclinical carotid atherosclerosis. Severe IPN and plaque ulceration, which are markers of the vulnerable plaque type, were detected in, respectively, 13 and 9% of these patients.
authors: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Thoraxcenter Room Ba304, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Stijn C H
authors: SC
authors: van den Oord
authors: Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Zeynettin
authors: Z
authors: Akkus
authors: Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Guillaume
authors: G
authors: Renaud
authors: Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Johan G
authors: JG
authors: Bosch
authors: Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Antonius F W
authors: AF
authors: van der Steen
authors: Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Eric J G
authors: EJ
authors: Sijbrands
authors: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Thoraxcenter Room Ba304, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands a.schinkel@erasmusmc.nl.
authors: Arend F L
authors: AF
authors: Schinkel
mesh_terms: D015415:Biomarkers / Q000032:analysis; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors; D012984:Software; D014463:Ultrasonography
chemical_list: D015415:Biomarkers
keywords: Atherosclerosis; Carotid ultrasound; Contrast-enhanced ultrasound; Diabetes mellitus