title: Three-dimensional carotid ultrasound plaque texture predicts vascular events.
abstract: OBJECTIVE
  Carotid ultrasound atherosclerosis measurements, including those of the arterial wall and plaque, provide a way to monitor patients at risk of vascular events. Our objective was to examine carotid ultrasound plaque texture measurements and the change in carotid plaque texture during 1 year in patients at risk of events and to compare these with measurements of plaque volume and other risk factors as predictors of vascular events.
  
  
  METHODS
  We evaluated 298 patients with carotid atherosclerosis using 3-dimensional (3D) ultrasound at baseline and after 1 year and measured carotid plaque volume and 376 measures of plaque texture. Patients were followed up to 5 years (median [range], 3.12 [0.77-4.66]) for myocardial infarction, transient ischemic attack, and stroke. Sparse Cox regression was used to select the most predictive plaque texture measurements in independent training sets using a 10-fold cross-validation, repeated 5×, to ensure unbiased results.
  
  
  RESULTS
  Receiver operator curves and Kaplan-Meier analysis showed that changes in texture and total plaque volume combined provided the best predictor of vascular events. In multivariate Cox regression, changes in plaque texture (median hazard ratio, 1.4; P<0.001) and total plaque volume (median hazard ratio, 1.5 per 100 mm(3); P<0.001) were both significant predictors, whereas the Framingham risk score was not.
  
  
  CONCLUSIONS
  Changes in both plaque texture and volume are strongly predictive of vascular events. In high-risk patients, 3D ultrasound plaque measurements should be considered for vascular event risk prediction.
authors.affiliation: From the Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands (A.v.E., W.J.N., M.d.B.); Stroke Prevention and Atherosclerosis Research Centre (T.W., J.D.S.), and Imaging Research Laboratories (G.P., A.F., J.D.S.), Robarts Research Institute, Western University, London, Canada; Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.); Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.); and Department of Computer Science, University of Copenhagen, Copenhagen, Denmark (M.d.B.). arna.vanengelen@gmail.com.
authors.forename: Arna
authors.initials: A
authors.lastname: van Engelen
authors.affiliation: From the Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands (A.v.E., W.J.N., M.d.B.); Stroke Prevention and Atherosclerosis Research Centre (T.W., J.D.S.), and Imaging Research Laboratories (G.P., A.F., J.D.S.), Robarts Research Institute, Western University, London, Canada; Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.); Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.); and Department of Computer Science, University of Copenhagen, Copenhagen, Denmark (M.d.B.).
authors.forename: Thapat
authors.initials: T
authors.lastname: Wannarong
authors.affiliation: From the Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands (A.v.E., W.J.N., M.d.B.); Stroke Prevention and Atherosclerosis Research Centre (T.W., J.D.S.), and Imaging Research Laboratories (G.P., A.F., J.D.S.), Robarts Research Institute, Western University, London, Canada; Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.); Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.); and Department of Computer Science, University of Copenhagen, Copenhagen, Denmark (M.d.B.).
authors.forename: Grace
authors.initials: G
authors.lastname: Parraga
authors.affiliation: From the Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands (A.v.E., W.J.N., M.d.B.); Stroke Prevention and Atherosclerosis Research Centre (T.W., J.D.S.), and Imaging Research Laboratories (G.P., A.F., J.D.S.), Robarts Research Institute, Western University, London, Canada; Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.); Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.); and Department of Computer Science, University of Copenhagen, Copenhagen, Denmark (M.d.B.).
authors.forename: Wiro J
authors.initials: WJ
authors.lastname: Niessen
authors.affiliation: From the Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands (A.v.E., W.J.N., M.d.B.); Stroke Prevention and Atherosclerosis Research Centre (T.W., J.D.S.), and Imaging Research Laboratories (G.P., A.F., J.D.S.), Robarts Research Institute, Western University, London, Canada; Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.); Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.); and Department of Computer Science, University of Copenhagen, Copenhagen, Denmark (M.d.B.).
authors.forename: Aaron
authors.initials: A
authors.lastname: Fenster
authors.affiliation: From the Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands (A.v.E., W.J.N., M.d.B.); Stroke Prevention and Atherosclerosis Research Centre (T.W., J.D.S.), and Imaging Research Laboratories (G.P., A.F., J.D.S.), Robarts Research Institute, Western University, London, Canada; Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.); Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.); and Department of Computer Science, University of Copenhagen, Copenhagen, Denmark (M.d.B.).
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
authors.affiliation: From the Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, Rotterdam, The Netherlands (A.v.E., W.J.N., M.d.B.); Stroke Prevention and Atherosclerosis Research Centre (T.W., J.D.S.), and Imaging Research Laboratories (G.P., A.F., J.D.S.), Robarts Research Institute, Western University, London, Canada; Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.); Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.); and Department of Computer Science, University of Copenhagen, Copenhagen, Denmark (M.d.B.).
authors.forename: Marleen
authors.initials: M
authors.lastname: de Bruijne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome
keywords: carotid arteries; stroke; ultrasound