title: Spatio-temporal Quantification of Carotid Plaque Neovascularization on Contrast Enhanced Ultrasound: Correlation with Visual Grading and Histopathology.
abstract: OBJECTIVE
  To evaluate whether carotid intraplaque neovascularization (IPN) can be accurately assessed by two types of quantitative analysis on contrast enhanced ultrasound (CEUS), the time intensity curve analysis and the analysis of contrast agent spatial distributions, and whether the quantitative analysis correlates with semiquantitative visual interpretation and histopathology.
  
  
  METHODS
  Forty-four plaques in 34 patients were included for CEUS examination. A three point score system (absent, moderate, and extensive) was used for semiquantitative grading of IPN. Eight spatial quantitative parameters were derived, including the IPN area ratio in plaque (AR) and the AR in plaque core (AR13). Two temporal quantitative parameters were obtained, namely the enhanced intensity in plaque (EI) and the enhanced intensity ratio (EIR). Histopathology with CD34 staining for quantification of microvessel density (MVD) was performed on 12 plaques excised by carotid endarterectomy.
  
  
  RESULTS
  Both spatial and temporal parameters were correlated with MVD on histology (AR: r = .854; AR13: r = .858; EI: r = .767; EIR: r = .750 [p < .01]), as well as with semiquantitative grading (p < .01). Five mutually independent factors were condensed from 10 interrelated parameters by using factor analysis, and they significantly predicted MVD with an radj value as high as .932 (p = .01).
  
  
  CONCLUSIONS
  Both spatial and temporal analysis on CEUS can accurately assess IPN. Combining them provides better IPN assessment and may be useful for plaque vulnerability evaluation and risk stratification.
authors.affiliation: School of Communication and Information Engineering, Shanghai University, 200072, Shanghai, China. Electronic address: zhangq@shu.edu.cn.
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.
authors.forename: H
authors.initials: H
authors.lastname: Han
authors.affiliation: School of Communication and Information Engineering, Shanghai University, 200072, Shanghai, China.
authors.forename: W
authors.initials: W
authors.lastname: Dai
authors.affiliation: School of Communication and Information Engineering, Shanghai University, 200072, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Electronic Engineering, Fudan University, 200433, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.
authors.forename: W
authors.initials: W
authors.lastname: Wang
mesh_terms: D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D016894:Endarterectomy, Carotid; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D055806:Microvessels / Q000000981:diagnostic imaging / Q000473:pathology; D009389:Neovascularization, Pathologic; D010743:Phospholipids; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Carotid plaque; Contrast enhanced ultrasound; Intraplaque neovascularization; Microvessels; Quantitative analysis; Spatial and temporal analysis