title: Plaque echodensity and textural features are associated with histologic carotid plaque instability.
abstract: Carotid plaque echodensity and texture features predict cerebrovascular symptomatology. Our purpose was to determine the association of echodensity and textural features obtained from a digital image analysis (DIA) program with histologic features of plaque instability as well as to identify the specific morphologic characteristics of unstable plaques.
  
  
  
  Patients scheduled to undergo carotid endarterectomy were recruited and underwent carotid ultrasound imaging. DIA was performed to extract echodensity and textural features using Plaque Texture Analysis software (LifeQ Medical Ltd, Nicosia, Cyprus). Carotid plaque surgical specimens were obtained and analyzed histologically. Principal component analysis (PCA) was performed to reduce imaging variables. Logistic regression models were used to determine if PCA variables and individual imaging variables predicted histologic features of plaque instability.
  
  
  
  Image analysis data from 160 patients were analyzed. Individual imaging features of plaque echolucency and homogeneity were associated with a more unstable plaque phenotype on histology. These results were independent of age, sex, and degree of carotid stenosis. PCA reduced 39 individual imaging variables to five PCA variables. PCA1 and PCA2 were significantly associated with overall plaque instability on histology (both P = .02), whereas PCA3 did not achieve statistical significance (P = .07).
  
  
  
  DIA features of carotid plaques are associated with histologic plaque instability as assessed by multiple histologic features. Importantly, unstable plaques on histology appear more echolucent and homogeneous on ultrasound imaging. These results are independent of stenosis, suggesting that image analysis may have a role in refining the selection of patients who undergo carotid endarterectomy.
authors.affiliation: Department of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Doonan
authors.affiliation: Department of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gorgui
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jean P
authors.initials: JP
authors.lastname: Veinot
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Chi
authors.initials: C
authors.lastname: Lai
authors.affiliation: Department of Computer Science and Engineering, Frederick University, Limassol, Cyprus; Department of Computer Science, University of Cyprus, Nicosia, Cyprus.
authors.forename: Efthyvoulos
authors.initials: E
authors.lastname: Kyriacou
authors.affiliation: Department of Surgery, Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Marc M
authors.initials: MM
authors.lastname: Corriveau
authors.affiliation: Department of Surgery, Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Oren K
authors.initials: OK
authors.lastname: Steinmetz
authors.affiliation: Department of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: stella.daskalopoulou@mcgill.ca.
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010641:Phenotype; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D025341:Principal Component Analysis; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D014463:Ultrasonography