Abstract
Objectives
To evaluate the ability of ultrasound non-invasive vascular elastography (NIVE) strain analysis to characterise carotid plaque composition and vulnerability as determined by high-resolution magnetic resonance imaging (MRI).
Methods
Thirty-one subjects with 50 % or greater carotid stenosis underwent NIVE and high-resolution MRI of internal carotid arteries. Time-varying strain images (elastograms) of segmented plaques were generated from ultrasonic raw radiofrequency sequences. On MRI, corresponding plaques and components were segmented and quantified. Associations between strain parameters, plaque composition and symptomatology were estimated with curve-fitting regressions and Mann–Whitney tests.
Results
Mean stenosis and age were 72.7 % and 69.3 years, respectively. Of 31 plaques, 9 were symptomatic, 17 contained lipid and 7 were vulnerable on MRI. Strains were significantly lower in plaques containing a lipid core compared with those without lipid, with 77–100 % sensitivity and 57–79 % specificity (P < 0.032). A statistically significant quadratic fit was found between strain and lipid content (P < 0.03). Strains did not discriminate symptomatic patients or vulnerable plaques.
Conclusions
Ultrasound NIVE is feasible in patients with significant carotid stenosis and can detect the presence of a lipid core with high sensitivity and moderate specificity. Studies of plaque progression with NIVE are required to identify vulnerable plaques.
Key points
• Non-invasive vascular elastography (NIVE) provides additional information in vascular ultrasound
• Ultrasound NIVE is feasible in patients with significant carotid stenosis
• Ultrasound NIVE detects a lipid core with high sensitivity and moderate specificity
• Studies on plaque progression with NIVE are required to identify vulnerable plaques
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Acknowledgments
The authors are grateful to Mrs Vicky Thiffault, Louise Allard and Andrée Cliche for their dedication in study coordination, IRB documentation preparation and patient recruitment. We would like to also acknowledge the contributions of Drs Stéphane Elkouri, Nathalie Beaudoin, Jean-Francois Blair and Eric Therasse in patient recruitment and useful advices. We would also like to thank Madame Marie-Pierre Sylvestre, biostatistician, who guided us through statistical analyses. The authors are also grateful to the Natural Sciences and Engineering Research Council of Canada, the Canadian Institutes of Health Research, Gestion Univalor and Bracco Diagnostics who provided grants to help fund this project.
Dr Gilles Soulez holds a national scientist award from the Fonds de la Recherche en Santé du Québec.
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Supplementary Fig. 1
Scatter plots with curve fitting functions of the natural logarithm of strain parameters with % calcium volume (bivariate analysis). (JPEG 306 kb)
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Naim, C., Cloutier, G., Mercure, E. et al. Characterisation of carotid plaques with ultrasound elastography: feasibility and correlation with high-resolution magnetic resonance imaging. Eur Radiol 23, 2030–2041 (2013). https://doi.org/10.1007/s00330-013-2772-7
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DOI: https://doi.org/10.1007/s00330-013-2772-7