The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis

The size of a JBA is linearly related to the risk of stroke and can be used in risk stratification models. These findings need to be confirmed in future prospective studies or in the medical arm of randomized controlled studies in the presence of optimal medical therapy. In the meantime, the JBA may be used to select asymptomatic patients at high stroke risk for carotid endarterectomy and spare patients at low risk from an unnecessary operation.

No abstract

Recent studies conclude that early and specialized prehospital management contributes to emergency case survival. We have developed a portable medical device that allows telediagnosis, long distance support, and teleconsultation of mobile healthcare providers by expert physicians. The device allows the transmission of vital biosignals and still images of the patient from the emergency site to the consultation site using the GSM mobile telephony network. The device can telematically "bring" an expert specialist doctor at the site of the medical emergency, allow him/her to evaluate patient data, and issue directions to the emergency personnel on treatment procedures until the patient is brought to be hospital. Legal reasons mandated the inclusion at the consultation site of a multimedia database able to store and manage the data collected by the system. The performance of the system has been validated in four different countries using a controlled medical protocol and a set of 100 patients per country treated has been collected and analyzed.

The intima-media thickness (IMT) of the common carotid artery (CCA) is widely used as an early indicator of cardiovascular disease (CVD). It was proposed but not thoroughly investigated that the composition and texture of the media layer (ML) can be used as an indicator for the risk of stroke. In this study, we investigate the application of texture analysis of the ML of the CCA and how texture is affected by age and gender. The study was performed on 100 longitudinal-section ultrasound images acquired from asymptomatic subjects at risk of atherosclerosis. The images were separated into three different age groups, namely below 50, 50-60, and above 60 years old. Furthermore, the images were separated according to gender. A total of 61 different texture features were extracted from the intima layer (IL), the ML, and the intima-media complex (IMC). The ML and the IMC were segmented manually by a neurovascular expert and also automatically by a snakes segmentation system. We have found that male patients tended to have larger media layer thickness (MLT) values as compared to the MLT of female patients of the same age. We have found significant differences among texture features extracted from the IL, ML and IMC from different age groups. Furthermore, for some texture features, we found that they follow trends that correlate with a patient's age. For example, the gray-scale median GSM of the ML falls linearly with increasing MLT and with increasing age. Our findings suggest that ultrasound image texture analysis of the media layer has potential as an assessment biomarker for the risk of stroke.

Computerised texture analysis of ultrasonic images of symptomatic carotid plaques can identify those that are associated with brain infarction, improving the results achieved by GSM alone. This methodology could be applied to prospective natural history studies of symptomatic patients not operated on or randomised trials of patients undergoing carotid angioplasty and stenting in order to identify high-risk subgroups for cerebral infarction.

The aim of this study was to investigate the usefulness of multilevel binary and gray scale morphological analysis in the assessment of atherosclerotic carotid plaques. Ultrasound images were recorded from 137 asymptomatic A. Nicolaides Vascular Screening and Diagnostic Centre, Nicosia, Cyprus and 137 symptomatic plaques (Stroke, Transient Ischaemic Attack (TIA), Amaurosis Fugax (AF)). We carefully develop the clinical motivation behind our approach. We do this by relating the proposed L-images, M-images and Himages in terms of the clinically established hypoechoic, isoechoic and hyperechoic classification.Normalized pattern spectra were computed for both a structural, multilevel binary morphological model, and a direct gray scale morphology model. From the plots of the average pattern spectra, it is clear that we have significant differences between the symptomatic and asymptomatic spectra. Here, we note that the morphological measurements appear to be in agreement with the clinical assertion that symptomatic plaques tend to have large lipid cores while the asymptomatic plaques tend to have small lipid cores.The derived pattern spectra were used as classification features with two different classifiers, the Probabilistic Neural Network (PNN) and the Support Vector Machine (SVM). Both classifiers were used for classifying the pattern spectra into either a symptomatic or an asymptomatic class. The highest percentage of correct classifications score was 73.7% for multilevel binary morphological image analysis and 66.8% for gray scale morphological analysis. Both were achieved using the SVM classifier. Among all features, the L-image pattern spectra, that also measure the distributions of the lipid core components (and some non-lipid components) gave the best classification results.

The results of this study indicate the diagnostic value and for the first time suggest a cut-off point of 8 mm(2) for JBA. This cut-off point needs to be validated in other groups and then applied to prospective studies of asymptomatic patients.