Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media

Zamani, Mahtab; Skagen, Karolina; Scott, Helge; Lindberg, B; Russell, David; Skjelland, Mona

doi:10.1161/strokeaha.119.025496

Cited by 64 publications

(52 citation statements)

References 33 publications

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“…Previously published study showed good agreement between CEUS and SMI in the assessment of IPN (21). Zamani et al (17) reported that plaques with higher IPN grades had higher numbers of neovessels quantified at histology (P=0.041, r=0.460). In their research, however, there was no statistically significant difference between symptomatic and asymptomatic patients with regard to the different levels of IMVF on SMI, which may be because of the relatively small sample size.…”

Section: Discussionmentioning

confidence: 99%

“…Moving enhancements were defined as intraplaque microvascular flow (IMVF), and static enhancements (considered to be tissue acoustic reflector) were excluded. IMVF levels were classified on a visual scale according to the previous study proposed by Mahtab Zamani as follows: grade 0, no IMVF or IMVF confined to the adjacent adventitia; grade 1, moving IMVF confined to the adventitial side; grade 2, moving IMVF at the plaque shoulder; grade 3, IMVF moving to the plaque core; and grade 4, extensive IMVF (17). SMI assessments were carried out in forty plaques from grade 0 to grade 4 IMVF on 2 occasions, which were >2 weeks apart to obtain the intra-and interobserver variability using κ statistics.…”

Section: Smi Protocolmentioning

confidence: 99%

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Advance ultrasound techniques for the assessment of plaque vulnerability in symptomatic and asymptomatic carotid stenosis: a multimodal ultrasound study

Zheng

Zhang

et al. 2021

Cardiovasc Diagn Ther

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Background: Advanced carotid ultrasound techniques may be useful in characterizing plaque vulnerability, but comprehensive studies are still lacking. The aim of this study was to identify factors associated with vulnerable plaques using advanced ultrasound techniques.Methods: This is a prospective observational study of patients with >50% internal carotid stenosis (ICA).All patients underwent conventional ultrasound, superb microvascular imaging (SMI) and shear wave elastography (SWE) examinations. Plaque size, echogenicity, stiffness and intraplaque neovascularization (IPN) were assessed and compared between symptomatic and asymptomatic groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SWE and SMI of the vulnerable plaques. Results:The final analysis included 123 patients (78.9% male; mean age, 66±8 years), 65 were enrolled in the symptomatic group, and 58 were enrolled in the asymptomatic group. The mean elasticity was 78.1±25.4 kPa for asymptomatic and 51.5±18.3 kPa for symptomatic plaques. Symptomatic plaques showed higher visual IPN grades on SMI than asymptomatic plaques (P<0.001). Multivariate regression analysis showed that plaque stiffness (PS) (OR 0.95, 95% CI, 0.919-0.974) and IPN level (OR 4.17, 95% CI, 2.008-8.664) were independently associated with symptomatic plaques. The combination of the two factors had a preferable accuracy to discriminate symptomatic plaques (AUC 0.89, 95% CI, 0.827-0.944).Conclusions: Advanced carotid ultrasound techniques can identify plaque characteristics that are associated with ischemic events and may be potentially indicative of plaque vulnerability. These factors may ultimately be used in the clinical management of carotid stenosis.

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Section: Discussionmentioning

confidence: 99%

Section: Smi Protocolmentioning

confidence: 99%

Advance ultrasound techniques for the assessment of plaque vulnerability in symptomatic and asymptomatic carotid stenosis: a multimodal ultrasound study

Zheng

Zhang

et al. 2021

Cardiovasc Diagn Ther

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“…These theoretical advantages of SMI have been investigated in assessment of synovial inflammation in rheumatologic conditions, as well as characterization of lesions located in thyroid gland, breast, and liver 13‐15 . Vascular applications of SMI mainly focused on characterization of carotid plaques by assessing neovascularization 16 . This could potentially identify vulnerable plaques and have important implications in stroke management 17 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of superb microvascular imaging in depiction of corkscrew collaterals in Buerger's disease

Nas

Kandemirli

Gursel

et al. 2020

J of Clinical Ultrasound

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PurposeTo evaluate the corkscrew collaterals in Buerger's disease by superb microvascular imaging (SMI) and power Doppler ultrasonography (PDU).MethodsWe evaluated with SMI and PDU 14 patients with Buerger's disease in whom corkscrew collaterals had been identified on digital subtraction angiography (DSA). Corkscrew collaterals were classified on DSA and PDU based on their size and morphology.ResultsA total of 17 vascular regions of collateral vessel formation were assessed. Based on DSA classification, there were three cases of type I collaterals (arterial diameter of >2 mm with large helical pattern), seven cases of type III collaterals (arterial diameter of 1‐1.5 mm with small helical pattern), and seven cases of type IV collaterals (arterial diameter of <1 mm with tiny helical pattern). On PDU, all type I collaterals on DSA appeared as “large snake” images, all type III collaterals on DSA appeared as “small snake” images, and all type IV collaterals on DSA appeared as dots. SMI imaging, both in color and monochrome mode, provided superior demonstration of the continuity of the vessel of large or small “snake” images. In cases appearing as dot pattern on PDU, color SMI was able to show continuity of the flow signal as a helical pattern.DiscussionSMI is a promising new Doppler imaging technique that is superior to conventional power Doppler imaging in depiction and identification of corkscrew collaterals in Buerger's disease.

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“…The receiver operating characteristic (ROC) curves will be used to evaluate the accuracy of SMI and CEUS in predicting microvessels observed at histology. The analysis for sample size estimation are based on existing data from our recently published study [22]. In this dataset mean SMI count in the asymptomatic group was 1.8 compared to 3.0 in the symptomatic group with an expected difference in mean of 1.2.…”

Section: Statistical Assessmentsmentioning

confidence: 99%

Advanced ultrasound methods in assessment of carotid plaque instability: a prospective multimodal study

et al. 2020

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Background: A significant proportion of ischemic strokes are caused by emboli from atherosclerotic, unstable carotid artery plaques. The selection of patients for endarterectomy in current clinical practice is primarily based on the degree of carotid artery stenosis and clinical symptoms. However, the content of the plaque is known to be more important for stroke risk. Intraplaque neovascularization (IPN) has recently emerged as a possible surrogate marker for plaque instability. Neo-microvessels from the adventitial vasa vasorum grow into the full thickness of the vessel wall in an adaptive response to hypoxia, causing subsequent intraplaque haemorrhage and plaque rupture. Conventional ultrasound cannot detect IPN. Contrast-enhanced ultrasound and Superb Microvascular Imaging (SMI), have, however, shown promise in IPN assessment. Recent research using Shear Wave Elastography (SWE) has also reported reduced tissue stiffness in the artery wall (reduced mean Young's modulus) in unstable compared to stable plaques. The purpose of this study is to identify unstable carotid artery plaques at risk of rupture and future ischemic stroke risk using multimodal assessments. Methods: Forty five symptomatic and 45 asymptomatic patients > 18 years, with > 50% carotid stenosis referred to Oslo University Hospital ultrasound lab will be included in this ongoing project. Patients will undergo contrast enhanced ultrasound, SMI, carotid-MRI and PET-(18 F-FDG). Contrast enhanced ultrasound will be analyzed semiquantitatively (5-levels visual classification) and quantitatively by plotting time-intensity curve analyses to obtain plaque peak contrast enhancement intensity. Plaques removed at carotid endarterectomy will be assessed histologically and the number of microvessels, areas of inflammation, granulation, calcification, lipid and fibrosis will be measured. Discussion: This multimodality study will primarily provide information on the clinical value of advanced ultrasound methods (SMI, SWE) for the detection of unstable carotid artery plaque in comparison with other methods including contrast-enhanced ultrasound, carotid-MRI and PET-(18 F-FDG) using histology as the gold standard. Secondly, findings from the methods mentioned above will be related to cerebrovascular symptoms, blood tests (leukocytes, CRP, ESR, lipoproteins and inflammatory markers) and cardiovascular risk factors at inclusion and at 1year follow-up. The overall aim is to optimize detection of plaque instability which can lead to better preventive decisions and reduced stroke rate.

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Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media

Cited by 64 publications

References 33 publications

Advance ultrasound techniques for the assessment of plaque vulnerability in symptomatic and asymptomatic carotid stenosis: a multimodal ultrasound study

Advance ultrasound techniques for the assessment of plaque vulnerability in symptomatic and asymptomatic carotid stenosis: a multimodal ultrasound study

Diagnostic utility of superb microvascular imaging in depiction of corkscrew collaterals in Buerger's disease

Advanced ultrasound methods in assessment of carotid plaque instability: a prospective multimodal study

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