Detection of Carotid Atherosclerotic Plaque Neovascularization Using Contrast Enhanced Ultrasound: A Systematic Review and Meta-Analysis of Diagnostic Accuracy Studies

CT and MR Imaging of Carotid Wall and Plaque

“…CT can also help with the detection of intra-plaque neovascularization and in its quantification as the amount of contrast enhancement on CT is associated with the extent of neovascularization. [48][49][50] On MRI, enhancement of the carotid plaque after the administration of gadolinium is associated with neovascularization (p<0.001). There is a correlation between the degree of plaque enhancement and the degree of neovascularization.…”

Intra-Plaque Vessels on Contrast-Enhanced Ultrasound Sonography Predict Carotid Plaque Histology

“…A pilot study indicated the association of the quantitative assessment of neovascularization with intraplaque hemorrhage [5]. Furthermore, a meta-analysis reported that CEUS is a useful, noninvasive modality for the diagnosis of intraplaque neovascularization [6]. We previously reported that the enhancement and its attenuation with time inside a carotid plaque on CEUS study was significantly associated with its vulnerability evaluated with magnetic resonance imaging [7].…”

In Vivo Assessment of Atherosclerotic Plaque Neovascularization by Contrast-Enhanced Ultrasound: An Unsolved Mystery?

“…[2][3][4] Several methods have been proposed for in vivo imaging and quantification of IPN, 3,5,6 but CEUS remains the most widely applied and examined technique. However, as Huang et al 1 noted, studies using CEUS suffer from both a lack of standardization regarding protocols used for CEUS-assisted identification of IPN and substantial variance in reporting of their findings. Moreover, regarding IPN quantification protocols, a number of limitations are comprehensively summarized by Huang et al Still, we would like to underline a couple of further issues.…”

“…In particular, when plaques located in the posterior arterial wall are evaluated, microbubbles may produce acoustic shadowing that alters grayscale intensity and therefore image interpretation, a phenomenon known as far-wall pseudoenhancement. 8 Finally, an issue pinpointed as a limitation by Huang et al 1 is the identification of the truly culprit plaques in the case of cerebrovascular events. The investigators assumed that in symptomatic patients, the evaluated plaque (under CEUS) should be the culprit one, but this may not be always the case.…”

“…In a recent issue of JASE, Huang et al 1 presented an interesting metaanalysis regarding the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) for the detection of carotid atherosclerotic intraplaque neovascularization (IPN). Beyond the meta-analysis, which was limited to studies that provided data regarding the sensitivity and specificity of CEUS in the recognition of IPN, the investigators also conducted an extensive review of the available literature, for which they should be congratulated.…”