Analysis of neovascularization of atherosclerotic carotid plaques in contrast enhanced ultrasound

2012 ◽  
Author(s):  
Zeynettin Akkus ◽  
Assaf Hoogi ◽  
Johan G. Bosch ◽  
Guillaume Renaud ◽  
Stijn C.H. van den Oord ◽  
...  
Keyword(s):  
Contrast Enhanced Ultrasound ◽  
Carotid Plaques ◽  
Contrast Enhanced

scholarly journals Molecular Imaging of Carotid Plaque Vulnerability

2014 ◽  
Vol 39 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Angelika Alonso ◽  
Dimitrios Artemis ◽  
Michael G. Hennerici
Keyword(s):  
Molecular Imaging ◽  
Carotid Endarterectomy ◽  
Contrast Enhancement ◽  
Phase Contrast ◽  
Late Phase ◽  
High Grade ◽  
Contrast Enhanced Ultrasound ◽  
Plaque Vulnerability ◽  
Carotid Plaques ◽  
Contrast Enhanced

Background: Carotid endarterectomy (CEA) has been shown to be beneficial in patients with high-grade symptomatic carotid artery stenosis. Patients with high-grade asymptomatic stenosis may only exceptionally benefit from CEA during periods of increased plaque vulnerability. Imaging modalities to characterize unstable, vulnerable plaques are strongly needed for better risk stratification in these patients. Summary: Contrast-enhanced ultrasound (CEUS) is a novel and noninvasive technique capable to identify several surrogate markers of vulnerable carotid plaques. The use of specific ultrasound microbubbles allows a reliable detection of microulcerations due to an optimized visualization of the plaque-lumen border. As microbubbles are strictly intravascular tracers, the detection of individual microbubbles within the plaque corresponds to intraplaque neovessels. The accuracy of CEUS in the visualization of newly formed microvessels has been confirmed in histological studies on carotid endarterectomy specimens. Together with the formation of adventitial vasa vasorum, intraplaque neovascularization is a strong predictor for symptomatic disease. The phenomenon of late phase contrast enhancement is based on the adherence of microbubble-containing monocytes on inflamed endothelium. Recent studies suggest that late phase contrast enhancement may reflect endothelial inflammation or activation within carotid plaques. The development of conjugated microbubbles that bind to specific ligands such as thrombotic material or neovessels has led to the term ‘molecular imaging'. CEUS with microbubbles targeted to P-selectin and VCAM-1, key molecules in leukocyte trafficking, was used to detect an inflammatory plaque phenotype, whereas microbubbles coupled to the VEGF-receptor may allow for a detection of neovascularization. Even though imaging with targeted microbubbles is yet in an experimental stage, this technique can visualize active plaque reorganization with increased vulnerability leading to generation of arterio-arterial embolism. Key Messages: The use of contrast-enhanced ultrasound can be recommended to assess atherosclerotic carotid lesions at risk for rupture. Prospective clinical studies are needed to validate the use of CEUS in patients with high risks of recurrent large artery strokes. In particular, this applies to the detection of intraplaque neovascularization, a well-established marker in preclinical and observational studies, while the clinical significance of late phase contrast enhancement still needs to be determined.

Abstract TMP47: The Clinical Utility of Contrast Enhanced Ultrasound Detecting Disrupted Carotid Plaques

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shuichi Tonomura ◽  
Kozue Saito ◽  
Hatsue Ishibashi-Ueda ◽  
Soichiro Abe ◽  
Kota Mori ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Carotid Plaque ◽  
Plaque Rupture ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Contrast Enhanced Ultrasound ◽  
Histopathological Findings ◽  
Carotid Plaques ◽  
Contrast Enhanced

Introduction: Contrast-enhanced ultrasound (CEUS) using new contrast agents which offer a stable contrast effect in vivo is a noninvasive modality to detect vulnerability of carotid plaque, ulceration and neovascularization. A recent study showed the superiority for the detection of small ulcers using CEUS to color-Doppler ultrasound (CDUS), which used computed tomographic angiography (CTA) as the reference technique. Hypothesis: We assumed CEUS enables us to detect disruption of carotid plaques that could not be detected by CDUS and CTA. We aimed to investigate the diagnostic accuracy for detecting the disruption of the carotid plaques comparing with histopathological findings. Methods: From July 2010 to July 2015, we enrolled 68 internal carotid stenosis (ICS) patients undergoing carotid endarterectomy (CEA) and preoperatively examined CEUS using Perflubutane (Sonazoid), CDUS and CTA. We compared the findings of the plaque disruptions detected by these three modalities with the histopathological findings of ulceration and present/recent plaque rupture. Results: Of 68 subjects (age 72±6.6years old, 66 men), 44 (64%) had symptomatic ICS. Pathologically, ulceration and present/recent plaque rupture were found in 58 cases (85.3%). The diagnostic accuracy for detecting the disruption of carotid plaque by CEUS was significantly superior to other modalities (Table 1). CEUS could find disrupted carotid plaque more accurately than CTA. Conclusions: The assessment of the disruption of the plaques using CEUS was well correlated with pathological findings of plaque rupture, which may help us to evaluate the plaque vulnerability in vivo real time.

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