Objective
To compare the consistency between superb microvascular imaging (SMI) and contrast-enhanced
ultrasound (CEUS) for the detection of neovascularization in carotid plaques of different
thicknesses and to evaluate the applied value of these two methods for detecting neovascularization
in carotid plaques in the clinic.
Methods
A total of 45 patients with carotid artery plaques who were diagnosed in our hospital
involving 76 hypoechoic plaques with a thickness ≥2.0 mm were selected. According
to thickness, the plaques were divided into three groups: 2.0–2.5 mm, 2.5–3.0 mm and
≥3.0 mm. Each group underwent both SMI and CEUS, and two experienced sonographers
(A and B) analyzed the ultrasound images to evaluate the neovascularization of carotid
plaques. The amount of the neovascular signal was assessed using a semi-quantitative
grading scale (vascularity grade: grade 0–3). SMI and CEUS were graded respectively
according to the visual methods as follows: grade 0: no blood flow signal/enhancement
within plaques; grade 1: a few blood flow signals/enhancement within plaques; grade
2: medium blood flow signals/enhancement within plaques; and grade 3: extensive blood
flow signals/enhancement within plaques. Kappa consistency test was used to analyze
the consistency of the grade of neovascularization in plaques between SMI with CEUS.
Gamma rank correlation analysis was used to examine the correlation between neovascularization
grade by SMI and CEUS in plaque and plaque thickness.
Results
Of these patients, 14 had unilateral plaques and 31 had bilateral plaques. The two
sonographers were highly consistent in terms of applying SMI and CEUS methods for
diagnosing neovascularization in carotid plaques (Kappa values were 0.736 and 0.680>0).
Consistency was found between SMI and CEUS by sonographers (sonographer A: Kappa=0.823;
sonographer B: Kappa=0.842) in evaluating the neovascular grade in the carotid plaques.
SMI and CEUS grades were positively correlated with plaque thickness (sonographer
A: γ = 0.735 and 0.772; sonographer B: γ = 0.805 and 0.798).
Conclusion
Neovascularization in carotid plaques was successfully detected by SMI in a manner
that concurred well with CEUS results. Our data indicate that both CEUS and SMI have
high diagnostic value for assessing the neovascularization of plaques.
Key Words
Abbreviations:
SMI (superb microvascular imaging), CEUS (contrast-enhanced ultrasound), US (ultrasound), CDI (color doppler image), PDI (power doppler image)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2019; 394: 1145-1158
- Increased Vascularization in the Vulnerable Upstream Regions of Both Early and Advanced Human Carotid Atherosclerosis.PLoS One. 2016; 11e0166918
- Carotid intraplaque neovascularization predicts coronary artery disease and cardiovascular events.Eur Heart J Cardiovasc Imaging. 2019; 20: 1239-1247
- Value of superb micro-vascular imaging in predicting ischemic stroke in patients with carotid atherosclerotic plaques.World J Clin Cases. 2019; 7: 839-848
- Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults.Circulation. 2017; 135: 759-771
- Carotid plaque instability and ischemic symptoms are linked to immaturity of microvessels within plaques.J Vasc Surg. 2007; 45: 155-159
- Plaque neovascularization detected with contrast-enhanced ultrasound predicts ischaemic stroke recurrence in patients with carotid atherosclerosis.Eur J Neurol. 2020; 27: 809-816
- Superb micro-vascular imaging for the detection of ulcerated plaque with neovascularization in carotid artery.Chinese J Ultrasound Med. 2015; 31: 680-682
- Neovascularization in carotid atherosclerotic plaques can be effectively evaluated by superb microvascular imaging (SMI): Initial experience.Vasc Med. 2020; 25: 328-333
- Clinical Applications of Superb Microvascular Imaging in the Superficial Tissues and Organs: A Systematic Review.Acad Radiol. 2021; 28: 694-703
- The value of SMI in the evaluation of carotid artery plaque neovascularization.Chinese J Ultrasound Med. 2014; 30: 1060-1063
- Comparison of superb micro-vascular imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow.J Med Ultrason. 2018; 45 (2001): 443-452
- Contrast ultrasound assessment of angiogenesis by perfusion and molecular imaging.Expert Rev Mol Diagn. 2005; 5: 447-455
- Evaluation of carotid plaque rupture and neovascularization by contrast-enhanced ultrasound imaging: an exploratory study based on histopathology.Transl Stroke Res. 2021; 12: 49-56
- Evaluating the Efficacy of Atorvastatin on Patients with Carotid Plaque by an Innovative Ultrasonography.J Stroke Cerebrovasc Dis. 2019; 28: 830-837
- Comparison of diagnostic values of ultrasound micro-flow imaging and contrast-enhanced ultrasound for neovascularization in carotid plaques.Exp Ther Med. 2017; 14: 680-688
- Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media.Stroke. 2019; 50: 3121-3127
- Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis?.Vasc Med (London, England). 2007; 12: 291-297
- Terminology for high-risk and vulnerable coronary artery plaques. Report of a meeting on the vulnerable plaque, June 17 and 18, 2003, Santorini, Greece.Eur Heart J. 2004; 25: 1077-1082
- Value of high-frame-rate contrast-enhanced ultrasound in evaluation of neovascularization in carotid atherosclerotic plaque.Chinese J Med Ultrasound. 2020; 17: 854-859
- Impact of H-Type Hypertension on Intraplaque Neovascularization Assessed by Contrast-Enhanced Ultrasound.J Atheroscler Thromb. 2022; 29: 492-501
- Assessment of neovascularization of carotid artery atherosclerotic plaques using superb microvascular imaging: a comparison with contrast-enhanced ultrasound imaging and histology.Quant Imaging Med Surg. 2021; 11: 1958-1969
- An Innovative Ultrasound Technique for Evaluation of Tumor Vascularity in Breast Cancers: Superb Micro-Vascular Imaging.J breast cancer. 2016; 19: 210-213
- Evaluation of Intraplaque Neovascularization Using Superb Microvascular Imaging and Contrast-Enhanced Ultrasonography.J Stroke Cerebrovasc Dis. 2018; 27: 2348-2353
- Application Value of Superb Microvascular Imaging and Contrast-enhanced Ultrasound in Neovascularization of Carotid Plaques with Different Thickness.Chinese J CT and MRI. 2019; 17: 63-65
Article info
Publication history
Published online: September 17, 2022
Accepted:
August 1,
2022
Received in revised form:
July 31,
2022
Received:
June 26,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
