TY - JOUR
T1 - Performance of acoustic radiation force impulse ultrasound imaging for carotid plaque characterization with histologic validation
AU - Czernuszewicz, Tomasz J.
AU - Homeister, Jonathon W.
AU - Caughey, Melissa C.
AU - Wang, Yue
AU - Zhu, Hongtu
AU - Huang, Benjamin Y.
AU - Lee, Ellie R.
AU - Zamora, Carlos A.
AU - Farber, Mark A.
AU - Fulton, Joseph J.
AU - Ford, Peter F.
AU - Marston, William A.
AU - Vallabhaneni, Raghuveer
AU - Nichols, Timothy C.
AU - Gallippi, Caterina M.
N1 - Publisher Copyright:
© 2017 Society for Vascular Surgery
PY - 2017/12
Y1 - 2017/12
N2 - Objective Stroke is commonly caused by thromboembolic events originating from ruptured carotid plaque with vulnerable composition. This study assessed the performance of acoustic radiation force impulse (ARFI) imaging, a noninvasive ultrasound elasticity imaging method, for delineating the composition of human carotid plaque in vivo with histologic validation. Methods Carotid ARFI images were captured before surgery in 25 patients undergoing clinically indicated carotid endarterectomy. The surgical specimens were histologically processed with sectioning matched to the ultrasound imaging plane. Three radiologists, blinded to histology, evaluated parametric images of ARFI-induced peak displacement to identify plaque features such as necrotic core (NC), intraplaque hemorrhage (IPH), collagen (COL), calcium (CAL), and fibrous cap (FC) thickness. Reader performance was measured against the histologic standard using receiver operating characteristic curve analysis, linear regression, Spearman correlation (ρ), and Bland-Altman analysis. Results ARFI peak displacement was two-to-four-times larger in regions of NC and IPH relative to regions of COL or CAL. Readers detected soft plaque features (NC/IPH) with a median area under the curve of 0.887 (range, 0.867-0.924) and stiff plaque features (COL/CAL) with median area under the curve of 0.859 (range, 0.771-0.929). FC thickness measurements of two of the three readers correlated with histology (reader 1: R2 = 0.64, ρ = 0.81; reader 2: R2 = 0.89, ρ = 0.75). Conclusions This study suggests that ARFI is capable of distinguishing soft from stiff atherosclerotic plaque components and delineating FC thickness.
AB - Objective Stroke is commonly caused by thromboembolic events originating from ruptured carotid plaque with vulnerable composition. This study assessed the performance of acoustic radiation force impulse (ARFI) imaging, a noninvasive ultrasound elasticity imaging method, for delineating the composition of human carotid plaque in vivo with histologic validation. Methods Carotid ARFI images were captured before surgery in 25 patients undergoing clinically indicated carotid endarterectomy. The surgical specimens were histologically processed with sectioning matched to the ultrasound imaging plane. Three radiologists, blinded to histology, evaluated parametric images of ARFI-induced peak displacement to identify plaque features such as necrotic core (NC), intraplaque hemorrhage (IPH), collagen (COL), calcium (CAL), and fibrous cap (FC) thickness. Reader performance was measured against the histologic standard using receiver operating characteristic curve analysis, linear regression, Spearman correlation (ρ), and Bland-Altman analysis. Results ARFI peak displacement was two-to-four-times larger in regions of NC and IPH relative to regions of COL or CAL. Readers detected soft plaque features (NC/IPH) with a median area under the curve of 0.887 (range, 0.867-0.924) and stiff plaque features (COL/CAL) with median area under the curve of 0.859 (range, 0.771-0.929). FC thickness measurements of two of the three readers correlated with histology (reader 1: R2 = 0.64, ρ = 0.81; reader 2: R2 = 0.89, ρ = 0.75). Conclusions This study suggests that ARFI is capable of distinguishing soft from stiff atherosclerotic plaque components and delineating FC thickness.
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U2 - 10.1016/j.jvs.2017.04.043
DO - 10.1016/j.jvs.2017.04.043
M3 - Article
C2 - 28711401
AN - SCOPUS:85023609200
SN - 0741-5214
VL - 66
SP - 1749-1757.e3
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 6
ER -