Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-84b7d79bbc-g5fl4 Total loading time: 0 Render date: 2024-07-25T07:40:52.456Z Has data issue: false hasContentIssue false

16 - Assessment of carotid plaque with conventional ultrasound

from Morphological plaque imaging

Published online by Cambridge University Press:  03 December 2009

By
Stephen Meairs
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Stephen Meairs
Affiliation:
University of Heidelberg, 68167 Mannheim, Germany
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
Get access

Summary

Introduction

Over three decades ago continuous-wave (CW) Doppler was introduced as the first ultrasound (US) investigation for evaluation of carotid stenosis. Since that time, the rapid development of noninvasive US techniques has resulted in a wide variety of clinical applications for assessment of carotid disease. This chapter will discuss the clinical merits and limitations of US techniques for evaluation of both early and advanced carotid disease. It will then address recent developments including carotid plaque perfusion and molecular imaging of carotid disease.

Ultrasound techniques for evaluation of carotid disease

Doppler sonography

US Doppler techniques are commonly used for examining the carotid arteries. Interpretation of Doppler signals is based on analysis of the audio signals and of the frequency spectrum. The Doppler effect is named after Christian Doppler, who described the effect of moving objects on the change in frequency of emitted light in 1842. This effect is familiar to anyone who has stood in one place and listened to a source of sound passing by. The rising pitch of the passing movement of sound rushes toward the listener and equally drops as the source leaves him behind. Similarly, the Doppler frequency shift, which is the difference between emitted and received US frequency, is proportional to the velocity of moving blood cells.

CW Doppler systems use two transducers, one of which emits while the other receives US continuously.

Keywords

atherosclerotic diseasecarotid artery stenosiscarotid plaquemolecular imagingultrasound techniquesultrasonographic techniques
Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 208 - 222
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barry, C. D., Allott, C. P., John, N. W., et al. (1997). Three-dimensional freehand ultrasound: image reconstruction and volume analysis. Ultrasound in Medicine and Biology, 23, 1209–24.CrossRefGoogle ScholarPubMed
Bassiouny, H. S., Davis, H., Massawa, N., et al. (1989). Critical carotid stenoses: morphologic and chemical similarity between symptomatic and asymptomatic plaques. Journal of Vascular Surgery, 9, 202–12.CrossRefGoogle ScholarPubMed
Bassiouny, H. S., Sakaguchi, Y., Mikucki, S. A., et al. (1997). Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. Journal of Vascular Surgery, 26, 585–94.CrossRefGoogle ScholarPubMed
Bluth, E. I., Kay, D., Merritt, C. R. B., et al. (1986). Sonographic characterization of carotid plaque: detection of hemorrhage. American Journal of Roentgenology, 1061–5.CrossRefGoogle ScholarPubMed
Chang, P. H., Shung, K. K. and Levene, H. B. (1996). Quantitative measurements of second harmonic Doppler using ultrasound contrast agents. Ultrasound in Medicine and Biology, 22, 1205–14.CrossRefGoogle ScholarPubMed
Christiansen, J. P., Leong-Poi, H., Klibanov, A. L., Kaul, S. and Lindner, J. R. (2002). Noninvasive imaging of myocardial reperfusion injury using leukocyte-targeted contrast echocardiography. Circulation, 105, 1764–7.CrossRefGoogle ScholarPubMed
Comerota, A. J., Katz, M. L., White, J. V. and Grosh, J. D. (1990). The preoperative diagnosis of the ulcerated carotid atheroma. Journal of Vascular Surgery, 11, 505–10.CrossRefGoogle ScholarPubMed
Dayton, P. A. and Ferrara, K. W. (2002). Targeted imaging using ultrasound. Journal of Magnetic Resonance Imaging, 16, 362–77.CrossRefGoogle ScholarPubMed
Bray, J. M. and Glatt, B. (1995). Quantification of atheromatous stenosis in the extracranial internal carotid artery. Cerebrovascular Disease, 5, 414–26.CrossRefGoogle Scholar
Detmer, P. R., Bashein, G., Hodges, T., et al. (1994). 3D ultrasonic image feature localization based on magnetic scanhead tracking: in vitro calibration and validation. Ultrasound in Medicine and Biology, 20, 923–36.CrossRefGoogle Scholar
Devuyst, G., Ruchat, P., Karapanayiotides, T., et al. (2005). Ultrasound measurement of the fibrous cap in symptomatic and asymptomatic atheromatous carotid plaques. Circulation, 111, 2776–82.CrossRefGoogle ScholarPubMed
Droste, D. W., Karl, M., Bohle, R. M. and Kaps, M. (1997). Comparison of ultrasonic and histopathological features of carotid artery stenosis. Neurological Research, 19, 380–4.CrossRefGoogle ScholarPubMed
Furst, G., Saleh, A., Wenserski, F., et al. (1999). Reliability and validity of noninvasive imaging of internal carotid artery pseudo-occlusion. Stroke, 30, 1444–9.CrossRefGoogle ScholarPubMed
Goes, E., Janssens, W., Maillet, B., et al. (1990). Tissue characterization of atheromatous plaques: correlation between ultrasound image and histological findings. Journal of Clinical Ultrasound, 18, 611–17.Google ScholarPubMed
Golemati, S., Sassano, A., Lever, M. J., et al. (2003). Carotid artery wall motion estimated from B-mode ultrasound using region tracking and block matching. Ultrasound in Medicine and Biology, 29, 387–99.CrossRefGoogle ScholarPubMed
Golledge, J., Cuming, R., Ellis, M., Davies, A. H. and Greenhalgh, R. M. (1997). Carotid plaque characteristics and presenting symptom. British Journal of Surgery, 84, 1697–701.CrossRefGoogle ScholarPubMed
Gronholdt, M. L., Wiebe, B. M., Laursen, H., et al. (1997). Lipid-rich carotid artery plaques appear echolucent on ultrasound B-mode images and may be associated with intraplaque haemorrhage. European Journal of Vascular and Endovascular Surgery, 14, 439–45.CrossRefGoogle ScholarPubMed
Hallam, M. J., Reid, J. M. and Cooperberg, P. L. (1989). Color-flow Doppler and conventional duplex scanning of the carotid bifurcation: prospective, double-blind, correlative study. American Journal of Roentgenology, 152, 1101–5.CrossRefGoogle ScholarPubMed
Hatsukami, T. S., Ferguson, M. S., Beach, K. W., et al. (1997). Carotid plaque morphology and clinical events. Stroke, 28, 95–100.CrossRefGoogle ScholarPubMed
Hennerici, M., Reifschneider, G., Trockel, U. and Aulich, A. (1984). Detection of early atherosclerotic lesions by duplex scanning of the carotid artery. Journal of Clinical Ultrasound, 12, 455–64.CrossRefGoogle ScholarPubMed
Henri, P. and Tranquart, F. (2000). B-flow ultrasonographic imaging of circulating blood. Journal of Radiology, 81, 465–7.Google ScholarPubMed
Horder, M. M., Barnett, S. B., Vella, G. J., Edwards, M. J. and Wood, A. K. (1998). In vivo heating of the guinea-pig fetal brain by pulsed ultrasound and estimates of thermal index. Ultrasound in Medicine and Biology, 24, 1467–74.CrossRefGoogle ScholarPubMed
Imparato, A. M., Riles, T. S., Mintzer, R. and Baumann, F. G. (1983). The importance of hemorrhage in the relationship between gross morphologic characteristics and cerebral symptoms in 376 carotid artery plaques. Annals of Surgery, 197, 195–203.CrossRefGoogle ScholarPubMed
Jespersen, S. K., Wilhjelm, J. E. and Sillesen, H. (2000). In vitro spatial compound scanning for improved visualization of atherosclerosis. Ultrasound in Medical Biology, 26, 1357–62.CrossRefGoogle ScholarPubMed
Kabalnov, A., Bradley, J., Flaim, S., et al. (1998). Dissolution of multicomponent microbubbles in the bloodstream: 2. Experiment. Ultrasound in Medicine and Biology, 24, 751–60.CrossRefGoogle ScholarPubMed
Kern, R., Szabo, K., Hennerici, M. and Meairs, S. (2004). Characterization of carotid artery plaques using real-time compound B-mode ultrasound. Stroke, 35, 870–5.CrossRefGoogle ScholarPubMed
Kofoed, S. C., Gronholdt, M. L., Wilhjelm, J. E., Bismuth, J. and Sillesen, H. (2001). Real-time spatial compound imaging improves reproducibility in the evaluation of atherosclerotic carotid plaques. Ultrasound in Medical Biology, 27, 1311–17.CrossRefGoogle ScholarPubMed
Krishnan, S. and O'Donnell, M. (1996). Transmit aperture processing for nonlinear contrast agent imaging. Ultrasonic Imaging, 18, 77–105.CrossRefGoogle ScholarPubMed
Lammie, G. A., Wardlaw, J., Allan, P., et al. (2000). What pathological components indicate carotid atheroma activity and can these be identified reliably using ultrasound?European Journal of Ultrasound, 11, 77–86.CrossRefGoogle ScholarPubMed
Landry, A., Spence, J. D. and Fenster, A. (2004). Measurement of carotid plaque volume by 3-dimensional ultrasound. Stroke, 35, 864–9.CrossRefGoogle ScholarPubMed
Langsfeld, M., Gray Weale, A. C. and Lusby, R. J. (1989). The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries. Journal of Vascular Surgery, 9, 548–57.CrossRefGoogle ScholarPubMed
Leen, E. J., Feeley, T. M., Colgan, M. P., et al. (1990). “Haemorrhagic” carotid plaque does not contain haemorrhage. European Journal of Vascular Surgery, 4, 123–8.CrossRefGoogle Scholar
Leong-Poi, H., Christiansen, J., Klibanov, A. L., Kaul, S. and Lindner, J. R. (2003). Noninvasive assessment of angiogenesis by ultrasound and microbubbles targeted to alpha(v)-integrins. Circulation, 107, 455–60.CrossRefGoogle ScholarPubMed
Lindner, J. R. (2002). Detection of inflamed plaques with contrast ultrasound. American Journal of Cardiology, 90, 32L–5L.CrossRefGoogle ScholarPubMed
Lovett, J. K., Redgrave, J. N. and Rothwell, P. M. (2005). A critical appraisal of the performance, reporting, and interpretation of studies comparing carotid plaque imaging with histology. Stroke, 36, 1091–7.CrossRefGoogle ScholarPubMed
Lusby, R. J., Ferrell, L. D., Ehrenfeld, W. K., Stoney, R. J. and Wylie, E. J. (1982). Carotid plaque hemorrhage. Its role in production of cerebral ischemia. Archives of Surgery, 117, 1479–88.CrossRefGoogle ScholarPubMed
Maroon, J. C., Pieroni, D. W. and Campbell, R. L. (1969). Ophthalmosonometry: an ultrasonic method for assessing carotid blood flow. Journal of Neurosurgery, 30, 238–46.CrossRefGoogle ScholarPubMed
Meairs, S., Beyer, J. and Hennerici, M. (2000). Reconstruction and visualization of irregularly sampled three- and four-dimensional ultrasound data for cerebrovascular applications. Ultrasound in Medicine and Biology, 26, 263–72.CrossRefGoogle ScholarPubMed
Meairs, S. and Hennerici, M. (1999). Four-dimensional ultrasonographic characterization of plaque surface motion in patients with symptomatic and asymptomatic carotid artery stenosis. Stroke, 30, 1807–13.CrossRefGoogle ScholarPubMed
Meairs, S. and Hennerici, M. (2000). Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology, 54, 2190.CrossRefGoogle ScholarPubMed
Meairs, S., Timpe, L., Beyer, J. and Hennerici, M. (2000). Acute aphasia and hemiplegia during karate training. Lancet, 356, 40.CrossRefGoogle ScholarPubMed
Melis-Kisman, E. and Mol, J. M. F. (1970). L'applicationde l'effet Doppler à l'exploration cérébrovasculaire – Rapport préliminaire. Revue Neurologique, 122, 470–2.Google Scholar
Milei, J., Parodi, J. C., Ferreira, M., et al. (2003). Atherosclerotic plaque rupture and intraplaque hemorrhage do not correlate with symptoms in carotid artery stenosis. Journal of Vascular Surgery, 38, 1241–7.CrossRefGoogle Scholar
Moreno, P. R., Purushothaman, K. R., Fuster, V., et al. (2004). Plaque neovascularization is increased in ruptured atherosclerotic lesions of human aorta: implications for plaque vulnerability. Circulation, 110, 2032–8.CrossRefGoogle ScholarPubMed
Nicolaides, A. N., Kakkos, S. K., Griffin, M., et al. (2005). Effect of image normalization on carotid plaque classification and the risk of ipsilateral hemispheric ischemic events: results from the asymptomatic carotid stenosis and risk of stroke study. Vascular, 13, 211–21.CrossRefGoogle ScholarPubMed
Park, A. E., McCarthy, W. J., Pearce, W. H., Matsumura, J. S. and Yao, J. S. (1998). Carotid plaque morphology correlates with presenting symptomatology. Journal of Vascular Surgery, 27, 872–8.CrossRefGoogle ScholarPubMed
Pignoli, P., Tremoli, E., Poli, A., Oreste, P. and Paoletti, R. (1986). Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation, 74, 1399–406.CrossRefGoogle ScholarPubMed
Riley, W. A., Barnes, R. W., Applegate, W. B., et al. (1992). Reproducibility of noninvasive ultrasonic measurement of carotid atherosclerosis. The Asymptomatic Carotid Artery Plaque Study. Stroke, 23, 1062–8.CrossRefGoogle ScholarPubMed
Rothwell, P. M., Gutnikov, S. A. and Warlow, C. P. (2003). Reanalysis of the final results of the European Carotid Surgery Trial. Stroke, 34, 514–23.CrossRefGoogle ScholarPubMed
Schumann, P. A., Christiansen, J. P., Quigley, R. M., et al. (2002). Targeted-microbubble binding selectively to GlycoproteinIIb IIIa receptors of platelet thrombi. Investigative Radiology, 37, 587–93.CrossRefGoogle Scholar
Sitzer, M., Fuerst, G., Fischer, H., et al. (1993). Between-method correlations in quantifying internal carotid stenosis. Stroke, 24, 1513–18.CrossRefGoogle ScholarPubMed
Sitzer, M., Furst, G., Siebler, M. and Steinmetz, H. (1994). Usefulness of an intravenous contrast medium in the characterization of high-grade internal carotid stenosis with color Doppler-assisted duplex imaging. Stroke, 25, 385–9.CrossRefGoogle ScholarPubMed
Steinke, W., Hennerici, M., Rautenberg, W. and Mohr, J. P. (1992). Symptomatic and asymptomatic high-grade carotid stenoses in Doppler color-flow imaging. Neurology, 42, 131–8.CrossRefGoogle ScholarPubMed
Steinke, W., Kloetzsch, C. and Hennerici, M. (1990). Carotid artery disease assessed by color Doppler flow imaging: correlation with standard Doppler sonography and angiography. American Journal of Neuroradiology, 11, 259–66.Google ScholarPubMed
Steinke, W., Meairs, S., Ries, S. and Hennerici, M. (1996). Sonographic assessment of carotid artery stenosis: comparison of power Doppler imaging and color Doppler flow imaging. Stroke, 27, 91–4.CrossRefGoogle ScholarPubMed
Strandness, D. E. and Eikelboom, B. C. (1998). Carotid artery stenosis–where do we go from here?European Journal of Ultrasound, 7 (Suppl. 3), S17–S26.CrossRefGoogle Scholar
Taylor, D. C. and Strandness, D. E. Jr. (1987). Carotid artery duplex scanning. Journal of Clinical Ultrasound, 15, 635–44.CrossRefGoogle ScholarPubMed
Touboul, P. J., Hennerici, M. G., Meairs, S., et al. (2004). Mannheim Intima-Media Thickness Consensus on Behalf of the Advisory Board of the 3rd Watching the Risk Symposium 2004, 13th European Stroke Conference, Mannheim, Germany, May 14, 2004. Cerebrovascular Diseases, 18, 346–9.CrossRefGoogle Scholar
Umemura, A. and Yamada, K. (2001). B-mode flow imaging of the carotid artery. Stroke, 32, 2055–7.CrossRefGoogle ScholarPubMed
Liew, H. D. and Burkard, M. E. (1995). Bubbles in circulating blood: stabilization and simulations of cyclic changes of size and content. Journal of Applied Physiology, 79, 1379–85.CrossRefGoogle ScholarPubMed
Virmani, R., Kolodgie, F. D., Burke, A. P., et al. (2005). Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arteriosclerosis, Thrombosis, and Vascular Biology, 25, 2054–61.CrossRefGoogle ScholarPubMed
Weissleder, R. and Mahmood, U. (2001). Molecular imaging. Radiology, 219, 316–33.CrossRefGoogle ScholarPubMed
Weller, G. E., Villanueva, F. S., Klibanov, A. L. and Wagner, W. R. (2002). Modulating targeted adhesion of an ultrasound contrast agent to dysfunctional endothelium. Annals of Biomedical Engineering, 30, 1012–19.CrossRefGoogle ScholarPubMed
Weskott, H. P. (2000). B-flow–a new method for detecting blood flow. Ultraschall inder Medizin, 21, 59–65.Google ScholarPubMed
Widder, B., Paulat, K., Hackspacher, J., et al. (1990). Morphological characterization of carotid artery stenoses by ultrasound duplex scanning. Ultrasound in Medicine and Biology, 16, 349–54.CrossRefGoogle ScholarPubMed
Wong, M., Edelstein, J., Wollman, J. and Bond, M. G. (1993). Ultrasonic-pathological comparison of the human arterial wall. Verification of intima-media thickness. Arteriosclerosis and Thrombosis, 13, 482–6.CrossRefGoogle ScholarPubMed
Yao, J., Sambeek, M. R., Dall'Agata, A., et al. (1998). Three-dimensional ultrasound study of carotid arteries before and after endarterectomy; analysis of stenotic lesions and surgical impact on the vessel. Stroke, 29, 2026–31.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×