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CLINICAL RESEARCH: CARDIAC IMAGING

Contrast-Enhanced Ultrasound Imaging of Intraplaque Neovascularization in Carotid Arteries

Correlation With Histology and Plaque Echogenicity

Stefano Coli, MD^_*,_*, Marco Magnoni, MD^_*, Giuseppe Sangiorgi, MD, FESC, Massimiliano M. Marrocco-Trischitta, MD^_*, Giulio Melisurgo, MD^_*, Alessandro Mauriello, MD, Luigi Spagnoli, MD, Roberto Chiesa, MD^_*, Domenico Cianflone, MD, FESC^_* and Attilio Maseri, MD, FACC^_*

^_* Department of Cardiothoracic and Vascular Diseases, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
Department of Cardiovascular Diseases, University of Rome Tor Vergata, Rome, Italy
Department of Pathology, University of Rome Tor Vergata, Rome, Italy.

Manuscript received December 12, 2007; revised manuscript received February 8, 2008, accepted February 12, 2008.

^_* Reprint request and correspondence: Dr. Stefano Coli, Department of Cardiothoracic and Vascular Diseases, University Vita-Salute, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy. (Email: coli.stefano{at}hsr.it).

Objectives: This study was designed to evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis as a clinical tool to study intraplaque neovascularization.

Background: Plaque neovascularization is associated with plaque vulnerability and symptomatic disease; therefore, imaging of neovascularization in carotid atherosclerosis may represent a useful tool for clinical risk stratification and monitoring the efficacy of antiatherosclerotic therapies.

Methods: Thirty-two patients with 52 carotid plaques were studied by standard and contrast-enhanced ultrasound imaging. In 17 of these patients who underwent endarterectomy, the surgical specimen was available for histological determination of microvessel density by CD31/CD34 double staining. Plaque echogenicity and degree of stenosis at standard ultrasound imaging were evaluated for each lesion. Contrast-agent enhancement within the plaque was categorized as absent/peripheral (grade 1) and extensive/internal (grade 2).

Results: In the surgical subgroup, plaques with higher contrast-agent enhancement showed a greater neovascularization at histology (grade 2 vs. grade 1 contrast-agent enhancement: median vasa vasorum density: 3.24/mm² vs. 1.82/mm², respectively, p = 0.005). In the whole series of 52 lesions, echolucent plaques showed a higher degree of contrast-agent enhancement (p < 0.001). Stenosis degree was not associated with neovascularization at histology or with the grade of contrast-agent enhancement.

Conclusions: Carotid plaque contrast-agent enhancement with sonographic agents correlates with histological density of neovessels and is associated with plaque echolucency, a well-accepted marker of high risk lesions, but it is unrelated to the degree of stenosis. Contrast-enhanced carotid ultrasound imaging may provide valuable information for plaque risk stratification and for assessing the response to antiatherosclerotic therapies, beyond that provided by standard ultrasound imaging.

Key Words: contrast-enhanced ultrasound imaging • vasa vasorum • atherosclerosis • carotid artery • imaging

Abbreviations and Acronyms   ICA = internal carotid artery   IMT = intima media thickness

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