Stabilization of Carotid Atheroma Assessed by Quantitative Ultrasound Analysis in Nonhypercholesterolemic Patients With Coronary Artery Disease
Keisuke Watanabe, MD*,
Seigo Sugiyama, MD, PhD*,*,
Kiyotaka Kugiyama, MD, PhD ,
Osamu Honda, MD*,
Hironobu Fukushima, MD*,
Hidenobu Koga, MD*,
Yoko Horibata, MD*,
Toshinori Hirai, MD, PhD ,
Tomohiro Sakamoto, MD, PhD*,
Michihiro Yoshimura, MD, PhD*,
Yasuyuki Yamashita, MD, PhD and
Hisao Ogawa, MD, PhD*
* Depatment of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Second Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering University of Yamanashi, Yamanashi, Japan
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Figure 1 Representative ultrasound images of atherosclerotic carotid plaques with ultrasound analysis. (A) Regular B-mode image of carotid atheroma as shown by arrowheads. Plaque-IMTmax was measured in this mode as shown by an arrow. (B) IBS-mode image. The red dotted line indicates the region of interest (ROI) in the plaque (intima-media complex), and the blue dotted line indicates the ROI in the adventitia using the manual outline definition mode. Values of cIBS and plaque-IMTmax of this plaque are –19.6 dB and 2.44 mm, respectively. CCA = common carotid artery; IBS = integrated backscatter; ICA = internal carotid artery; IMT = intima-media thickness.
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Figure 2 Reduction values of total cholesterol (T-CHO) and low-density lipoprotein cholesterol (LDL-C) in the statin group and diet group during the follow-up period. The box and whisker plots show that the reduction values of total cholesterol (A) and LDL-C (B) were significantly greater in the statin group than in the diet group (p < 0.001).
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Figure 3 Representative multispectral magnetic resonance images of echolucent carotid plaques. (A) High-resolution B-mode image of carotid atheroma as shown by gray arrowheads. CCA = common carotid artery; ICA = internal carotid artery. (B) Presence of echolucent plaque visualized by Doppler-ultrasound. (C) Short-axis Doppler-ultrasound image of carotid atheroma. (D) T1-weighted (T1W) image. (E) T2-weighted (T2W) image. (F) proton density-weighted (PDW) image. (G) Time-of-flight (TOF) image. White arrowheads indicate adventitia of carotid artery, and the asterisk indicates the carotid vein.
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Figure 4 Representative IBS images of carotid atheroma from baseline to follow-up. (A) Carotid atheroma at pretreatment. Values of cIBS and plaque-IMTmax of this plaque are –17.8 dB and 2.05 mm, respectively. (B) The same carotid atheroma post-pravastatin therapy (6 months). Values of cIBS and plaque-IMTmax of this plaque are –14.2 dB and 2.10 mm, respectively. Abbreviations as in Figure 1.
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Figure 5 Changes of cIBS and plaque-IMTmax values from baseline to follow-up in the two treatment groups. (A) Statin therapy significantly (p < 0.001) increased echogenicity from baseline to follow-up, whereas diet therapy did not. (B) The increase in cIBS values was significantly greater in the statin group than in the diet group (p < 0.001). (C) Plaque-IMTmax values were not significantly changed from baseline to follow-up in either treatment group. (D) Regression values of plaque-IMTmax were not significantly different between the statin group and diet group. Abbreviations as in Figure 1.
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Figure 6 Relationship between the changes of cIBS values and of lipoprotein levels from baseline to follow-up. The change of cIBS values significantly correlated with the change of total cholesterol (T-CHO) (A) and low-density lipoprotein cholesterol (LDL-C) (B) levels from baseline to follow-up (p < 0.001). cIBS = calibrated integrated backscatter.
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