Stroke, Vol 24, 1507-1512, Copyright © 1993 by American Heart Association
MP Urbani, E Picano, G Parenti, A Mazzarisi, L Fiori, M Paterni, G Pelosi and L Landini
BACKGROUND AND PURPOSE: The ultrasonic image can offer unique information
on the composition of atherosclerotic plaque, ie, the relative content of
lipids, fibrous tissue, and calcific deposits. To date, however, the
echographic assessment of plaque structure is based on a subjective,
qualitative evaluation of the bidimensional images. We evaluated the
feasibility and accuracy of assessing, in vivo, the acoustic properties of
arterial carotid plaques by means of a suitably modified echographic
apparatus allowing direct access to the radiofrequency signal. METHODS: In
15 patients undergoing carotid thromboendarterectomy, the ultrasonic
findings in 70 discrete sites (within the plaque, n = 54; normal sites, n =
11; or intraluminal thrombi, n = 5) were correlated with the histological
analysis (hematoxylin-eosin and Mallory trichrome stains) independently
performed on the arterial samples. The pathological examination was carried
out at a similar level of the insonation; the sites analyzed within the
plaque were chosen because of their uniform echoic characteristics. In each
ultrasonic region of interest selected from the echographic image, the
integrated amplitude of the rectified radiofrequency signal was measured as
the integrated backscatter index. RESULTS: The intimal-medial layer of
normal carotid wall (n = 11) exhibited values of -32.5 +/- 9.4 dB. The
integrated backscatter index in fatty sites (n = 11, -40.3 +/- 5.4 dB)
differed from that of fibrous (n = 12, -23.8 +/- 5.0 dB) and calcified (n =
26, -11.5 +/- 5.2 dB, P < .01 for all intergroup differences) sites.
Intraluminal thrombotic sites (n = 5, -42 +/- 5.1 dB, P < .01) differed
from fibrous and calcified subsets (P < .01) but overlapped (P = NS)
with fatty sites. Histological sampling also showed two sites of
intraplaque hemorrhage that exhibited very low backscatter values (-53 and
-58 dB) and three fibrofatty sites showing backscatter values (-28, -28,
and -32 dB) intermediate between the fibrous and the fatty subsets.
CONCLUSIONS: Quantitative analysis of integrated backscatter of the
arterial wall is feasible in humans and provides an operator-independent
assessment of plaque echoic structure. In particular, integrated
backscatter is effective in distinguishing lipidic, fibrotic, and calcific
components in human atherosclerotic plaques.
ARTICLES
In vivo radiofrequency-based ultrasonic tissue characterization of the atherosclerotic plaque
CNR, Institute of Clinical Physiology, Pisa, Italy.
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