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(Stroke. 2006;37:824.)
© 2006 American Heart Association, Inc.

Original Contributions

Correlation of Cerebrovascular Symptoms and Microembolic Signals With the Stratified Gray-Scale Median Analysis and Color Mapping of the Carotid Plaque

From the Departments of Neurology (R.S., I.M.-M.) and Neurosurgery (S.M.), University Hospital Geneva and Medical School, Switzerland; and the Department of Statistics (M.C.), University of Pavia, Italy.

Correspondence to Roman Sztajzel, MD, Neurosonology Unit, Department of Neurology, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail Roman.Sztajzel{at}hcuge.ch

Background and Purpose— To determine whether a stratified gray-scale median (GSM) analysis of the carotid plaque combined with color mapping correlated better with the presence of neurological symptoms and microembolic signals (MES) than a whole plaque measurement.

Methods— A total of 131 patients presenting 167 carotid stenoses between 30% and 99% were analyzed by ultrasound. Emboli detection was performed by transcranial Doppler. For each plaque, the GSM values at depth 0 mm (surface) and at one third (30) and one half (50) of the plaque thickness were compared with the values obtained for the whole plaque. The plaque pixels were mapped into 3 colors: red, yellow and green, depending on their GSM value.

Results— Mean GSM values were lower among symptomatic plaques, but a statistically significant difference between values of the whole plaque and those of the surface was obtained only for MES+ stenoses (P<0.01). In a proportional odds logistic regression model based on 4 subgroups with an increasing clinical risk (MES–/symptoms–; MES–/symptoms+; MES+/symptoms–; +; MES+/symptoms+), low mean GSM values and the predominant red color at the surface were independent factors associated with the presence of symptoms or MES (P<0.0005). Furthermore, compared with a whole plaque measurement, analysis of the surface values predicted systematically with a greater sensitivity and specificity (receiver operating characteristic curves) each one of these 4 subgroups.

Conclusions— Low mean GSM values and predominance of the red color at the surface correlated with most of the symptomatic or MES+ stenoses. This combined approach should be further investigated in a longitudinal study.

Key Words: carotid artery plaque • carotid stenosis • embolism • ultrasonography, Doppler, transcranial • stroke