Published Online
on February 10, 2005

A more recent version of this article appeared on April 1, 2005

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Submitted on September 2, 2004
Revised on October 29, 2004
Accepted on December 2, 2004

Stratified Gray-Scale Median Analysis and Color Mapping of the Carotid Plaque. Correlation With Endarterectomy Specimen Histology of 28 Patients

R. Sztajzel MD^*; S. Momjian MD; I. Momjian-Mayor MD; N. Murith MD; K. Djebaili MD; G. Boissard; M. Comelli; and G. Pizolatto MD

From the Departments of Neurology (R.S., I.M.-M.), Neurosurgery (S.M.), Cardiovascular Surgery (N.M., K.D.), and Pathology (G.P.), University Hospital Geneva, Switzerland; the Department of Statistics (M.C.), University of Pavia, Italy; and Consultant in Biostatistics (G.B.), Pavia, Italy.

^* To whom correspondence should be addressed. 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 could predict plaque histology better than an overall GSM measurement.

Methods--Thirty-one carotid plaques derived from 28 patients undergoing carotid endarterectomy were investigated by ultrasound. GSMs of the whole plaque were used as measurement of echogenicity. A profile of the regional GSM as a function of distance from the plaque surface could be generated. Plaque pixels were further mapped into 3 different colors depending on their GSM value.

Results--Plaques with large calcifications presented the highest GSM values, and those with large hemorrhagic areas or with a predominant necrotic core exhibited the lowest. Fibrous plaques had intermediate GSM values. A necrotic core located in a juxtalumenal position was associated with significantly lower GSM values (P=0.009) and with a predominant red color (GSM <50) at the surface (P=0.0019). With respect to the thickness of the fibrous cap and the position of the necrotic core, the sensitivity and specificity of the predominant red color of the whole plaque was respectively 45% and 67% and 53% and 75%; considering the predominant red color of the surface, the sensitivity and specificity increased to 73% and 67% and 84% and 75%, respectively.

Conclusions--The stratified GSM measurement combined with color mapping showed a good correlation with the different histopathological components and further allowed identification with good accuracy determinants of plaque instability. This approach should be investigated in a prospective, natural history study.

Key words: carotid artery plaque • pathology • ultrasonography

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