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. 2021 Jun;11(6):2292-2306.
doi: 10.21037/qims-20-1012.

Computer-assisted ultrasound assessment of plaque characteristics in radiation-induced and non-radiation-induced carotid atherosclerosis

Yuanxi Li  1 , Dora Lai-Wan Kwong  2 , Vincent Wing-Cheung Wu  1 , Shea-Ping Yip  1 , Helen Ka-Wai Law  1 , Shara Wee-Yee Lee  1 , Michael Tin-Cheung Ying  1
Affiliations

Computer-assisted ultrasound assessment of plaque characteristics in radiation-induced and non-radiation-induced carotid atherosclerosis

Yuanxi Li et al. Quant Imaging Med Surg. 2021 Jun.

Abstract

Background: This study investigated the feasibility of using a computer-assisted method to evaluate and differentiate the carotid plaque characteristics in radiation-induced and non-radiation-induced carotid atherosclerosis.

Methods: This study included 107 post-radiotherapy (post-RT) nasopharyngeal carcinoma (NPC) patients and 110 subjects with cardiovascular risk factors (CVRFs). Each participant had a carotid ultrasound examination, and carotid plaques and carotid intima-media thickness (CIMT) were evaluated with grey scale ultrasound. The carotid plaque characteristics were evaluated for grey-scale median (GSM) and detailed plaque texture analysis (DPTA) using specific computer software. In DPTA, five different intra-plaque components were colour-coded according to different grey scale ranges. A multivariate linear regression model was used to evaluate the correlation of risk factors and carotid plaque characteristics.

Results: Post-RT NPC patients have significantly higher CIMT (748±15.1 µm, P=0.001), more patients had a plaque formation (80.4%, P<0.001) and more plaque locations (2.3±0.2, P<0.001) than CVRF subjects (680.4±10.0 µm, 38.2% and 0.5±0.1 respectively). Among the five intra-plaque components, radiation-induced carotid plaques had significantly larger area of calcification (4.8%±7.7%, P=0.012), but lesser area of lipid (42.1%±16.9%, P=0.034) when compared to non-radiation-induced carotid plaques (3.0%±5.7% and 46.3%±17.9% respectively). Age, radiation and number of CVRF were significantly associated with the carotid atherosclerosis burden (P<0.001). Besides, age was significantly associated with the amount of lipid and calcification within carotid plaques (P<0.001).

Conclusions: Radiation caused more severe carotid artery disease than CVRF with larger CIMT and more prevalent of carotid plaque. Radiation-induced carotid plaques tended to have more intra-plaque calcifications, whereas non-radiation-induced carotid plaques had more lipids. Ultrasound aided by computer-assisted image analysis has potential for more accurate assessment of carotid atherosclerosis.

Keywords: Atherosclerotic plaque; carotid atherosclerosis; radiation effects; ultrasound.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-1012). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The comparison of CIMT between post-RT NPC and CVRF subjects. Longitudinal sonograms show CIMT of 1-cm segment in 1 cm proximal to the inferior end of the carotid bulb of a post-RT NPC patient (A) and of a CVRF subject (B). Noted the radiation-induced CIMT is higher (A) than the non-radiation-induced one (B). CIMT, carotid intima-media thickness; RT, radiotherapy; NPC, nasopharyngeal carcinoma; CVRF, cardiovascular risk factor.
Figure 2
Figure 2
Grey scale ultrasound and DPTA of carotid plaque. Longitudinal sonograms show carotid plaques (large arrows) in the carotid bifurcation of a post-RT NPC patient (A) and in the CCA of a CVRF subject (B). In image (A), note the intra-plaque calcification that appears hyperechoic (small arrow) with acoustic shadowing (arrowhead). Images (C,D) show the detailed plaque texture analysis of the two carotid plaques. Noted the radiation-induced carotid plaque has more calcification (C) than the non-radiation-induced carotid plaque (D). DPTA, detailed plaque texture analysis; RT, radiotherapy; NPC, nasopharyngeal carcinoma; CCA, common carotid artery; CVRF, cardiovascular risk factor.
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