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. 2024 Feb 1;14(2):1994-2007.
doi: 10.21037/qims-23-1193. Epub 2024 Jan 23.

Value of carotid intima thickness in assessing advanced carotid plaque vulnerability: a study based on carotid artery ultrasonography and carotid plaque histology

Ya-Chao Zhao  1 , Jia Zhang  1 , Fei Wang  2 , Yi-Ming He  2 , Ming-Jun Xu  1 , Dong-Hai Wang  2 , Mei Zhang  1
Affiliations

Value of carotid intima thickness in assessing advanced carotid plaque vulnerability: a study based on carotid artery ultrasonography and carotid plaque histology

Ya-Chao Zhao et al. Quant Imaging Med Surg. .

Abstract

Background: Research has shown that carotid intima-media thickness (CIMT) could help to predict carotid plaque (CP) progression in patients with mild carotid stenosis. However, the debate continues as to the value of carotid intima thickness (CIT) in monitoring the development of CP in patients with severe carotid stenosis. This study sought to evaluate the relationships between CIT and the ultrasonic characteristics of CP and to analyze the value of CIT and the ultrasonic parameters of CP in assessing plaque vulnerability in advanced human carotid atherosclerosis.

Methods: A total of 55 individuals who underwent carotid endarterectomy (CEA) were included in the study (mean age: 65±7 years; female: 9.1%). CIMT and CIT were examined at the common carotid artery (CCA). Plaque textural features, such as the gray-scale median (GSM), superb microvascular imaging (SMI) level, and total plaque area (TPA), were also identified. A Spearman correlation coefficient analysis was performed to examine the relationship between CIT and the ultrasonic parameters of CP. The CIT of various plaque types was compared. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic values of the ultrasound characteristics to evaluate CP vulnerability.

Results: The mean CIT of all the participants was 0.382±0.095 mm, the mean CIT of the participants with stable plaques was 0.328±0.031 mm, and the mean CIT of participants with vulnerable plaques was 0.424±0.106 mm (P<0.001). CIT was associated with the SMI level (Spearman's correlation coefficient: r=0.392, P=0.005), TPA (Spearman's correlation coefficient: r=0.337, P=0.012). Patients with thicker CIT had larger lipid cores, higher levels of plaque vulnerability, and more intraplaque hemorrhages (IPHs). The areas under the ROCs (AUCs) with 95% confidence interval (CI) for CIMT, CIT, the SMI level, the GSM, the TPA, and the combined model for identifying vulnerable plaques were 0.673 (0.533-0.793), 0.849 (0.727-0.932), 0.771 (0.629-0.879), 0.669 (0.529-0.790), 0.858 (0.738-0.938), and 0.949 (0.854-0.990), respectively.

Conclusions: CIT was associated with both the histology and ultrasonic features of CP. CIT may be helpful in the detection of severe CP development.

Keywords: Carotid intima thickness (CIT); gray-scale median (GSM); plaque vulnerability; superb microvascular imaging (SMI); total plaque area (TPA).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1193/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
SMI measurement and its relationship to histopathology. (A) Plaque SMI examination. A cross-section of the entire patch was displayed, with the B mode on the left and the SMI on the right. The light color denotes a positive signal (blue arrows). (B) A magnification of the SMI image in (A) provides a more accurate depiction of a positive SMI signal. (C) Histological slice of the plaque (CD34 staining, ×1). (D) A magnification of the patch’s shoulder (which is depicted by the blue box in C), several CD34 positive neovessels are present (arrows, ×10). ICA, internal carotid artery; SMI, superb microvascular imaging.
Figure 2
Figure 2
Measurements of CIT, GSM, and TPA. (A) Measurements of the CIT, CMT, and CIMT. Longitudinal-axis image of the carotid artery 3 cm before the carotid bifurcation on the left, and a zoom image of the region of interest on the right. (B) Carotid plaque with a histogram of gray-tone frequency distribution of pixels in the normalized image’s selected area (plaque). (C) Carotid plaque area measurement. Each plaque was measured in a longitudinal perspective in the plane where the plaque is maximal, and a cursor was traced around the perimeter of the cross-section. The microprocessor in the duplex scanner displays the plaque’s cross-sectional area (cm2). CIT, carotid intima thickness; CMT, carotid media thickness; GSM, gray-scale median; TPA, total plaque area; CIMT, carotid intima-media thickness.
Figure 3
Figure 3
Flowchart of the patient recruitment process. CIT, carotid intima thickness; CEA, carotid endarterectomy.
Figure 4
Figure 4
Correlations between CIT and plaque ultrasonic appearance. CIT, carotid intima thickness; SMI, superb microvascular imaging; TPA, total plaque area.
Figure 5
Figure 5
Relations between CIT and plaque types. CIT thickening was associated with larger lipid cores, increased fibrous cap cell infiltration, increased IPH, and worse overall instability. CIT, carotid intima thickness; IPH, intraplaque hemorrhage.
Figure 6
Figure 6
Receiver operating characteristic analysis of different parameters and a combined model for differentiating vulnerable plaques. The combined model, which included the TPA and CIT, had the largest area under the curve. CIMT, carotid intima-media thickness; AUC, area under the receiver operating characteristic curve; CIT, carotid intima thickness; SMI, superb microvascular imaging; GSM, greyscale median; TPA, total plaque area; CI, confidence interval.
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