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Background: Intraplaque neovascularization is critical in promoting atherosclerotic lesion instability. B-flow imaging (BFI) has been introduced, extending B-mode imaging capabilities to fine blood flow.Aim: The aim of this study was to assess capabilities of BFI to visualize carotid plaque neovascularizationMethods: In 74 patients, carotid plaques were imaged by B-mode, color Doppler imaging (CDI), and BFI. Plaque echogenecity was assessed as a maker of high risk lesions by gray-scale medium (GSM) values. In 10 patients who underwent carotid endarterectomy, the surgical specimens were available for histological studies.Results: Intraplaque signals were visualized with BFI in 28 of 90 plaques, in which no intraplaque flow signal were observed with CDI. They were found more frequently in echolucent plaques with GSM<50 (echolucent plaque 89% vs echogenic plaques 11%, P<0.001). In the surgical subgroup, 3 of 7 plaques with intraplaque flow signal predominantly consisted of lipid and small amount of hemorrhage with neovessels, and other 4 plaques were complexes consisting of lipid, fibrocalcificfication and hemorrhage with neovessels. In 3 plaques without intraplaque flow signal, 2 plaques predominantly consisted of massive hemorrhage, and another one consisted of fibrocalicification with few neovessels.Conclusions: Histological studies revealed BFI could visualize carotid plaque neovascularization. BFI may provide additional information for plaque characterization in high risk plaques by standard ultrasound imaging.