Introduction: Contrast-enhanced ultrasound (CEUS) using new contrast agents which offer a stable contrast effect in vivo is a noninvasive modality to detect vulnerability of carotid plaque, ulceration and neovascularization. A recent study showed the superiority for the detection of small ulcers using CEUS to color-Doppler ultrasound (CDUS), which used computed tomographic angiography (CTA) as the reference technique.
Hypothesis: We assumed CEUS enables us to detect disruption of carotid plaques that could not be detected by CDUS and CTA. We aimed to investigate the diagnostic accuracy for detecting the disruption of the carotid plaques comparing with histopathological findings.
Methods: From July 2010 to July 2015, we enrolled 68 internal carotid stenosis (ICS) patients undergoing carotid endarterectomy (CEA) and preoperatively examined CEUS using Perflubutane (Sonazoid), CDUS and CTA. We compared the findings of the plaque disruptions detected by these three modalities with the histopathological findings of ulceration and present/recent plaque rupture.
Results: Of 68 subjects (age 72±6.6years old, 66 men), 44 (64%) had symptomatic ICS. Pathologically, ulceration and present/recent plaque rupture were found in 58 cases (85.3%). The diagnostic accuracy for detecting the disruption of carotid plaque by CEUS was significantly superior to other modalities (Table 1). CEUS could find disrupted carotid plaque more accurately than CTA.
Conclusions: The assessment of the disruption of the plaques using CEUS was well correlated with pathological findings of plaque rupture, which may help us to evaluate the plaque vulnerability in vivo real time.