Gerrit L. ten Kate, MD, Stijn C. H. van den Oord, MD, Eric J. G

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Presentation transcript:

Current status and future developments of contrast-enhanced ultrasound of carotid atherosclerosis Gerrit L. ten Kate, MD, Stijn C.H. van den Oord, MD, Eric J.G. Sijbrands, MD, PhD, Aad van der Lugt, MD, PhD, Nico de Jong, PhD, Johan G. Bosch, PhD, Antonius F.W. van der Steen, PhD, Arend F.L. Schinkel, MD, PhD Journal of Vascular Surgery Volume 57, Issue 2, Pages 539-546 (February 2013) DOI: 10.1016/j.jvs.2012.07.028 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Evaluation of vascular wall irregularities and intraplaque neovascularization by contrast-enhanced ultrasound (CEUS). Carotid artery ultrasound scan performed in the side-by-side contrast mode, acquiring the contrast only images (A and D) and B-mode images (B and E) at the same time. C and F, present an overlay image of both the contrast (yellow) and the B-mode (blue) images, allowing for better delineation of the plaque. In the contrast-enhanced image (A) a small noncalcified plaque of 1.5 mm thick is present in the near wall, proximally to the carotid bifurcation (long thin arrows), which is barely noticeable on the B-mode image (B). In the overlay image (C), a void can be observed between the lumen contrast and vessel wall. The luminal plaque surface appears irregular and is probably ulcerated (arrowhead). The bright regions outside the vessel lumen (thick arrows) are saturation artifacts caused by high scattering regions and are constantly present during the examination. Lower panels: approximately 10 seconds after contrast has reached the carotid lumen, the contrast microbubbles have entered the atherosclerotic plaque indicating intraplaque neovascularization (D and F, small arrows). (Images acquired with a Philips iU22 ultrasound system with a L9-3 probe, SonoVue contrast agent injected intravenously in boluses of 0.5 to 1.0 mL). Journal of Vascular Surgery 2013 57, 539-546DOI: (10.1016/j.jvs.2012.07.028) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Identification of intraplaque neovascularization by contrast-enhanced ultrasound (CEUS) scan. Carotid artery B-mode ultrasound (A), and CEUS (B-D) acquired at three consecutive time points. Atherosclerotic plaques are present (small arrows) in the proximal part and distal part of the bulbus. The distal plaque contains a calcification, identifiable by the shadowing (B-D: arrowheads). The highly enhanced regions (B-D) on the left and right side of the arrow are saturation artifacts. Panel (B) was acquired 0.5 seconds before a high mechanical index flash to destroy the contrast given. Contrast enhancement can be observed in the plaque (large arrow). Panel (C) was acquired 1.5 seconds after the flash, the intraluminal contrast has been replenished quickly, while the plaque enhancement has disappeared (large arrow). Panel (D) was acquired 6 seconds after the flash and shows the contrast microbubbles in the plaque (large arrow) indicating the presence of intraplaque neovascularization (image acquisition described in Fig 1 legend). Journal of Vascular Surgery 2013 57, 539-546DOI: (10.1016/j.jvs.2012.07.028) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Flow chart of the literature search and study selection. The initial search yielded 163 eligible studies, of which 36 review articles and 5 animal studies were excluded. The remaining 122 studies were evaluated, and after cross-referencing, a total of 15 articles were included in the review. Journal of Vascular Surgery 2013 57, 539-546DOI: (10.1016/j.jvs.2012.07.028) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Contrast-enhanced 3D ultrasound scan using volume rendering (A) and multiplanar reconstruction demonstrating the transversal (B), sagittal (C), and coronal plane (D), reconstructed from a freehand sweep of the carotid artery (QLAB; Philips Healthcare, Best, The Netherlands). The volume rendering image shows the common carotid artery, (1) carotid bifurcation, (2) proximal internal, (3) and external carotid artery. (4) The superior thyroid artery (5) branches from the external carotid artery and descends to the thyroid gland. Journal of Vascular Surgery 2013 57, 539-546DOI: (10.1016/j.jvs.2012.07.028) Copyright © 2013 Society for Vascular Surgery Terms and Conditions