Aterosclerotic plaque valnurability detection with new multiparametric ultrasound methods

There are several causes for cerebral ischemia and if risk factors are diagnosed timely, the risk of stroke can be reduced significantly. The unstable arterial atherosclerotic plaque is one of the main risk factors for cerebral ischemia. CEUS is a new noninvasive method, that may facilitate early detection of unstable carotid plaque (neovascularization) and may change patient management regardless stenosis grade concept in high stroke risk. The purpose of the study was to analyse multi-parametric US techniques ability to confirm the plaque’s instability more precisely than the baseline investigation of Duplex US and find out correlation between the new multi-parametric US techniques results and histological findings. During the prospective research, conducted in the period from 2018 to 2020, 75 patients with unstable plaque detected with duplex US, were included. Each patient was analyzed with B mode, Duplex US, SMI, CEUS and CTA methods. In 50 cases the results were histologically proven. Unstable plaque was diagnosed in 75 patients using Duplex US method and in 74 patients using CT method. Comparing both methods statistically significant correlation was found (rs = 0,781; p = 0,0001). The neovascularization was diagnosed in 35 (46.7%) patients by CEUS - in 18 cases (51.4%) plaques showed neovascularization grade 1 and in 17 cases (48.6%) grade 2 plaques were detected. Using SMI method neovascularization were found in 17 (22.7%) patients, with statistically significant correlation between CEUS and SMI (rs = 0,701; p = 0,0001). Comparing CEUS method and results of histology statistically significant correlation was found (rs = 0,61; p = 0,002). New ultrasound methods such as CEUS and SMI provide additional information to the atherosclerotic plaque instability and vasa vasorum detecting, with positive correlation to the grade of stenosis and histological results.