Ultrasound Strain Imaging for Characterizing Atherosclerotic Plaque in the Carotid Arteries of Asymptomatic Subjects

Hendrik H G Hansen; Alies H M Bekkers; Inge C L van den Munckhof; Eveline van der Kolk; Frederick J A Meijer; Marinette van der Graaf; Joost H W Rutten; Chris L de Korte

doi:10.1016/j.ultrasmedbio.2024.10.009

Ultrasound Strain Imaging for Characterizing Atherosclerotic Plaque in the Carotid Arteries of Asymptomatic Subjects

Ultrasound Med Biol. 2025 Feb;51(2):321-329. doi: 10.1016/j.ultrasmedbio.2024.10.009. Epub 2024 Nov 19.

Authors

Hendrik H G Hansen¹, Alies H M Bekkers², Inge C L van den Munckhof³, Eveline van der Kolk², Frederick J A Meijer⁴, Marinette van der Graaf⁴, Joost H W Rutten³, Chris L de Korte⁵

Affiliations

¹ Department of Medical Imaging, Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands.
² Department of Medical Imaging, Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, The Netherlands.
³ Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴ Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Department of Medical Imaging, Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, The Netherlands; Physics of Fluids Group, University of Twente, Meander (27), Enschede, The Netherlands. Electronic address: chris.dekorte@radboudumc.nl.

PMID: 39567334
DOI: 10.1016/j.ultrasmedbio.2024.10.009

Abstract

Objective: The rupture of vulnerable plaques in the carotid artery is a leading cause of strokes. While magnetic resonance imaging (MRI) is the standard for quantifying plaque composition, its high costs and lengthy procedure times limit large-scale use. Compound ultrasound strain imaging (CUSI) ultrasound offers a non-invasively alternative by assessing tissue deformation/strain within the arterial wall. Previous studies have demonstrated the relationship between strain values and plaque composition, primarily focusing on longitudinal acquisitions, which only image the proximal and distal parts of the wall. This study examines CUSI in transverse imaging planes, which enables visualization of the entire cross-section of the vessel wall. CUSI has already been validated on a symptomatic population. Therefore, the aim is to determine whether CUSI can differentiate plaque composition in asymptomatic individuals with an increased cardiovascular risk profile, validated by MRI.

Methods: This cross-sectional study included 42 plaques in 28 participants. Ultrasound data were acquired with a Samsung Medison Accuvix V10 with an L5-13IS transducer and RF-interface. An experienced neuroradiologist classified plaques with MRI using the Siemens 3.0T MAGNETOM Skyra MRI (Erlangen, Germany) with a dedicated coil. Strain differences were compared across four plaque categories (calcified, lipid, hemorrhagic, fibrous/aspecific) and for vulnerable versus stable plaques.

Results: A difference in strain values was found between lipid and calcified plaques (Kruskal-Wallis test, p < 0.05). Additionally, vulnerable plaques exhibited higher strain values than stable plaques (independent samples test, p < 0.05).

Conclusion: CUSI values differ between lipid and calcified and between stable and vulnerable plaques. Minor differences were found between the other plaque types.

Keywords: Carotid plaque; Compound ultrasound strain imaging; Magnetic resonance; Vulnerability.

MeSH terms

Aged
Asymptomatic Diseases
Carotid Arteries* / diagnostic imaging
Carotid Artery Diseases / diagnostic imaging
Cross-Sectional Studies
Female
Humans
Magnetic Resonance Imaging / methods
Male
Middle Aged
Plaque, Atherosclerotic* / diagnostic imaging
Reproducibility of Results
Ultrasonography* / methods