Regular Article
Computer Analysis of Ultrasonic Plaque Echolucency in Identifying High Risk Carotid Bifurcation Lesions

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Abstract

Objectives: to confirm that plaque echogenicity evaluated by computer analysis, as suggested by preliminary studies, can identify plaques associated with a high incidence of strokes. Materials and methods: a series of 96 patients with carotid stenosis in the range of 50–99% were studied retrospectively (41 with TIAs and 55 asymptomatic). Carotid plaque echogenicity was evaluated using a computerised measurement of the median grey scale value (GSM). All patients had a CT brain scan to determine the presence of infarction in the carotid territory. Results: the incidence of ipsilateral brain CT infarctions was 16% in the asymptomatic and 32% in the symptomatic plaques (p =0.076). It was 20% for <70% stenosis and 25% for >70% stenosis (p =0.52). It was 9% for plaques which had a GSM >50 and 40% in those with GSM <50 (p <0.001) with a relative risk of 4.6 (95% CI 1.8 to 11.6). Conclusions: the results confirm that computer analysis of plaque echogenicity is better than the degree of stenosis in identifying plaques associated with an increased incidence of CT brain-scan infarction and consequently useful for identifying individuals at high risk of stroke. What is required is a form of image standardisation in order to apply this method to natural history studies with stroke as the endpoint.

Keywords

Carotid artery
Carotid occlusive disease
Carotid stenosis
Duplex scan.

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Paper presented at the Xth ESVS Annual Meeting held in Venice in September 1996.

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Please address all correspondence to: G. M. Biasi, Division of Vascular Surgery, Bassini Teaching Hospital, University of Milan, Via M. Gorki 50, 20092 Cinisello Balsamo (Milan), Italy.