Abstract 17471: 3D Contrast-enhanced Ultrasound (CEUS) Imaging of Carotid Artery Plaques and Intra-plaque Angiogenesis

• Published in: Circulation (New York, N.Y.) N.Y.), 2014-11, Vol.130 (suppl_2)
• Main Authors: Gourineni, Venu, Saha, Sandeep, Cao, Kunlin, Jin, Jing, Dentinger, Aaron M, Mills, David M, Padfield, Dirk R, Wallace, Kirk D, Reddy, Vijaya, Shur, Boris M, Yamout, Frank, McCarthy, Walter, March, Robert, Jacobs, Chad, Liuzzo, Adele, Goldin, Marshall, Adam, Dan, Feinstein, Steven
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.130.suppl_2.17471

Abstract only Introduction: Vulnerable plaque is marked by increased intra-plaque vascularity, hemorrhage and is associated with cerebrovascular (CV) events. Current use of 2D CEUS carotid imaging does not provide a true volumetric representation of the intra-plaque angiogenesis. Therefore, this is the first clinical trial using 3D CEUS to assess intra-plaque angiogenesis, in patients with clinically significant plaques prior to carotid endarterectomy (CEA). Methods: Data were acquired on 11 patients that were asked to participate in this pilot study prior to CEA. All patients had MR and/or CT angiogram as part of their standard care and all carotid artery plaque specimens were collected and sent for histologic evaluation. CEUS volumes were acquired using a GE LOGIQ E9, RSP6-16 4D probe and Optison. In order to assess plaque vulnerability, semi-automatic image analysis algorithms were developed to segment the lumen, plaque, and intra-plaque vascularity. Measurements derived from 3D CEUS images were validated against CT, MR, and histology. Results: Preliminary results from 3 patients were analyzed and lumen volumes were segmented from all available modalities (figure shows CEUS example). Lumen measurements of the CCA, ICA, and ECA from 3D CEUS were compared to MR or CT. High correlation is shown in the figure for these patients (R 2 =0.95). Further analysis of the 3D CEUS images demonstrates that we can identify intra-plaque vascularity (see segmentation from one patient). These CEUS results estimated an average cross-sectional vascular density of 7-11% in the plaque, matching histology estimates of 10% from a single slice. Conclusion: These results demonstrate that it is feasible to use 3D CEUS for quantitative, volumetric imaging of the carotid artery and intra-plaque angiogenesis in patients scheduled for CEA. Future work will extend this analysis to all patients and make a quantitative comparison of intra-plaque vascular density from 3D CEUS vs. multiple histology slices.