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Ultrasound Imaging for Risk Assessment in Atherosclerosis
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Ultrasound Tissue Characterization of Vulnerable Atherosclerotic Plaque

Biomedicine Department, NU School of Medicine, Astana 010000, Kazakistan
CNR (Consiglio Nazionale Ricerche), Institute of Clinical Physiology, 56124 Pisa, Italy
Author to whom correspondence should be addressed.
Academic Editor: Michael Henein
Int. J. Mol. Sci. 2015, 16(5), 10121-10133;
Received: 30 January 2015 / Revised: 23 April 2015 / Accepted: 24 April 2015 / Published: 5 May 2015
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
PDF [939 KB, uploaded 5 May 2015]


A thrombotic occlusion of the vessel fed by ruptured coronary atherosclerotic plaque may result in unstable angina, myocardial infarction or death, whereas embolization from a plaque in carotid arteries may result in transient ischemic attack or stroke. The atherosclerotic plaque prone to such clinical events is termed high-risk or vulnerable plaque, and its identification in humans before it becomes symptomatic has been elusive to date. Ultrasonic tissue characterization of the atherosclerotic plaque is possible with different techniques—such as vascular, transesophageal, and intravascular ultrasound—on a variety of arterial segments, including carotid, aorta, and coronary districts. The image analysis can be based on visual, video-densitometric or radiofrequency methods and identifies three distinct textural patterns: hypo-echoic (corresponding to lipid- and hemorrhage-rich plaque), iso- or moderately hyper-echoic (fibrotic or fibro-fatty plaque), and markedly hyperechoic with shadowing (calcific plaque). Hypoechoic or dishomogeneous plaques, with spotty microcalcification and large plaque burden, with plaque neovascularization and surface irregularities by contrast-enhanced ultrasound, are more prone to clinical complications than hyperechoic, extensively calcified, homogeneous plaques with limited plaque burden, smooth luminal plaque surface and absence of neovascularization. Plaque ultrasound morphology is important, along with plaque geometry, in determining the atherosclerotic prognostic burden in the individual patient. New quantitative methods beyond backscatter (to include speed of sound, attenuation, strain, temperature, and high order statistics) are under development to evaluate vascular tissues. Although not yet ready for widespread clinical use, tissue characterization is listed by the American Society of Echocardiography roadmap to 2020 as one of the most promising fields of application in cardiovascular ultrasound imaging, offering unique opportunities for the early detection and treatment of atherosclerotic disease. View Full-Text
Keywords: atherosclerosis; plaque; tissue characterization; ultrasound atherosclerosis; plaque; tissue characterization; ultrasound

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Picano, E.; Paterni, M. Ultrasound Tissue Characterization of Vulnerable Atherosclerotic Plaque. Int. J. Mol. Sci. 2015, 16, 10121-10133.

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