Goudot Guillaume, Khider Lina, Pedreira Olivier, Poree Jonathan, Julia Pierre, Alsac Jean-Marc, Amemiya Kisaki, Bruneval Patrick, Messas Emmanuel, Pernot Mathieu, Mirault Tristan
Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France.
Vascular Department, Hôpital Européen Georges Pompidou, APHP, Paris, France.
Front Physiol. 2020 Mar 3;11:157. doi: 10.3389/fphys.2020.00157. eCollection 2020.
The degree of stenosis of a carotid plaque is a well-established risk factor for ischemic stroke. Nevertheless, the risk of ipsilateral stroke in asymptomatic carotid stenosis remains low and new imaging markers are needed to better target which patients would benefit most from endarterectomy or intensive medical therapy. Ultrafast ultrasound imaging offers parameters helping at characterizing the carotid plaque by shear wave elastography and Ultrafast Doppler (UFD). We aimed at using these techniques to characterize 3 different ultrasound biomarkers: plaque stiffness heterogeneity, wall shear stress (WSS) and intraplaque micro-flows and to correlate these biomarkers with findings on computed tomography angiography (CTA) and the pathological examination.
We present the case of a multimodal evaluation of a carotid plaque using ultrasound. Elastography has been coupled to the WSS assessment and the detection of intraplaque micro-flows by UFD. The data have been compared to CTA and to the pathology examination of the tissue after carotid endarterectomy.
Elastography allowed at identifying stiff areas corresponding to calcifications, as well as a soft area corresponding to an intraplaque hemorrhage. The flow evaluation with UFD showed an increase of the WSS along the plaque and identified the presence of a plaque rupture, confirmed by the pathologist.
Ultrafast ultrasound imaging is an innovative, easily accessible technique that provides imaging modalities on top of the conventional B-mode. Ultrafast ultrasound biomarkers such as plaque stiffness heterogeneity, WSS and intraplaque micro-flows could help to define the vulnerability of the carotid plaque in order to stratify patients that could benefit most from endarterectomy or intensive medical therapy.
颈动脉斑块的狭窄程度是缺血性卒中公认的危险因素。然而，无症状性颈动脉狭窄患者同侧卒中的风险仍然较低，需要新的影像学标志物来更好地确定哪些患者能从内膜切除术或强化药物治疗中获益最大。超快超声成像可通过剪切波弹性成像和超快多普勒（UFD）提供有助于表征颈动脉斑块的参数。我们旨在利用这些技术来表征3种不同的超声生物标志物：斑块硬度异质性、壁面切应力（WSS）和斑块内微血流，并将这些生物标志物与计算机断层血管造影（CTA）结果及病理检查结果相关联。
我们展示了一例使用超声对颈动脉斑块进行多模态评估的病例。弹性成像与WSS评估以及通过UFD检测斑块内微血流相结合。已将数据与CTA以及颈动脉内膜切除术后组织的病理检查结果进行了比较。
弹性成像能够识别出对应于钙化的硬区以及对应于斑块内出血的软区。UFD进行的血流评估显示沿斑块的WSS增加，并确定存在斑块破裂，这一点得到了病理学家的证实。
超快超声成像是一种创新的、易于获得的技术，它在传统B模式基础上提供了成像方式。超快超声生物标志物，如斑块硬度异质性、WSS和斑块内微血流，有助于确定颈动脉斑块的易损性，以便对最能从内膜切除术或强化药物治疗中获益的患者进行分层。
