Goudot Guillaume, Sitruk Jonas, Jimenez Anatole, Julia Pierre, Khider Lina, Alsac Jean-Marc, El Batti Salma, Bruneval Patrick, Amemyia Kisaki, Pedreira Olivier, Mortelette Hélène, Calvet David, Tanter Mickaël, Mirault Tristan, Pernot Mathieu, Messas Emmanuel
Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris University, Paris, France.
INSERM U970 PARCC, Paris University, Paris, France.
Transl Stroke Res. 2022 Feb;13(1):100-111. doi: 10.1007/s12975-021-00920-6. Epub 2021 Jun 28.
Ultrafast ultrasound imaging (UUI) provides an estimation of carotid plaque stiffness by shear wave elastography (SWE) and the quantification of wall shear stress (WSS) by ultrafast Doppler. We aimed to evaluate the combined criteria of plaque stiffness and WSS applied on the plaque as potential biomarkers of plaque vulnerability assessed by histology. We included patients for whom carotid endarterectomy had been decided by a multidisciplinary team. UUI was performed within 48 h before surgery, and acquisitions were obtained on a carotid longitudinal view. After endarterectomy, gross examination and histological analysis were performed on each removed plaque. Forty-six plaques with SWE data and 29 with WSS data were analyzed. Histological analysis revealed 29 vulnerable and 17 stable plaques. Gray-scale median analysis by B-mode, mean, and standard deviation of stiffness by SWE did not differ between vulnerable and stable plaques. SWE analysis revealed that the percentage of stiffness range of 3-5 m/s was significantly increased in vulnerable plaques (p = 0.048). WSS alone showed no difference between stable and vulnerable plaques regardless of the segment of the plaque which was analyzed. A multiparametric score using maximal WSS at the peak of the plaque associated with SWE texture analysis parameters was calculated by stepwise regression, leading to a score with a sensitivity of 80% and a specificity of 78%. Area under the receiver operating characteristics curve was 0.85. A multiparameter scoring system including plaque stiffness and flow analysis using UUI allows to effectively identify histologically vulnerable carotid plaques. ClinicalTrials.gov Identifier: NCT03234257.
超快超声成像（UUI）通过剪切波弹性成像（SWE）估计颈动脉斑块硬度，并通过超快多普勒对壁面剪应力（WSS）进行量化。我们旨在评估应用于斑块的斑块硬度和WSS的联合标准，作为通过组织学评估的斑块易损性的潜在生物标志物。我们纳入了由多学科团队决定进行颈动脉内膜切除术的患者。在手术前48小时内进行UUI，在颈动脉纵视图上进行采集。内膜切除术后，对每个切除的斑块进行大体检查和组织学分析。分析了46个有SWE数据的斑块和29个有WSS数据的斑块。组织学分析显示29个易损斑块和17个稳定斑块。B模式的灰阶中位数分析、SWE的硬度平均值和标准差在易损斑块和稳定斑块之间没有差异。SWE分析显示，易损斑块中硬度范围为3-5m/s的百分比显著增加（p = 0.048）。无论分析斑块的哪个节段，单独的WSS在稳定斑块和易损斑块之间均无差异。通过逐步回归计算使用斑块峰值处的最大WSS与SWE纹理分析参数相关的多参数评分，得出的评分灵敏度为80%，特异性为78%。受试者操作特征曲线下面积为0.85。包括使用UUI的斑块硬度和血流分析的多参数评分系统能够有效识别组织学上易损的颈动脉斑块。ClinicalTrials.gov标识符：NCT03234257。
