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Ultrasound

What is the role of Superb Micro-vascular Imaging (SMI) in the detection of carotid plaque neovascularization?

Intraplaque neovascularization (IPN) is a key feature of plaque instability but its detection is traditionally difficult with B-mode and Doppler Imaging.
Case example of an asymptomatic patient with more than 70% carotid stenosis (predominantly hypoechoic plaque) in the right internal carotid artery. ​On CEUS, bubbles moving into the plaque core can be observed. Similarly, intraplaque microvascular flow signals moving towards the plaque core can be observed on SMI as well.
  • SMI performed in 31 patients with internal carotid stenosis ≥50% and compared to CEUS and histology

  • Very strong relationship between SMI and CEUS (correlation r=0.911, P<0.001)

  • Plaques with higher IPN grades on SMI also showed significantly more neovessels on histology
Case example of an asymptomatic patient with more than 70% carotid stenosis (predominantly hypoechoic plaque) in the right internal carotid artery. ​On CEUS, bubbles moving into the plaque core can be observed. Similarly, intraplaque microvascular flow signals moving towards the plaque core can be observed on SMI as well.
Conclusion: “These findings demonstrate that SMI can detect neovascularization with accuracy comparable to CEUS, suggesting SMI as a promising noninvasive alternative to CEUS.”

Reference:
Zamani et al. | Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media | Stroke (2019) 
https://pubmed.ncbi.nlm.nih.gov/31510899/
Correctly predicted large vessel occlusion (LVO) in case with right middle cerebral artery (MCA) occlusion. Top row shows coronal and axial views of the correctly labeled LVO, as indicated by the red box*. Bottom row shows the same case with 2D MIP subtraction and 3D MIP subtraction (right) where you can visualize the lack of contrast distal to the occlusion. * Not available in all geographies.
All cases; n=303:
Accuracy 81%
Sensitivity 73%
Specificity 98%

Internal carotid artery (ICA); n=160:
Accuracy 95%
Sensitivity 90%
Specificity 98%
Correctly predicted large vessel occlusion (LVO) in case with right middle cerebral artery (MCA) occlusion. Top row shows coronal and axial views of the correctly labeled LVO, as indicated by the red box*. Bottom row shows the same case with 2D MIP subtraction and 3D MIP subtraction (right) where you can visualize the lack of contrast distal to the occlusion. * Not available in all geographies.
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Scientific papers

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