Ultrasound Int Open 2016; 02(04): E106-E112
DOI: 10.1055/s-0042-115564
Review
© Georg Thieme Verlag KG Stuttgart · New York

Ultrasound Vascular Elastography as a Tool for Assessing Atherosclerotic Plaques – A Systematic Literature Review

B. Mahmood
1   Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
,
C. Ewertsen
1   Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
,
J. Carlsen
1   Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
,
M. B. Nielsen
1   Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
› Author Affiliations
Further Information

Publication History

received 20 May 2016

accepted 05 August 2016

Publication Date:
13 October 2016 (online)

Abstract

Atherosclerosis is a widespread disease that accounts for nearly 3-quarters of deaths due to cardiovascular disease. Ultrasound elastography might be able to reliably identify characteristics associated with vulnerable plaques. There is a need for the evaluation of elastography and its ability to distinguish between vulnerable and stable plaques. The aim of this paper is to provide an overview of the literature on vascular elastography. A systematic search of the available literature for studies using elastography for assessing atherosclerotic plaques was conducted using the MEDLINE, Embase, Cochrane Library and Web of Science databases. A standardized template was used to extract relevant data following the PRISMA 2009 checklist. 20 articles were included in this paper. The studies were heterogeneous. All studies reported that elastography was a feasible technique and provided additional information compared to B-mode ultrasound alone. Most studies reported higher strain values for vulnerable plaques. Ultrasound elastography has potential as a clinical tool in the assessment of atherosclerotic plaques. Elastography is able to distinguish between different plaque types, but there is considerable methodological variation between studies. There is a need for larger studies in a clinical setting to determine the full potential of elastography.

 
  • References

  • 1 GBD 2013 . Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385: 117-171
  • 2 Behler RH, Nichols TC, Zhu H et al. ARFI imaging for noninvasive material characterization of atherosclerosis. Part II: toward in vivo characterization. Ultrasound Med Biol 2009; 35: 278-295
  • 3 Nandalur KR, Baskurt E, Hagspiel KD et al. Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on MDCT. AJR Am J Roentgenol 2005; 184: 295-298
  • 4 Gomez SM, Gomez CR, Hall IS. Transcranial Doppler ultrasonographic assessment of intermittent light stimulation at different frequencies. Stroke 1990; 21: 1746-1748
  • 5 Zhang P-F, Su H-J, Zhang M et al. Atherosclerotic plaque components characterization and macrophage infiltration identification by intravascular ultrasound elastography based on b-mode analysis: validation in vivo. Int J Cardiovasc Imaging 2011; 27: 39-49
  • 6 Bamber J, Cosgrove D, Dietrich CF et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall in Med 2013; 34: 169-184
  • 7 Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall in Med 2013; 34: 238-253
  • 8 Garra BS. Elastography. Ultrasound 2011; 3: 177-186
  • 9 Moher D, Liberati A, Tetzlaff J et al. PRISMA Group . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann. Intern. Med. 2009; 151: 264-294
  • 10 Dahl JJ, Dumont DM, Allen JD et al. Acoustic radiation force impulse imaging for noninvasive characterization of carotid artery atherosclerotic plaques: a feasibility study. Ultrasound Med Biol 2009; 35: 707-716
  • 11 Naim C, Douziech M, Therasse E et al. Vulnerable atherosclerotic carotid plaque evaluation by ultrasound, computed tomography angiography, and magnetic resonance imaging: An overview. Canadian Association of Radiologists Journal 2014; 65: 275-286
  • 12 Garrard JW, Ummur P, Nduwayo S et al. Shear wave elastography may be superior to greyscale median for the identification of carotid plaque vulnerability: A comparison with histology. Ultraschall in Med 2015; 36: 386-390
  • 13 Dumont D, Dahl J, Miller E et al. Lower-limb vascular imaging with acoustic radiation force elastography: demonstration of in vivo feasibility. IEEE Trans Ultrason Ferroelectr Freq Control 2009; 56: 931-944
  • 14 Ramnarine KV, Garrard JW, Dexter K et al. Shear wave elastography assessment of carotid plaque stiffness: in vitro reproducibility study. Ultrasound Med Biol 2014; 40: 200-209
  • 15 Liu F, Yong Q, Zhang Q et al. Real-time tissue elastography for the detection of vulnerable carotid plaques in patients undergoing endarterectomy: a pilot study. Ultrasound Med Biol 2015; 41: 705-712
  • 16 Okimoto H, Ishigaki Y, Koiwa Y et al. A novel method for evaluating human carotid artery elasticity: possible detection of early stage atherosclerosis in subjects with type 2 diabetes. Atherosclerosis 2008; 196: 391-397
  • 17 Wang X, Jackson DC, Varghese T et al. Correlation of cognitive function with ultrasound strain indices in carotid plaque. Ultrasound Med Biol 2014; 40: 78-89
  • 18 Takimura H, Hirano K, Muramatsu T et al. Vascular elastography: a novel method to characterize occluded lower limb arteries prior to endovascular therapy. J Endovasc Ther 2014; 21: 654-661
  • 19 Ribbers H, Lopata RGP, Holewijn S et al. Noninvasive two-dimensional strain imaging of arteries: validation in phantoms and preliminary experience in carotid arteries in vivo. Ultrasound Med Biol 2007; 33: 530-540
  • 20 Ramnarine KV, Garrard JW, Kanber B et al. Shear wave elastography imaging of carotid plaques: feasible, reproducible and of clinical potential. Cardiovasc Ultrasound 2014; 12: 49
  • 21 Keshavarz-Motamed Z, Saijo Y, Majdouline Y et al. Coronary artery atherectomy reduces plaque shear strains: an endovascular elastography imaging study. Atherosclerosis 2014; 235: 140-149
  • 22 De Korte CL, Sierevogel MJ, Mastik F et al. Identification of atherosclerotic plaque components with intravascular ultrasound elastography in vivo: a Yucatan pig study. Circulation 2002; 105: 1627-1630
  • 23 de Korte CL, Carlier SG, Mastik F et al. Morphological and mechanical information of coronary arteries obtained with intravascular elastography; feasibility study in vivo. Eur. Heart J. 2002; 23: 405-413
  • 24 Hu X-B, Zhang P-F, Su H-J et al. Intravascular ultrasound area strain imaging used to characterize tissue components and assess vulnerability of atherosclerotic plaques in a rabbit model. Ultrasound Med Biol 2011; 37: 1579-1587
  • 25 Liang Y, Zhu H, Friedman MH. The correspondence between coronary arterial wall strain and histology in a porcine model of atherosclerosis. Phys Med Biol 2009; 54: 5625-5641
  • 26 Majdouline Y, Ohayon J, Keshavarz-Motamed Z et al. Endovascular shear strain elastography for the detection and characterization of the severity of atherosclerotic plaques: in vitro validation and in vivo evaluation. Ultrasound Med Biol 2014; 40: 890-903
  • 27 Schaar JA, De Korte CL, Mastik F et al. Characterizing vulnerable plaque features with intravascular elastography. Circulation 2003; 108: 2636-2641
  • 28 de Korte CL, Pasterkamp G, van der Steen AF et al. Characterization of plaque components with intravascular ultrasound elastography in human femoral and coronary arteries in vitro. Circulation 2000; 102: 617-623
  • 29 Lorenz MW, Markus HS, Bots ML et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115: 459-467
  • 30 Chambless LE, Folsom AR, Clegg LX et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol 2000; 151: 478-487
  • 31 Brott TG, Halperin JL, Abbara S et al. 2011; ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011; 124: 489-532
  • 32 Lovett JK, Redgrave JNE, Rothwell PM. A critical appraisal of the performance, reporting, and interpretation of studies comparing carotid plaque imaging with histology. Stroke 2005; 36: 1091-1097
  • 33 Saam T, Ferguson MS, Yarnykh VL et al. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler. Thromb Vasc Biol 2005; 25: 234-239
  • 34 Kawahara I, Morikawa M, Honda M et al. High-resolution magnetic resonance imaging using gadolinium-based contrast agent for atherosclerotic carotid plaque. Surg Neurol 2007; 68: 605-656
  • 35 Loree HM, Kamm RD, Stringfellow RG et al. Effects of fibrous cap thickness on peak circumferential stress in model atherosclerotic vessels. Circ. Res. 1992; 71: 850-858
  • 36 Ohayon J, Finet G, Gharib AM et al. Necrotic core thickness and positive arterial remodeling index: emergent biomechanical factors for evaluating the risk of plaque rupture. Am. J. Physiol. Heart Circ. Physiol 2008; 295: 717-727
  • 37 Nair A, Margolis MP, Kuban BD et al. Automated coronary plaque characterisation with intravascular ultrasound backscatter: ex vivo validation. Euro Intervention 2007; 3: 113-120
  • 38 Nair A, Kuban BD, Tuzcu EM et al. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002; 106: 2200-2206
  • 39 Frutkin AD, Mehta SK, McCrary JR et al. Limitations to the use of virtual histology-intravascular ultrasound to detect vulnerable plaque. Eur Heart J 2007; 28: 1783-1784
  • 40 Thim T, Hagensen MK, Wallace-Bradley D et al. Unreliable assessment of necrotic core by virtual histology intravascular ultrasound in porcine coronary artery disease. Circ Cardiovasc Imaging 2010; 3: 384-391
  • 41 Brugaletta S, Gomez-Lara J, Garcia-Garcia HM et al. Analysis of 1 year virtual histology changes in coronary plaque located behind the struts of the everolimus eluting bioresorbable vascular scaffold. Int J Cardiovasc Imaging 2012; 28: 1307-1314
  • 42 Guo J, Maehara A, Mintz GS et al. A virtual histology intravascular ultrasound analysis of coronary chronic total occlusions. Catheter Cardiovasc Interv 2013; 81: 464-470
  • 43 Murray SW, Stables RH, Hart G et al. Defining the magnitude of measurement variability in the virtual histology analysis of acute coronary syndrome plaques. Eur Heart J Cardiovasc Imaging 2013; 14: 167-174