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Title: Manual planimetric measurement of carotid plaque volume using three-dimensional ultrasound imaging

Abstract

We investigated the utility of three manual planimetric methods to quantify carotid plaque volume. A single observer measured 15 individual plaques from 15 three-dimensional (3D) ultrasound (3D US) images of patients ten times each using three different planimetric approaches. Individual plaque volumes were measured (range: 32.6-597.1 mm{sup 3}) using a standard planimetric approach (M1) whereby a plaque end was identified and sequential contours were measured. The same plaques were measured using a second approach (M2), whereby plaque ends were first identified and the 3D US image of the plaque was then subdivided into equal intervals. A third method (M3) was used to measure total plaque burden (range: 165.1-1080.0 mm{sup 3}) in a region ({+-}1.5 cm) relative to the carotid bifurcation. M1 systematically underestimated individual plaque volume compared to M2 (V{sub 2}=V{sub 1}+14.0 mm{sup 3}, r=0.99, p=0.006) due to a difference in the mean plaque length measured. Coefficients of variance (CV) for M1 and M2 decrease with increasing plaque volume, with M2 results less than M1. Root mean square difference between experimental and theoretical CV for M2 was 3.2%. The standard deviation in the identification of the transverse location of the carotid bifurcation was 0.56 mm. CVs for plaque burden measuredmore » using M3 ranged from 1.2% to 7.6% and were less than CVs determined for individual plaque volumes of the same volume. The utility of M3 was demonstrated by measuring carotid plaque burden and volume change over a period of 3 months in three patients. In conclusion, M2 was determined to be a more superior measurement technique than M1 to measure individual plaque volume. Furthermore, we demonstrated the utility of M3 to quantify regional plaque burden and to quantify change in plaque volume.« less

Authors:
; ; ; ;  [1];  [2];  [2];  [2];  [2]
  1. Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada)
  2. (Canada)
Publication Date:
OSTI Identifier:
20951165
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 34; Journal Issue: 4; Other Information: DOI: 10.1118/1.2715487; (c) 2007 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIFURCATION; BLOOD VESSELS; CARDIOVASCULAR DISEASES; IMAGES; PATIENTS; ULTRASONOGRAPHY

Citation Formats

Landry, Anthony, Ainsworth, Craig, Blake, Chris, Spence, J. David, Fenster, Aaron, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8, Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8, Imaging Research Laboratories and Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8, and Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8. Manual planimetric measurement of carotid plaque volume using three-dimensional ultrasound imaging. United States: N. p., 2007. Web. doi:10.1118/1.2715487.
Landry, Anthony, Ainsworth, Craig, Blake, Chris, Spence, J. David, Fenster, Aaron, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8, Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8, Imaging Research Laboratories and Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8, & Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8. Manual planimetric measurement of carotid plaque volume using three-dimensional ultrasound imaging. United States. doi:10.1118/1.2715487.
Landry, Anthony, Ainsworth, Craig, Blake, Chris, Spence, J. David, Fenster, Aaron, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8, Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8, Imaging Research Laboratories and Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8, and Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8. Sun . "Manual planimetric measurement of carotid plaque volume using three-dimensional ultrasound imaging". United States. doi:10.1118/1.2715487.
@article{osti_20951165,
title = {Manual planimetric measurement of carotid plaque volume using three-dimensional ultrasound imaging},
author = {Landry, Anthony and Ainsworth, Craig and Blake, Chris and Spence, J. David and Fenster, Aaron and Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8 and Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 and Imaging Research Laboratories and Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario N6A 5K8 and Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8},
abstractNote = {We investigated the utility of three manual planimetric methods to quantify carotid plaque volume. A single observer measured 15 individual plaques from 15 three-dimensional (3D) ultrasound (3D US) images of patients ten times each using three different planimetric approaches. Individual plaque volumes were measured (range: 32.6-597.1 mm{sup 3}) using a standard planimetric approach (M1) whereby a plaque end was identified and sequential contours were measured. The same plaques were measured using a second approach (M2), whereby plaque ends were first identified and the 3D US image of the plaque was then subdivided into equal intervals. A third method (M3) was used to measure total plaque burden (range: 165.1-1080.0 mm{sup 3}) in a region ({+-}1.5 cm) relative to the carotid bifurcation. M1 systematically underestimated individual plaque volume compared to M2 (V{sub 2}=V{sub 1}+14.0 mm{sup 3}, r=0.99, p=0.006) due to a difference in the mean plaque length measured. Coefficients of variance (CV) for M1 and M2 decrease with increasing plaque volume, with M2 results less than M1. Root mean square difference between experimental and theoretical CV for M2 was 3.2%. The standard deviation in the identification of the transverse location of the carotid bifurcation was 0.56 mm. CVs for plaque burden measured using M3 ranged from 1.2% to 7.6% and were less than CVs determined for individual plaque volumes of the same volume. The utility of M3 was demonstrated by measuring carotid plaque burden and volume change over a period of 3 months in three patients. In conclusion, M2 was determined to be a more superior measurement technique than M1 to measure individual plaque volume. Furthermore, we demonstrated the utility of M3 to quantify regional plaque burden and to quantify change in plaque volume.},
doi = {10.1118/1.2715487},
journal = {Medical Physics},
number = 4,
volume = 34,
place = {United States},
year = {Sun Apr 15 00:00:00 EDT 2007},
month = {Sun Apr 15 00:00:00 EDT 2007}
}
  • In the last two decades, a substantial number of articles have been published to provide diagnostic solutions for patients with carotid atherosclerotic disease. These articles have resulted in a shift of opinion regarding the identification of stroke risk in patients with carotid atherosclerotic disease. In the recent past, the degree of carotid artery stenosis was the sole determinant for performing carotid intervention (carotid endarterectomy or carotid stenting) in these patients. We now know that the degree of stenosis is only one marker for future cerebrovascular events. If one wants to determine the risk of these events more accurately, other parametersmore » must be taken into account; among these parameters are plaque composition, presence and state of the fibrous cap (FC), intraplaque haemorrhage, plaque ulceration, and plaque location. In particular, the FC is an important structure for the stability of the plaque, and its rupture is highly associated with a recent history of transient ischaemic attack or stroke. The subject of this review is imaging of the FC.« less
  • The purpose of this study was to evaluate the feasibility, safety and midterm outcome of elective implantation of the Carotid Wallstent (registered) in patients considered to be at high surgical risk. In a prospective study, 54 carotid artery stenoses in 51 patients were stented over a 24-month period. Three patients underwent bilateral carotid artery stenting. Institutional inclusion criteria for invasive treatment of carotid occlusive disease (carotid endarterectomy or carotid artery stenting) are patients presenting with a 70% or more symptomatic stenosis and those with an 80% or more asymptomatic stenosis having a life-expectancy of more than 1 year. All patientsmore » treated by carotid artery stenting were considered at high risk for carotid endarterectomy because of a hostile neck (17 patients-31.5%) or because of severe comorbidities (37 patients-68.5%). No cerebral protection device was used. Of the 54 lesions, 33 (61.1%) were symptomatic and 21 (38.8%) were asymptomatic. Follow-up was performed by physical examination and by duplex ultrasonography at 1 month, 6 months, 1 year and 2 years after the procedure. All 54 lesions could be stented successfully without periprocedural stroke. Advert events during follow-up (mean 13.9 {+-} 5.7 months) were non-stroke-related death in 6 patients (11.1%), minor stroke in 4 stented hemispheres(7.4%), transient ipsilateral facial pain in 1 patient (1.8%),infection of the stented surgical patch in 1 patient (1.8%) and asymptomatic in stent restenosis in 4 patients (7.4%). The percutaneous implantation of the Carotid Wallstent (registered) , even without cerebral protection device, appears to be a safe procedure with acceptable clinical and ultrasonographic follow-up results in patients at high surgical risk. But some late adverse events such as ipsilateral recurrence of non-disabling (minor) stroke or in stent restenosis still remain real challenging problems.« less
  • Purpose. To retrospectively assess the feasibility, safety, and clinical mid-term outcome of patients undergoing carotid artery stenting with stent-grafts. Methods. Over a 4 year period stent-grafts were used in the endovascular treatment of symptomatic internal carotid artery stenosis in 12 patients (2 women, 10 men, aged 47-83 (mean 64) years). Protection devices were not used. Possible microembolic complications were evaluated by magnetic resonance imaging (MRI) examinations of the brain before and the day after the procedure in all patients. Mean follow-up was 22 months (range 1-42 months), by Doppler ultrasonography and conventional angiography as well as clinical examination .Results. Themore » technical success rate was 100%. A total of 13 coronary stent-grafts were used. The mean stenosis rate (in terms of diameter) was 85% and the mean length of stent-grafts used was 20.9 mm. The mean diameter to which the stent-grafts were dilated was 4.66 mm. In-hospital complications occurred in 1 patient who suffered a minor femoral access hematoma that did not require transfusion or surgical decompression. Post-stenting diffusion-weighted MRI revealed several ipsilateral silent microemboli in only 1 case, which was completely asymptomatic. Two patients had a major stroke after 2 years of follow-up. Restenosis was found in 2 patients who underwent successful balloon dilatation followed by placement of a self-expandable bare stent within the stent-grafts. Conclusions. Stent-grafts may prevent microembolic complications during stenting of atherosclerotic carotid lesions in selected cases, offering immediate exclusion of the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Comparative, randomized studies in larger series of patients are needed with carotid-dedicated stent-graft designs.« less