Diagnostic accuracy of gray-scale analysis on B-mode ultrasound for identifying intraplaque hemorrhage and lipid-rich necrotic core in carotid plaques

Among 113 enrolled patients, 75 patients (mean age 75 years; 69% men; 40% with symptomatic CS) were included in the analysis. On MRI, 43 patients (57%) had LRNC, and 32 patients (43%) showed IPH in the index artery. In the group without IPH, LRNC status could not be scored for 19 index arteries. Echolucency of the plaque surface with a gray-scale value < 20 showed the strongest association with IPH, with an area under the ROC curve (AUC) of 0.58 (95% CI 0.43, 0.71) and a negative predictive value of 0.64 (95% CI 0.50, 0.69) for the presence of IPH (sensitivity 0.50, specificity 0.65). For LRNC without IPH, several thresholds yielded the best-performing AUC of 0.48 (95% CI 0.23, 0.73/0.74)Conclusion:Quantitative ultrasound does not reliably predict the presence of IPH or LRNC, as detected by MRI, in patients with atherosclerotic internal CS.

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Publication Details

Journal
Vascular Medicine
Published
2026-02-25
DOI
https://doi.org/10.1177/1358863x251410527
Primary Topic
Cerebrovascular and Carotid Artery Diseases
Type
article
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article

Diagnostic accuracy of gray-scale analysis on B-mode ultrasound for identifying intraplaque hemorrhage and lipid-rich necrotic core in carotid plaques

Joachim Fladt, Annaelle V. Zietz, Andrea Wiencierz, Mandy D. Müller et al.
Vascular Medicine
Cerebrovascular and Carotid Artery Diseases
article

Diagnostic accuracy of gray-scale analysis on B-mode ultrasound for identifying intraplaque hemorrhage and lipid-rich necrotic core in carotid plaques

Joachim Fladt, Annaelle V. Zietz, Andrea Wiencierz, Mandy D. Müller, Josefin E. Kaufmann, Andrea S Jauslin, Daniel Staub, Nils Peters, LH Bonati, Sasha Mukhija, Tolga Dittrich, Edin Mujagic, Benjamin Wagner, Thomas Wolff, Mohamed Kassem, on behalf of the BIOPLAQUE Collaborative Group, Gian Marco De Marchis, Stefan T Engelter, Philippe Lyrer, Ioannis Tsogkas, Christopher Traenka, M Eline Kooi, Marios Psychogios, Henrik Gensicke
article en

Abstract

Among 113 enrolled patients, 75 patients (mean age 75 years; 69% men; 40% with symptomatic CS) were included in the analysis. On MRI, 43 patients (57%) had LRNC, and 32 patients (43%) showed IPH in the index artery. In the group without IPH, LRNC status could not be scored for 19 index arteries. Echolucency of the plaque surface with a gray-scale value < 20 showed the strongest association with IPH, with an area under the ROC curve (AUC) of 0.58 (95% CI 0.43, 0.71) and a negative predictive value of 0.64 (95% CI 0.50, 0.69) for the presence of IPH (sensitivity 0.50, specificity 0.65). For LRNC without IPH, several thresholds yielded the best-performing AUC of 0.48 (95% CI 0.23, 0.73/0.74)Conclusion:Quantitative ultrasound does not reliably predict the presence of IPH or LRNC, as detected by MRI, in patients with atherosclerotic internal CS.

Vascular Medicine
University of Bern (CH), University of Basel (CH), University of St.Gallen (CH), Maastricht University Medical Centre (NL), University Hospital of Bern (CH), University Hospital of Basel (CH), Maastricht University (NL), Klinik Hirslanden (CH), Felix Platter-Hospital (CH), Reha Rheinfelden (CH)
Good health and well-being
Openalex Percentile: Top 43%
Cerebrovascular and Carotid Artery Diseases
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