Role of Preoperative Ultrasound Shear-Wave Elastography and Radiofrequency-Based Arterial Wall Tracking in Assessing the Vulnerability of Carotid Plaques Preliminary Results

Mazzaccaro D, Giannetta M, Fancoli F, Matrone G, Curcio N, Conti M, Righini P, Nano G. Role of Preoperative Ultrasound Shear-Wave Elastography and Radiofrequency-Based Arterial Wall Tracking in Assessing the Vulnerability of Carotid Plaques: Preliminary Results. Diagnostics (Basel). 2023 Feb 20;13(4):805. doi: 10.3390/diagnostics13040805. PMID: 36832293; PMCID: PMC9955800. Abstract We aimed at evaluating the ability of point shear-wave elastography (pSWE) and of a radiofrequency (RF) echo-tracking-based method in preoperatively assessing the vulnerability of the carotid plaque in patients undergoing carotid endarterectomy (CEA) for significant asymptomatic stenosis. All patients who underwent CEA from 03/2021 to 03/2022 performed a preoperative pSWE and an RF echo-based wall evaluation of arterial stiffness using an Esaote MyLab ultrasound system (EsaoteTM, Genova, Italy) with dedicated software. The data derived from these evaluations (Young's modulus (YM), augmentation index (AIx), pulse-wave velocity (PWV)) were correlated with the outcome of the analysis of the plaque removed during the surgery. Data were analyzed on 63 patients (33 vulnerable and 30 stable plaques). In stable plaques, YM was significantly higher than in vulnerable plaques (49.6 + 8.1 kPa vs. 24.6 + 4.3 kPa, p = 0.009). AIx also tended to be slightly higher in stable plaques, even if it was not statistically significant (10.4 + 0.9% vs. 7.7 + 0.9%, p = 0.16). The PWV was similar (12.2 + 0.9 m/s for stable plaques vs. 10.6 + 0.5 m/s for vulnerable plaques, p = 0.16). For YM, values >34 kPa had a sensitivity of 50% and a specificity of 73.3% in predicting plaque nonvulnerability (area under the curve = 0.66). Preoperative measurement of YM by means of pSWE could be a noninvasive and easily applicable tool for assessing the preoperative risk of plaque vulnerability in asymptomatic patients who are candidates for CEA.Mazzaccaro D, Giannetta M, Fancoli F, Matrone G, Curcio N, Conti M, Righini P, Nano G. 术前超声剪切波弹性成像与基于射频的动脉壁追踪技术在评估颈动脉斑块易损性中的初步研究结果[J]. Diagnostics (Basel), 2023, 13(4):805. DOI: 10.3390/diagnostics13040805. PMID: 36832293; PMCID: PMC9955800. 摘要 本研究旨在评估点剪切波弹性成像（point shear-wave elastography, pSWE）以及基于射频（radiofrequency, RF）回声追踪技术，在对因重度无症状性狭窄接受颈动脉内膜切除术（carotid endarterectomy, CEA）的患者术前评估颈动脉斑块易损性中的应用价值。本研究纳入2021年3月至2022年3月期间接受CEA的所有患者，术前均采用配有专用软件的Esaote MyLab超声系统（Esaote™，意大利热那亚）完成pSWE检查与基于RF回声的动脉僵硬度壁层评估。将上述检查所得参数（杨氏模量（Young's modulus, YM）、增强指数（augmentation index, AIx）、脉搏波速度（pulse-wave velocity, PWV)）与术中切除斑块的病理分析结果进行相关性分析。最终纳入63例患者的资料进行分析，其中斑块易损型33例、稳定型30例。稳定型斑块的YM值显著高于易损型斑块（49.6±8.1 kPa vs. 24.6±4.3 kPa，p=0.009）。稳定型斑块的AIx值也略高于易损型斑块，但差异无统计学意义（10.4±0.9% vs.7.7±0.9%，p=0.16）。两组的PWV值无显著差异（稳定型斑块组为12.2±0.9 m/s，易损型斑块组为10.6±0.5 m/s，p=0.16）。以YM值>34 kPa作为预测斑块非易损性的临界值，其灵敏度为50%，特异度为73.3%，曲线下面积为0.66。采用pSWE术前检测YM值，可作为一种无创且易于推广的工具，用于评估拟行CEA的无症状患者的斑块易损性术前风险。