Key result
Lower downstream wall shear stress accurately identifies vulnerable carotid plaques with an AUC of ~0.96.
Why the study?
The study was conducted to compare characteristics of stable and vulnerable carotid plaques and evaluate the diagnostic performance of wall shear stress based on magnetic resonance plaque imaging.
Does downstream wall shear stress (WSSdown) measured via MRI differentiate vulnerable carotid plaques from stable carotid plaques?
Cross-Sectional (n=64)
No
Does downstream wall shear stress (WSSdown) measured via MRI differentiate vulnerable carotid plaques from stable carotid plaques?
Downstream wall shear stress evaluated via MRI-based computational fluid dynamics provides high discriminative value for identifying vulnerable carotid plaques.
Answers are grounded in this paper and cite their sources.
May support noninvasive vulnerable plaque detection; hypothesis-generating and requires prospective validation before practice change.
To compare the characteristics of stable and vulnerable carotid plaques, and investigate the diagnostic performance of wall shear stress (WSS) based on magnetic resonance plaque imaging in carotid plaques. Retrospectively analyzed and divided 64 atherosclerotic plaques into stable carotid plaque groups with mild-to-moderate stenosis and vulnerable carotid plaque groups with significant stenosis. Computational fluid dynamics simulations were performed to calculate WSS parameters by using three-dimensional wall geometry based on high-resolution magnetic resonance plaque imaging of carotid bifurcation and patient specific boundary conditions obtained through color Doppler ultrasound. WSS parameters including upstream (WSSup), downstream (WSSdown), and core (WSScore) of plaque. The WSS parameters values were compared between the stable and vulnerable carotid plaque groups. Receiver operating characteristic curves and area under the curve (ROC-AUC) and Python were used to evaluate discriminative efficacy of WSS. WSSdown exhibited significant decrease in the vulnerable carotid plaque group (2.88 ± 0.41 Pa) compared to the stable carotid plaque group (4.47 ± 0.84 Pa) (P = .003). The difference of WSSup (3.28 ± 0.85 Pa vs 4.02 ± 0.74 Pa) and WSScore (1.12 ± 0.18 Pa vs 1.38 ± 0.38 Pa) between the two groups were also pronounced (P = .02, 0.01, respectively). The ROC-AUC values for WSSup, WSSdown, WSScore were 0.75 (95% CI, 0.58-0.93), 0.96 (95% CI, 0.79-1.14), 0.69 (95% CI, 0.56-0.83) respectively. When the value of WSSdown was 3.5 Pa, the sensitivity was 93.7% (95% CI, 76.1-111), specificity and accuracy was 87.5% (95% CI, 70.0-105), 88.4% (95% CI, 70.6-105) respectively. Notably, among these parameters, WSSdown demonstrated the highest discriminative efficiency with a F1 Score of 0.90, Diagnostic Odds Ratio of 105.0 and Matthews Correlation Coefficient of 0.81. Vulnerable carotid plaques with significant stenosis have lower WSS compared to stable plaques with mild-to-moderate stenosis, and downstream WSS showing the highest diagnostic efficacy.
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Liu et al. (2024) conducted a cross-sectional in Carotid atherosclerotic plaques (n=64). Vulnerable carotid plaque with significant stenosis vs. Stable carotid plaque with mild-to-moderate stenosis was evaluated on Discriminative efficacy of downstream wall shear stress (WSSdown) between vulnerable and stable carotid plaques (ROC-AUC 0.96, 95% CI 0.79-1.14, p=0.003). Downstream wall shear stress (WSSdown) was significantly lower in vulnerable carotid plaques compared to stable plaques and demonstrated high diagnostic efficacy with an ROC-AUC of 0.96.
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