Key result
Combining ultrasound-derived echolucent plaque proportion with CT-derived volumetric heterogeneity yielded an AUC of 0.83 for discriminating symptomatic from asymptomatic carotid stenosis, compared to 0.76 for ultrasound alone (p=0.062).
Why the study?
Whether ultrasound plaque features are associated with symptomatic carotid plaques and whether combining them with computed tomography parameters improves diagnostic accuracy remained to be evaluated.
Does multimodal ultrasound and computed tomography imaging improve diagnostic discrimination between symptomatic and asymptomatic patients with carotid stenosis?
Cohort (n=188)
No
Does multimodal ultrasound and computed tomography imaging improve diagnostic discrimination between symptomatic and asymptomatic patients with carotid stenosis?
Combining ultrasound and CT imaging features may improve the identification of symptomatic carotid plaques, potentially aiding in risk stratification before endarterectomy.
Answers are grounded in this paper and cite their sources.
Combined US-CT plaque metrics may aid symptomatic carotid identification; hypothesis-generating and requires prospective validation before clinical adoption.
Study objective: To evaluate whether ultrasound (US) plaque features are associated with plaques from symptomatic patients and whether the combination with computed tomography (CT) parameters improves diagnostic accuracy. Design: Single-center prospective cohort study. Setting: Tertiary academic center for cardiovascular medicine in Germany. Participants: 188 patients who underwent carotid endarterectomy (CEA) with 156 receiving US and 152 receiving CT. Interventions: US assessment of plaque echogenicity, heterogeneity, calcification, discrete white areas, juxtaluminal echolucency. CT assessment of calcified plaque volume and heterogeneity. Multimodal combination of US and CT parameters. Main outcome measures: Comparison of plaque features between patients with symptomatic and asymptomatic carotid stenosis. Diagnostic performance using logistic regression, receiver operating characteristic (ROC) curve analysis and area under the curve (AUC). Results: Patients with symptomatic carotid stenosis had lower echogenicity (plaque with gray-scale (GS) <25: 61.6 ± 35.9% vs. 30.9 ± 27.4%, P < 0.001), greater US heterogeneity (coefficient of variation (CV): 1.20 ± 0.54 vs. 0.82 ± 0.48, P < 0.001), and more juxtaluminal echolucency (23.2% vs. 3.0%, P < 0.001). Plaque with GS <25 achieved an AUC of 0.76 (95% confidence interval, 0.68–0.84). Combining this US measure with CT-derived heterogeneity yielded a higher AUC of 0.83 (0.74–0.92), P = 0.062, with 80.0% sensitivity and 82.0% specificity. Conclusions: US identifies patients with symptomatic carotid stenosis via echogenicity, heterogeneity, and qualitative features. Combining US with CT may improve diagnostic accuracy and warrants further validation. Multimodal plaque imaging should be evaluated concerning prospective stroke risk to assess its role in risk stratification before CEA.
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Stemmler et al. (2026) conducted a cohort in Carotid stenosis (n=188). Multimodal ultrasound and computed tomography imaging vs. Unimodal ultrasound imaging was evaluated on Diagnostic discrimination (AUC) between symptomatic and asymptomatic carotid stenosis (AUC 0.83, 95% CI 0.74-0.92, p=0.062). Combining ultrasound-derived echolucent plaque proportion with CT-derived volumetric heterogeneity yielded an AUC of 0.83 for discriminating symptomatic from asymptomatic carotid stenosis, compared to 0.76 for ultrasound alone (p=0.062).
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