Juxtaluminal hypoechoic area in ultrasonic images of carotid plaques and hemispheric symptoms
AuthorGriffin, Maura B.
Kyriacou, Efthyvoulos C.
Pattichis, Constantinos S.
Kakkos, Stavros K.
Doré, C. J.
Nicolaïdes, Andrew N.
SourceJournal of Vascular Surgery
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Objectives: The aim was to determine the diagnostic value of a juxtaluminal black (hypoechoic) area without a visible echogenic cap (JBA) in ultrasonic images of internal carotid artery plaques. Methods: Ultrasonic images of plaques from 324 patients with asymptomatic (n = 139) and symptomatic (n = 185) internal carotid 50% to 99% stenosis in relation to the bulb (European Carotid Surgery Trial) referred for duplex scanning were studied. The JBA in mm2 and the gray-scale median (GSM) were obtained after image normalization. Cut-off points for GSM and JBA (combined highest sensitivity with highest specificity) were determined from receiver operator characteristic (ROC) curves. Results: JBA ≥ 8 mm2 was associated with a high prevalence of symptomatic plaques in all grades of stenosis. In a multiple logistic regression model, increasing stenosis (mild, moderate, severe), GSM ≤ 15 and JBA ≥ 8 mm2 were independent predictors of the presence of hemispheric symptoms. This model could identify a high-risk group of 188 plaques that contained 142 (77%) of the 185 symptomatic plaques (odds ratio [OR], 6.795% confidence interval [CI], 4.08-10.91), (P < .001), (sensitivity: 77%specificity 66%positive predictive value 75%negative predictive value 68%). Conclusions: The results of this study indicate the diagnostic value and for the first time suggest a cut-off point of 8 mm2 for JBA. This cut-off point needs to be validated in other groups and then applied to prospective studies of asymptomatic patients. © 2010 Society for Vascular Surgery.
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