A Study on the Value of Ultrasound Imaging Features in Predicting Intraplaque Hemorrhage in Carotid Arteries.

Purpose: This study evaluated the predictive value of ultrasound imaging features for intraplaque hemorrhage (IPH) in carotid atherosclerotic plaques, using high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) as the gold standard.

Materials and methods: This prospective study assessed 70 carotid plaques from 56 patients who underwent conventional ultrasound, contrast-enhanced ultrasound (CEUS), and high-resolution magnetic resonance vessel wall imaging (HRMR-VWI). Ultrasound features, including plaque echogenicity (PE), plaque ulceration (PU), juxtaluminal black area (JBA), normalized wall index (NWI), and lumen stenosis rate (LSR), among others, were systematically recorded. Logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to evaluate the diagnostic and predictive value of these features for IPH.

Results: PU, JBA, and NWI were identified as independent risk factors for intraplaque hemorrhage (IPH), with odds ratios (ORs) of 7.43 (95% CI: 2.15-25.67, p = 0.002), 4.90 (95% CI: 1.42-16.92, p = 0.012), and 2.55 (95% CI: 1.19-5.45, p = 0.016), respectively. Among individual predictors, NWI showed the highest diagnostic performance, with an area under the curve (AUC) of 0.78 (95% CI: 0.67-0.89). A combined diagnostic model incorporating PU, JBA, and NWI significantly improved performance, achieving an AUC of 0.86 (95% CI: 0.77-0.95), a sensitivity of 81.82%, and a specificity of 78.38%.

Conclusion: Ultrasound imaging features, particularly PU, JBA, and NWI, are valuable predictors of IPH in carotid atherosclerotic plaques. Combined analysis of these features significantly enhances diagnostic accuracy. These findings underscore the potential of ultrasound as a cost-effective, noninvasive modality for early IPH detection and stroke risk assessment.