Korean J Radiol.  2018 Feb;19(1):15-22. 10.3348/kjr.2018.19.1.15.

Carotid Plaque Stiffness Measured with Supersonic Shear Imaging and Its Correlation with Serum Homocysteine Level in Ischemic Stroke Patients

• Shang J
• Wang W
• Feng J
• Luo GG
• Dang Y
• Sun J
• Yang YQ
• Ruan LT

• KMID: 2425104
• DOI: http://doi.org/10.3348/kjr.2018.19.1.15

Abstract

OBJECTIVE
To ascertain the feasibility of using shear wave velocity (SWV) in assessing the stiffness of carotid plaque by supersonic shear imaging (SSI) and explore preliminary clinical value for such evaluation.
MATERIALS AND METHODS
Supersonic shear imaging was performed in 142 patients with ischemic stroke, including 76 males and 66 females with mean age of 66 years (range, 45-80 years). The maximum, minimum, and mean values of SWV were measured for 129 carotid plaques. SWVs were compared between echolucent and echogenic plaques. Correlations between SWVs and serum homocysteine levels were investigated. Based on neurological symptom, the surrogate marker of vulnerable plaque (VP), binary logistic regression was performed and area under curve (AUC) of homocysteine only and homocysteine combing SWVmean was calculated respectively.
RESULTS
Echogenic plaques (n = 51) had higher SWVs than echolucent ones (n = 78) (SWVmin 3.91 [3.24-4.17] m/s vs. 1.51 [1.04-1.94] m/s; SWVmean, 4.29 [3.98-4.57] m/s vs. 2.09 [1.69-2.41] m/s; SWVmax, 4.67 [4.33-4.86] m/s vs. 2.62 [2.32-3.31] m/s all p values < 0.01). Pearson correlation analysis showed that stiffness of plaques was negatively correlated with homocysteine level. R values for SWVmin, SWVmean, and SWVmax were −0.205, −0.213, and −0.199, respectively. Binary logistic regression analysis showed that sex (p = 0.008), low-density lipoprotein (p = 0.015), triglycerides (p = 0.011), SWVmean (p = 0.004), and hyper-homocysteinemia (p = 0.010) were significantly associated with symptomatic ischemic stroke. Receiver operating characteristic curves revealed that SWVmean combing serum homocysteine level (AUC = 0.67) presented better diagnostic value than serum homocysteine only (AUC = 0.60) for symptomatic ischemic stroke.
CONCLUSION
Supersonic shear imaging could be used to quantitatively evaluate stiffness of both echolucent and echogenic carotid plaques. More importantly, SWVs of plaques were not only correlated to serum homocysteine level, but also associated with symptomatic ischemic stroke, suggesting that SSI might be useful for understanding more about VP.

Keyword

Ultrasonic elastography; Carotid plaque; Stiffness; Shear wave velocity (SWV); Homocysteine; Ischemic stroke

MeSH Terms

Area Under Curve
Biomarkers
Female
Homocysteine*
Humans
Lipoproteins
Logistic Models
Male
ROC Curve
Stroke*
Triglycerides
Biomarkers
Homocysteine
Lipoproteins
Triglycerides

Figure

• 

  Fig. 1 SWVs measurements for echogenic and echolucent carotid plaques.A. Maximum, mean, and minimum SWV for echogenic plaque on posterior wall of carotid artery was 5.64, 5.26, and 4.03 m/s, respectively. B. Maximum, mean, and minimum SWV for echolucent plaque on anterior wall of carotid artery was 3.59, 2.24, and 1.19 m/s, respectively. SWV = shear wave velocity

• 

  Fig. 2 Pearson correlation analyses between carotid plaque SWVs and serum homocysteine levels.A. Correlation between hcy and SWVmin. B. Correlation between hcy and SWVmean. C. Correlation between hcy and SWVmax. hcy = homocysteinemia

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