The Value of Multimodal Ultrasonic Scoring System in the Diagnosis of Carotid Vulnerable Plaque

Background and Aims Vulnerable plaques are closely related to ischemic stroke. To investigate the diagnostic value of multimodal plaque vulnerability ultrasound scoring system (PV‐USS) using histopathology as the gold standard. Methods A total of 45 subjects who would be underwent carotid endarterectomy were recruited. The postoperative specimens were examined by histopathology. All responsible plaques were scanned dynamically in multiple sections by carotid ultrasound to measure maximum thickness and lumen stenotic degree, as well as, the echo, homogeneity, surface morphology, and echo type were observed. The above two‐dimensional (2D) ultrasonic features were systematically scored, that is, PV‐USS 2D . Combined with contrast‐enhanced ultrasonography (CEUS), neovascularization grade in plaque was scored, which is PV‐USS 2D+CEUS . Results According to the pathological results, 45 subjects were divided into vulnerable plaque group (27 cases, 60%) and non‐vulnerable plaque group (18 cases, 40%). PV‐USS 2D and PV‐USS 2D+CEUS in vulnerable plaque group were higher than those in non‐vulnerable plaque group (PV‐USS 2D : 9.44 ± 2.10 vs 7.22 ± 1.73; PV‐USS 2D+CEUS: 12.37 ± 2.10 vs 8.28 ± 1.81, P < .001). ROC curve analysis showed that the AUC of PV‐USS 2D and PV‐USS CEUS was 0.783 and 0.929, respectively ( P < .001). The best cutoff values of PV‐USS 2D and PV‐USS 2D+CEUS were, respectively, 9.5 (the maximum Youden index was 0.425, the sensitivity was 48.1%, the specificity was 94.4%) and 10.5 (the maximum Youden index was 0.667, the sensitivity was 77.8%, the specificity was 88.9%). Conclusions Ultrasound scoring system may be used as an effective method to evaluate the vulnerability of plaque. The diagnostic efficiency of PV‐USS 2D+CEUS is more higher than PV‐USS 2D .