Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/jvb.2013.038
Jornal Vascular Brasileiro
Original article

Comparacoes preliminares entre a histologia virtual ultrassonografica in vivo e os achados histopatologicos da placa carotidea produto de endarterectomia

Preliminary comparisons between in vivo ultrasonographic virtual histology and histopathological findings of endarterectomized carotid plaque

Fabio Husemann Menezes; Thiago do Carmo Silveira; Sandra Aparecida Ferreira Silveira; Sergio Xavier Salles-Cunha; Konradin Metze; Ana Silvia Carvalho de Menezes

http://dx.doi.org/10.1590/jvb.2013.038 J Vasc Bras, vol.12, n3, p.193-201, 2013
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Resumo

CONTEXTO: A doença aterosclerótica da carótida extracraniana é uma das principais causas evitáveis de acidente vascular cerebral isquêmico (AVCi), sendo este a segunda causa mais comum de morte nos países desenvolvidos. Nos grandes estudos sobre a cirurgia carotídea, a indicação estava embasada fundamentalmente no grau de estenose arterial. Analisar somente o grau de estenose, entretanto, não revela todas as características da placa, na medida em que a morfologia e a composição da placa complementam a avaliação da doença carotídea avançada e são fundamentais para a análise e o acompanhamento da maioria das placas carotídeas tratadas clinicamente. OBJETIVO: Correlacionar a caracterização dos componentes da placa de ateroma pela histologia virtual ultrassonográfica (HVUS) com a histologia. MÉTODOS: As imagens pré-operatórias obtidas por ultrassonografia transcutânea de 12 placas de ateroma de bifurcação carotídea foram submetidas a um programa de computador, o qual correlacionou os níveis de cinza com os prováveis componentes da placa da bifurcação carotídea (HVUS). Estes achados foram correlacionados com o exame anatomopatológico das placas coletadas pela cirurgia de endarterectomia. RESULTADOS: O coeficiente de correlação de Pearson para os conteúdos de lipídeos e músculo/tecido fibroso foram, respectivamente, R=0,83 para gordura e R=0,91 para músculo/tecido fibroso. Quanto ao cálcio e ao sangue, foram R=0,05 e R=0,19, respectivamente. CONCLUSÕES: O presente trabalho corrobora a literatura demonstrando que a histologia virtual computadorizada baseada em ultrassonografia transcutânea apresenta boa correlação com os achados da histologia quanto ao conteúdo da placa. Maiores estudos para a padronização da técnica e o aperfeiçoamento do programa de análise permitirão maior uso clínico deste método.

Palavras-chave

aterosclerose carotidea, histologia, ultrassonografia

Abstract

BACKGROUND: Extracranial carotid artery atherosclerosis is a major preventable cause of strokes, the second most common cause of death in developed countries. The degree of arterial lumen stenosis is the basis for surgical indications, but does not provide information about other plaque aspects. Studies in the literature suggest that the morphological characteristics of the plaque and its composition should also be included in the assessment of this disease. OBJECTIVE: Investigate the correlation between atherosclerotic plaque composition defined by computer-assisted analysis of ultrasound images (virtual histology - USVH) and conventional histology. METHOD: The images of twelve plaques, obtained during preoperative ultrasound scanning, were analyzed by computer, and the grey scale images were correlated with the plaque components and subsequently compared with the histological findings of the analysis of the endarterectomy specimens. RESULTS: The amount of lipids and fibromuscular tissue were strongly correlated in the two tests (R=0.83 and 0.91). There were no significant correlations with amount of blood or calcium (R=0.05 and 0.19). CONCLUSION: This study confirmed the usefulness of noninvasive USVH. Further technical improvements and software developments may promote the clinical application of this method.

Keywords

atherosclerosis, carotid, ultrasound, histology

References

Kwee RM, Van Oostenbrugge RJ, Hofstra L. Indentifying vulnerable carotid plaques by noninvasive imaging. Neurology. ;70:2401-409.

U-King-Im JM, Young V, Gillard JH. Carotid-artery imaging in the diagnosis and management of patients at risk of stroke. Lancet Neurol. ;8:569-80.

Hermus L, Van Dam GM, Zeebregts CJ. Advanced carotid plaque imaging. Eur J Vasc Endovasc Sug. ;39:125-33.

Baroncini LAV, Pazin A Fº, Junior >LOM. Ultrasonic tissue characterization of vulnerable carotid plaque: correlation between video densitometric method and histological examination. Cardiovasc Ultrasound. ;4:32-2.

Swinjndregt ADM, Elbers HRJ, Moll FL, Letter J, Ackerstaff RGA. Ultrasonographic characterization of carotid plaques. Ultrasound Med Biol. ;24(4):489-93.

Gao T, Zhang Z, Yu W, Zhang Z, Wang Y. Atherosclerotic carotid vulnerable plaques and subsequent stroke: a high-resolution MRI study. Cerebrovasc Dis. ;27:345-52.

Malgor RD, Wood EA, Lavarone OA, Labropoulos N. Stratifying risk: asymptomatic carotid disease. J Vasc Bras. ;11(1):43-52.

Endarterectomy for Asymptomatic Carotid Artery Stenosis. JAMA. ;273:1421-428.

Barnett HJM, Taylor DW, Eliasziw M. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med. ;339:415-25.

Randomised trial of endarterectomy of recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. ;351:1379-387.

Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. ;363:1491-502.

Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG. The carotid revascularization endarterectomy versus stenting trial (CREST). Stroke. ;41:S31-S34.

JK Lovett, JNE Redgrave, PM Rothwell. A critical appraisal of the performance, reporting, and interpretation of studies comparing carotid plaque imaging with histology. Stroke. ;36:1085-091.

Wintermark M, Jawadi SS, Rapp JH. High-resolution CT imaging of carotid artery atherosclerotic plaques. Am J Neuroradiol. ;29:875-82.

Farooq MU, Khasnis A, Majid A, Kassab MY. The role of optical coherence tomography in vascular medicine. Vasc Med. ;14:63-71.

Sakalihasan N, Michel JB. Functional imaging of atherosclerosis to advance vascular biology. Eur J Vasc Endovasc Sug. ;37:728-34.

Gao P, Chen ZQ, Bao YH, Jiao LQ, Ling F. Correlation between carotid intraplaque hemorrhage and clinical symptoms: systematic review of observational studies. Stroke. ;38:2382-390.

EI-Barghouty N, Geroulakos G, Nicolaides A, Androulakis A, Bahai Nicolaides V. Computer-Assisted Carotid Plaque Characterisation. Eur J Vasc Endovasc Surg. ;9:389-95.

Grønholdt MLM, Nordestgaard BG, Schroeder TV, Vorstrup S, Sillensen H. Ultrasonic Echolucent Carotid Plaques Predict Future Strokes. Circulation. ;104:68-3.

Lal BK, Hobson RW, Pappas PJ. Pixel distribution analysis of B-mode ultrasound scan images predicts histologic features of atherosclerotic carotid plaques. J Vasc Surg. ;35:1210-217.

Menezes FH, Luccas GC, Matsui I, Santos ACOQ, Silveira SAF. Avaliação através da ultra-sonografia duplex de reestenose da carótida interna dos pacientes submetidos à endarterectomia aberta de bifurcação carotídea, com eversão parcial da carótida interna. J Vasc Br. ;4(1):47-4.

Tan TW, Weyman AK, Barkhordarian S, Patterson RB. Single center experience with modified eversion carotid endarterectomy. Ann Vasc Surg. ;25:87-93.

García-García HM, Gogas BD, Serruys PW, Bruining N. IVUS-based imaging modalities for tissue characterization: similarities and differences. Int J Cardiovasc Imaging. ;27(2):215-24.

Mathiesen EB, Bønaa KH, Joakimsen O. Echolucent Plaques Are Associated With High Risk of Ischemic Cerebrovascular Events in Carotid Stenosis : The Tromsø Study. Circulation. ;103:2171-175.

Pedro LM, Fernandes JF, Pedro MM. Ultrasonographic Risk Score of Carotid Plaques. Eur J Vasc Endovasc Surg. ;24:492-98.

Biasi GM, Froio A, Diethrich EB. Carotid plaque echolucency increases the risk of stroke in carotid stenting. The Imaging In Carotid Angioplasty And Risk Of Stroke (ICAROS) study. Circulation. ;110:756-62.

Kakkos SK, Stevens JM, Nicolaides AM. Texture analysis of ultrasonic images of symptomatic carotid plaques can identify those plaques associated with ipsilateral embolic brain infarction. Eur J Vasc Endovasc Surg. ;33:422-29.

Russell DA, Wijeyaratne SM, Gough MJ. Changes in carotid plaque echomorphology with time since a neurologic event. J Vasc Surg. ;45:367-72.

Mathiesen EB, Johnsen SH, Wilsgaard T, Bønaa KH, Løchen ML, Njølstad I. Carotid plaque area and intima-media thickness in prediction of first-ever ischemic Sstroke: A 10-year follow-up of 6584 men and women: The Tromsø Study. Stroke. ;42:972-78.

Gray-Weale AC, Graham JC, Burnett JR. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg. ;29:676-81.

Cassou-Birckholz MF, Engelhorn CA, Salles-Cunha SX. Assessment of deep venous thrombosis by grayscale median analysis of ultrasound images. Ultrasound Q. ;27(1):55-61.

Valiente Engelhorn AL, Engelhorn CA, Salles-Cunha SX, Ehlert R, Akiyoshi FK, Assad KW. Ultrasound tissue characterization of the normal kidney. Ultrasound Q. ;28(4):275-80.

Salles Cunha SX. Inovação. Nota técnica: avaliação de aneurismas da aorta tratados com endopróteses. J Vasc Bras. ;11(2):150-53.

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