Detection of Carotid Artery Plaque Ulceration Using 3-Dimensional Ultrasound

BACKGROUND: Three-dimensional (3D) ultrasound imaging is a new technique that maximizes the information and image quality of traditional 2-dimensional (2D) B-mode scanning. The aim of this study was to evaluate the ability of the 3D ultrasound technique to characterize ulcerated atherosclerotic carotid plaque. METHODS: Using conventional 2D ultrasound, we examined 284 carotid arteries from 142 consecutive patients (101 men and 41 women; average age, 64 years). Eighty-two carotid arteries were symptomatic with atherosclerotic plaque causing 50-99% stenosis. In 62 arteries, the atherosclerotic plaques were visualized completely and were further processed to construct 3D images. Two independent observers rated plaque morphology according to a standardized protocol. RESULTS: The 3D ultrasound showed carotid plaque ulceration more frequently than the 2D method (16.1% and 14.5% of plaques, for observers 1 and 2, respectively, versus 6.5% and 9.7% of plaques, for observers 1 and 2, respectively, P=.125 and P=.063, for observers 1 and 2, respectively). The interobserver reproducibility was very good for both methods (κ=.973, SE=.027, P<.001 for 3D, and κ=.885, SE=.055, P<.001 for 2D), although the 3D method was slightly superior to 2D. CONCLUSIONS: 3D ultrasound reliably characterized the surface morphology of atherosclerotic carotid plaques. A trend of superiority of 3D ultrasound over 2D was found in detecting ulcers of carotid artery plaque.