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(Circulation. 2000;102:766.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Quantitative Ultrasonic Tissue Characterization Can Identify High-Risk Atherosclerotic Alteration in Human Carotid Arteries

Shin Takiuchi, MD; Hiromi Rakugi, MD; Katsuya Honda, MD; Tohru Masuyama, MD; Nobuaki Hirata, MD; Hiroshi Ito, MD; Ken Sugimoto, MD; Yoshihiro Yanagitani, MD; Koichi Moriguchi, MD; Atsunori Okamura, MD; Jitsuo Higaki, MD; Toshio Ogihara, MD

From the Department of Geriatric Medicine (S.T., H.R., Y.Y., K.M., A.O., J.H., T.O.), Division of Legal Medicine (K.H.), Department of Internal Medicine and Therapeutics (T.M.), and Department of Surgery, Course of Interventional Medicine (N.H.), Osaka University Graduate School of Medicine, Suita, Japan; and Division of Cardiology (H.I., K.S.), Sakurabashi Watanabe Hospital, Osaka, Japan.

Correspondence to Jitsuo Higaki, MD, Department of Geriatric Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. E-mail higaki{at}geriat.med.osaka-u.ac.jp

Background—Recently, ultrasonic tissue characterization of the composition of plaques has been performed in a quantitative fashion on the basis of integrated backscatter (IBS) analysis, but most of those studies have used high-frequency ultrasound to obtain microscopic images.

Methods and Results—We performed B-mode measurement and IBS signal analysis with acoustic densitometry with a 7.5-MHz linear-array transducer in freshly excised human aortas (n=58) (normal, atheromatous, and fibrous tissue) obtained at autopsy. Atheromatous and fibrous tissue had a similar intima-media thickness (IMT), but the IBS value in atheromatous specimens was lower than that in fibrous specimens. We further applied this method to human carotid ultrasonography. The subjects were young (80 regions), middle aged with 1 or no coronary risk factors (low risk) (120 regions), middle aged with 2 coronary risk factors (high risk) (240 regions), or elderly (80 regions) or were patients with myocardial infarction (MI) with multivessel disease (90 regions). The IMT was similar in middle-aged, elderly, and MI subjects. In contrast, the IBS value was significantly higher in elderly subjects and lower in high-risk middle-aged and MI subjects compared with that in low-risk middle-aged subjects. The percent of regions diagnosed as atheromatous (IBS less than mean minus 2-SD value of IBS in young subjects) was 11% in low-risk middle-aged subjects, 29% in high-risk middle-aged subjects, and 63% in the MI group.

Conclusions—In conjunction with conventional B-mode imaging, IBS analysis with carotid ultrasonography appeared to provide prognostic information to identify a high-risk group with systemic atherosclerosis, which could lead to coronary heart disease in individuals with early-stage disease.

Key Words: atherosclerosis • ultrasonics • plaque • arteries • myocardial infarction

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