Imaging of plaque perfusion using contrast-enhanced ultrasound – Clinical significance

SummaryThe identification of vulnerable and unstable carotid atherosclerotic lesions is up-to-date an important topic of research, in order to adopt the adequate strategy for preventing cerebrovascular events. Plaque inflammation, presence of adventitial vasa vasorum, intimal angiogenesis and plaque neovascularization have been identified in histological studies as indicators of the instability of the atheroma of carotid arteries in cerebrovascular patients and of coronary arteries in cardiovascular patents. Consequently, the identification “in vivo” of these pathophysiological aspects has been objective for the development of new imaging techniques. Ultrasound of carotid arteries, with ultrasound contrast agents, is not only able to provide an enhanced visualization of the arterial lumen and plaque morphology, but also allows to directly visualize adventitial vasa-vasorum and carotid plaque neovascularization. This technique and its clinical implications in the unstable plaque identification are discussed in the present paper.