Can ultrasound confirm atherosclerosis (hardening of the arteries)?

From the Guidelines

Yes, ultrasound can confirm atherosclerosis, as it is a non-invasive and effective method for detecting atherosclerotic plaque in the carotid arteries, measuring intima-media thickness (IMT), and assessing the degree of stenosis. Carotid ultrasound is particularly useful for identifying plaque characteristics, including size, composition, and surface features, which help determine stroke risk 1. The procedure uses high-frequency sound waves to create images of the arteries and can detect differences in tissue density, allowing visualization of plaque buildup along arterial walls.

Key Points

• Carotid ultrasound is a non-invasive, painless procedure that uses high-frequency sound waves to create images of the arteries.
• It can detect atherosclerotic plaque, measure intima-media thickness (IMT), and assess the degree of stenosis.
• Ultrasound can identify plaque characteristics, including size, composition, and surface features, which help determine stroke risk.
• The procedure typically takes 15-30 minutes and requires no special preparation.
• Carotid ultrasound is an excellent first-line diagnostic tool for atherosclerosis, and it can also be used to detect atherosclerosis in other vessels like the femoral, brachial, and aortic arteries.

Indications for Carotid Ultrasound

• Cervical bruit in an asymptomatic patient
• Follow-up of known stenosis (>50%) in asymptomatic individuals
• Vascular assessment in a patient with multiple risk factors for atherosclerosis
• Stroke risk assessment in a patient with CAD or PAD
• Amaurosis fugax
• Hemispheric TIA
• Stroke in a candidate for carotid revascularization
• Follow-up after a carotid revascularization procedure
• Intraoperative assessment during CEA or stenting

Limitations and Considerations

• The quality of images produced by carotid ultrasound can differ from one institution to another.
• No single imaging modality can be recommended as uniformly superior.
• Correlation of findings obtained by multiple modalities should be part of a program of quality assurance in every laboratory and institution.
• Catheter-based angiography may be necessary in some cases for definitive diagnosis or to resolve discordance between noninvasive imaging findings 1.

From the Research

Ultrasound Diagnosis of Atherosclerosis

• Ultrasound methods, including bright (B)-mode US and Doppler mode, can provide a rapid and cost-efficient way to visualize established plaques and give a rapid risk stratification of the patient 2.
• The measurement of carotid intima-media thickness (C-IMT) may prove useful in identifying subclinical atherosclerosis, although its usefulness is rather disputed 2.
• Contrast-enhanced ultrasonography (CEUS) allows for better image resolution and the visualization and quantification of plaque neovascularization, which has been correlated with future cardiovascular events 2.
• Elastography techniques, such as strain elastography and shear-wave elastography, add a new dimension to the evaluation of atherosclerosis by assessing the biomechanics of the arterial wall 2.

Peripheral Atherosclerosis Evaluation

• Ultrasound examination of peripheral arteries, especially superficial vessels such as the femoral arteries, is quite easy, quick, and accurate 3.
• The staging of subclinical atherosclerosis may help in further clinical decisions, and ultrasound is a promising examination that should find wider application in clinical practice 3.
• The latest ESC guidelines emphasize the usefulness of carotid ultrasound in the diagnosis of coronary artery disease (CAD) and subclinical assessment of atherosclerosis 3.

Carotid and Femoral Atherosclerotic Lesions

• Clinically evident atherosclerosis is preceded by preclinical changes in the arterial wall, characterized by increased thickness of the intima-media complex (IMT) 4.
• A complex ultrasound assessment of the peripheral vessels can be used as part of the cardiovascular risk stratification 4.
• Significantly higher values of the IMT in the peripheral arteries were observed in patients with coronary artery lesions than in those without 4.

Subclinical Atherosclerosis Imaging

• Subclinical atherosclerosis imaging leverages the long latency period of clinical atherosclerotic cardiovascular disease (ASCVD) to estimate and improve future ASCVD risk 5.
• Carotid intima-media thickness and ankle-brachial index are other modalities whose predictive value becomes incremental when added to traditional risk models 5.
• Coronary artery calcium (CAC) scoring has the most robust data in the detection of subclinical atherosclerosis 5.

Association of Carotid Artery Parameters

• Although carotid intima-media thickness (IMT) is the most commonly used ultrasonic measurement of atherosclerosis, plaque burden can be also assessed by ultrasound (US) 6.
• Total plaque area (TPA) and total plaque volume (TPV) showed significant positive correlation with CAD severity 6.
• Multivariate linear regression analysis showed that age was the only significant attributor to IMT, TPA, and TPV 6.