Original Articles| Volume 12, ISSUE 2, P59-65, March 2003

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Evaluation of B-mode ultrasonographic images of carotid lesions by computer analysis as compared with visual assessment


      To establish an objective method for evaluating the characteristics of carotid artery lesions by B-mode ultrasonography, we compared the reproducibility of computer analysis with that of visual evaluation. Using two different models of ultrasonograph, we evaluated B-mode ultrasonographic images of 100 carotid artery lesions in a blinded fashion by computer analysis and visual evaluation, two times at a 1-month interval. Another 35 lesions were simultaneously imaged by the two models of ultrasonograph and were evaluated visually and by computer analysis to examine the correlation between results. For visual evaluation, carotid artery lesions were divided into the following 3 types based on texture and relative echogenicity as compared with that of adjacent muscle tissue: heterogeneous, hypoechoic, and hyperechoic. For computer analysis, images were computerized by means of a scanner (using Adobe Photoshop software). The echogenicity of all pixels included in the lesion and adjacent areas of muscular tissue was measured, and the lesion was classified into the following 3 types based on the shape of histograms of echogenicity: mixed- echoic (M), hyperechoic (H), and lucent (L). The reproducibility of the results derived by computer analysis had a significantly higher coincidence coefficient (κ = 0.89) than those derived by visual evaluation (κ =0.68). The coincidence coefficient (κ) of the same lesions depicted by two different models of equipment was 0.77 for computer analysis as compared with only 0.32 for visual evaluation. These findings indicate that computer analysis of histogram shape and lesion echogenicity can improve intra-sonographer and inter-equipment reproducibility in the evaluation of lesion echogenicity and texture. Copyright © 2003 by National Stroke Association


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        • Widder B
        • Paulat K
        • Hackspacher J
        • et al.
        Morphological characterization of carotid artery stenoses by ultrasound duplex scanning.
        Ultrasound Med Biol. 1990; 16: 349-354
        • Geroulakos G
        • Domjan J
        • Nicolaides A
        • et al.
        Ultrasonic carotid artery plaque structure and the risk of cerebral infarction on computed tomography.
        J Vasc Surg. 1994; 20: 263-266
        • Feeley TM
        • Leen EJ
        • Colgan MP
        • et al.
        Histologic characteristics of carotid artery plaque.
        J Vasc Surg. 1991; 13: 719-724
        • Kagawa R
        • Moritake K
        • Shima T
        • et al.
        Validity of B-mode ultrasonographic findings in patients undergoing carotid endarterectomy in comparison with angiographic and clinicopathologic features.
        Stroke. 1996; 27: 700-705
        • Reilly LM
        • Lusby RJ
        • Hughes L
        • et al.
        Carotid plaque histology using real-time ultrasonography: Clinical and therapeutic implications.
        Am J Surg. 1983; 146: 188-193
        • O'Donnell Jr, TF
        • Erdoes L
        • Mackey WC
        • et al.
        Correlation of B-mode ultrasound imaging and arteriography with pathologic findings at carotid endarterectomy.
        Arch Surg. 1985; 120: 443-449
        • Ratliff DA
        • Gallagher PJ
        • Hames TK
        • et al.
        Characterisation of carotid artery: Comparison of duplex scanning with histology.
        Ultrasound Med Biol. 1985; 11: 835-840
        • Gray-Weale AC
        • Graham JC
        • Bumett JR
        • et al.
        Carotid artery atheroma: Comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology.
        J Cardiovasc Surg. 1988; 29: 676-681
        • Goes E
        • Janssens W
        • Maillet B
        • et al.
        Tissue characterization of atheromatous plaques: Correlation between ultrasound image and histological findings.
        J Clin Ultrasound. 1990; 18: 611-617
        • European Carotid Plaque Study Group
        Carotid artery plaque composition -Relationship to clinical presentation and ultrasound B-mode imaging.
        Eur J Vasc Endovasc Surg. 1995; 10: 23-30
        • Lammie GA
        • Wardlaw J
        • Allan P
        • et al.
        What pathological components indicate carotid athemma activity and can these be identified reliably using ultrasound?.
        Eur J Ultrasound. 2000; 11: 77-86
        • van Swijndregt ADM
        • Elbers HRJ
        • Moll FL
        • et al.
        Ultrasonographic characterization of carotid plaques.
        Ultrasound Med Biol. 1998; 24: 489-493
        • Sabetai MM
        • Tegos TJ
        • Nicolaides AN
        • et al.
        Reproducibility of computer-quantified carotid plaque echogenicity: Can we overcome the subjectivity?.
        Stroke. 2000; 31: 2189-2196
        • Iwamoto T
        • Enomoto M
        • Okada T
        • et al.
        Interrater reliability for clinical diagnoses of extracranial carotid plaques using B-mode ultrasonography (abstract in English).
        Zasshi Tokyo Ika Daigaku (Japan). 1995; 53: 637-643
        • Arnold JAC
        • Modaresi KB
        • Thomas N
        • et al.
        Carotid plaque characterization by duplex scanning: observer error may undetermine currem clinical trials.
        Stroke. 1999; 30: 61-65
        • deBray JM
        • Baud JM
        • Dauzat M
        Consensus concerning the morphology and the risk of carotid plaques.
        Cerebrovasc Dis. 1997; 7: 289-296
        • deBray JM
        • Baud JM
        • Delanoy P
        • et al.
        Reproducibility in ultrasonic characterization of carotid plaques.
        Cerebrovasc Dis. 1998; 8: 273-277
        • El-Barghouty N
        • Geroulakos G
        • Nicolaides A
        • et al.
        Computer-assisted carotid plaque characterisation.
        Eur J Vasc Endovasc Surg. 1995; 9: 389-393
        • Aly S
        • Bishop CC
        An objective characterization of athemsclemtic lesion: An altemative method to identify unstable plaque.
        Stroke. 2000; 31: 1921-1934
        • El-Barghouty N
        • Nicolaides A
        • Bahal V
        • et al.
        The identification of the high risk carotid plaque.
        Eur J Vasc Endovasc Surg. 1996; 11: 470-478
        • Beletsky VY
        • Kelley RE
        • Fowler M
        • et al.
        Ultrasound densitometric analysis of carotid plaque composition: pathoanatomic correlation.
        Stroke. 1996; 27: 2173-2177
        • Wilhjelm JE
        • Gronholdt MLM
        • Wiebe B
        • et al.
        Quantitative analysis of ultrasound B-mode images of carotid atherosclerotic plaque: Correlation with visual classification and histological examination.
        IEEE Trans Med Imaging. 1998; 17: 910-922
        • Biasi GM
        • Sampaolo A
        • Mingazzini P
        • et al.
        Computer analysis of ultrasonic plaque echolucency in identifying high risk carotid bifurcation lesions.
        Eur J Vasc Endovasc Surg. 1999; 17: 476-479
        • Elatrozy T
        • Nicolaides A
        • Tegos T
        • et al.
        The effect of B-mode ultrasonic image standardisation on the echodensity of symptomatic and asymptomatic carotid bifurcation plaques.
        Int Angiol. 1998; 17: 179-186
        • Tegos TJ
        • Sabetai MM
        • Nicolaides AN
        • et al.
        Comparability of the ultrasonic tissue characteristics of carotid plaques.
        J Ultrasound Med. 2000; 19: 399-407
        • Iwamoto T
        • Shinozaki K
        • Miyaji Y
        • et al.
        Comparison of computer-analyzed B-mode ultrasonographic images of carotid lesions with histology of endarterectomy specimen (abstract in English).
        Neurosonology. 2002; 15: 70-75