Current status and advances in ultrasound evaluation of neovascularization within carotid artery plaques: a systematic review

Abstract

Vulnerable plaques are significant risk factors for acute ischemic events, and intraplaque neovascularization (IPN) is an important indicator for evaluating plaque vulnerability. This review summarizes the importance of IPN in the assessment of carotid plaque vulnerability, the current status of ultrasound examination of IPN, and the technical advancements in ultrasound imaging of IPN, These techniques include: Superb micro-vascular imaging; Contrast-enhanced ultrasound; Plane wave ultra-sensitive blood flow imaging; Ultrasound-targeted microbubble destruction; Ultrasound Super-Resolution Imaging. Aiming to provide a reference for the prevention and treatment of ischemic cardiovascular and cerebrovascular events.

Keywords: Contrast-enhanced ultrasound (CEUS); Intraplaque neovascularization (IPN); Plane wave ultra-sensitive blood flow imaging (Angio PLUS); Superb micro-vascular imaging (SMI); Ultrasound super-resolution imaging (SRI); Ultrasound-targeted microbubble destruction (UTMD).

Fig. 1

4 Category Classification of IPN by SMI. The 4-category Classification of IPN by SMI is illustrated as follows: a: Grade 0: No blood flow signal within the plaque. b: Grade 1: One or several punctate blood vessels visible within the plaque (indicated by arrows); c: Grade 2: Punctate blood vessels and 1–2 linear blood vessels detected (indicated by arrows); d: Grade 3: Multiple linear blood vessels visible within the plaque, with most penetrating through the plaque (indicated by arrows)

Fig. 2

Four-Category Classification of IPN Enhancement on CEUS