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Title: Computer-assisted ultrasound assessment of plaque characteristics in radiation-induced and non-radiation-induced carotid atherosclerosis
Authors: Li, YX 
Kwong, DLW
Wu, VWC 
Yip, SP 
Law, HKW 
Lee, SWY 
Ying, MTC 
Issue Date: Jun-2021
Source: Quantitative imaging in medicine and surgery, June 2021, v. 11, no. 6, p. 2292-2306
Abstract: Background: This study investigated the feasibility of using a computer-assisted method to evaluate and differentiate the carotid plaque characteristics in radiation-induced and non-radiation-induced carotid atherosclerosis.
Methods: This study included 107 post-radiotherapy (post-RT) nasopharyngeal carcinoma (NPC) patients and 110 subjects with cardiovascular risk factors (CVRFs). Each participant had a carotid ultrasound examination, and carotid plaques and carotid intima-media thickness (CIMT) were evaluated with grey scale ultrasound. The carotid plaque characteristics were evaluated for grey-scale median (GSM) and detailed plaque texture analysis (DPTA) using specific computer software. In DPTA, five different intra-plaque components were colour-coded according to different grey scale ranges. A multivariate linear regression model was used to evaluate the correlation of risk factors and carotid plaque characteristics.
Results: Post-RT NPC patients have significantly higher CIMT (748 +/- 15.1 mu m, P=0.001), more patients had a plaque formation (80.4%, P<0.001) and more plaque locations (2.3 +/- 0.2, P<0.001) than CVRF subjects (680.4 +/- 10.0 mu m, 38.2% and 0.5 +/- 0.1 respectively). Among the five intra-plaque components, radiationinduced carotid plaques had significantly larger area of calcification (4.8%+/- 7.7%, P=0.012), but lesser area of lipid (42.1%+/- 16.9%, P=0.034) when compared to non-radiation-induced carotid plaques (3.0%+/- 5.7% and 46.3%+/- 17.9% respectively). Age, radiation and number of CVRF were significantly associated with the carotid atherosclerosis burden (P<0.001). Besides, age was significantly associated with the amount of lipid and calcification within carotid plaques (P<0.001).
Conclusions: Radiation caused more severe carotid artery disease than CVRF with larger CIMT and more prevalent of carotid plaque. Radiation-induced carotid plaques tended to have more intra-plaque calcifications, whereas non-radiation-induced carotid plaques had more lipids. Ultrasound aided by computer-assisted image analysis has potential for more accurate assessment of carotid atherosclerosis.
Keywords: Atherosclerotic plaque
Carotid atherosclerosis
Radiation effects
Publisher: AME Publishing Company
Journal: Quantitative imaging in medicine and surgery 
ISSN: 2223-4292
EISSN: 2223-4306
DOI: 10.21037/qims-20-1012
Rights: © Quantitative Imaging in Medicine and Surgery. All rights reserved.
This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See:
The following publication Li Y, Kwong DLW, Wu VWC, Yip SP, Law HKW, Lee SWY, Ying MTC. Computer-assisted ultrasound assessment of plaque characteristics in radiationinduced and non-radiation-induced carotid atherosclerosis. Quant Imaging Med Surg 2021;11(6):2292-2306 is available at
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