Correlation of ultrasonic image features with histologic characteristics of atherosclerotic plaque

A study was undertaken to determine the ability of preoperative duplex sonography to characterize carotid atherosclerotic lesions and to correlate these findings with histologic studies of carotid endarterectomy specimens in order to establish the reliability of noninvasive ultrasound in assessing plaque morphology. Regions of uniform echogenicity were correlated with fibrous atheromatous disease in 43/43 specimens. Plaque calcification was associated with a hyperechoic pattern with acoustical shadowing obscuring deeper-lying tissue in 26/27 specimens. Significant interplaque hemorrhage corresponded to anechoic regions within the plaque in 30 of 33 specimens. The final image pattern was one of a mottled texture of mixed echogenicities; in 26 of 30 specimens this was associated with complex atheromatous disease of dense fibrous tissue, pockets of necrotic debris, and regions of old, organized plaque hemorrhage