Diagnostic accuracy of gray-scale analysis on B-mode ultrasound for identifying intraplaque hemorrhage and lipid-rich necrotic core in carotid plaques

Among 113 enrolled patients, 75 patients (mean age 75 years; 69% men; 40% with symptomatic CS) were included in the analysis. On MRI, 43 patients (57%) had LRNC, and 32 patients (43%) showed IPH in the index artery. In the group without IPH, LRNC status could not be scored for 19 index arteries. Echolucency of the plaque surface with a gray-scale value < 20 showed the strongest association with IPH, with an area under the ROC curve (AUC) of 0.58 (95% CI 0.43, 0.71) and a negative predictive value of 0.64 (95% CI 0.50, 0.69) for the presence of IPH (sensitivity 0.50, specificity 0.65). For LRNC without IPH, several thresholds yielded the best-performing AUC of 0.48 (95% CI 0.23, 0.73/0.74)Conclusion:Quantitative ultrasound does not reliably predict the presence of IPH or LRNC, as detected by MRI, in patients with atherosclerotic internal CS.