3D Vascular US quantifies early carotid and femoral atherosclerotic plaque burden

By Staff News Brief

Identifying and quantifying cardiovascular risk factors in asymptomatic middle-aged individuals can be a lifesaving opportunity to make lifestyle changes and obtain timely treatment. Detecting subclinical atherosclerosis improves cardiovascular risk prediction, and two-dimensional vascular ultrasound is used for this purpose.

Now, researchers in Spain report that three-dimensional vascular ultrasound (3DVUS) is a safe and reproducible approach to detect and quantify early atherosclerotic burden in the carotid and femoral arteries.

The multi-institutional research team reported their analysis of 3,860 asymptomatic adults between 40 and 54 years of age in the Journal of the American College of Cardiology. The individuals are participants in the PESA-CNIC-Santander (Progression of Early Subclinical Atherosclerosis) ongoing observational prospective study characterizing early subclinical atherosclerotic burden and determinants of atherosclerosis presence and progression. All participants had a baseline 3DVUS examination of carotid and femoral arterial segments upon enrollment.

The 3DVUS protocol used to image carotid arteries consisted of a 30º automatic sweep of 6 cm in length centered at the carotid bulb to include the distal common carotid artery, the bulb, the bifurcation, and the proximal internal and external carotid artery segments. Image acquisition for femoral arteries included the 30º and 6 cm of the mid-distal common femoral artery, the bifurcation, and the proximal superficial and deep femoral artery segments. Vascular plaque quantification software was used to analyze 15,936 arteries, with data reviewed by four technicians blinded to other test results.

Lead author Beatriz Lopez-Melgar, MD, PhD, of HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM in Madrid and co-authors quantified plaque burden by measuring the volumes of all atherosclerotic plaques visualized within the standard 6 cm acquisition. The sum of plaque volumes in the right and left carotid and femoral arteries defined global plaque burden. For each individual, the presence/absence of plaque was recorded. Where plaque was identified, the total number was recorded as well as the number of arteries affected.

Carotid plaque burden was identified in 27.2% of the participants and femoral plaque burden in 32.1%. The authors quantified plaque detection and plaque burden by age, sex, types and number of cardiovascular risk factors, and by types of therapy for cardiovascular risk, if any. Their findings are summarized below:

  • Carotid and femoral 3DVUS identifies higher plaque burden in men, in the femoral arteries, and with increasing age;
  • The pattern of disease changes with age are sex- and artery-dependent;
  • 3DVUS is strongly associated with cardiovascular risk factors, especially at the femoral level;
  • The evaluation of plaque burden in addition to plaque presence provides a closer match with global cardiovascular risk than plaque detection alone.

“Adding plaque burden quantification to the detection of plaque presence provides a clearer picture of the relationship between risk and subclinical disease. Among individuals with the same number of plaques or affected territories, global plaque burden was independently and positively associated with estimated atherosclerotic cardiovascular disease. Global plaque volume, by integrating plaque presence, number, and plaque size is a more comprehensive index of disease burden that may better reflect individual susceptibility,” the researchers wrote.

The authors emphasized that because 3DVUS offers incremental value, and is a simple, reproducible, inexpensive imaging examination to perform, it has the potential to become a key large-scale screening tool for identifying at risk individuals.


  1. Lopez-Melgar B, Fernandez-Friera L, Sanches-Gonzalez J, et al. Accurate quantification of atherosclerotic plaque volume by 3D vascular ultrasound using the volumetric linear array method. Atherosclerosis. 2016; 248: 230-237.
  2. Lopez-Melgar B, Fernandez-Friera L, Oliva B, et al. Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life: The PESA Study. J Am Coll Cardiol. 2017 70; 3:301-313.
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3D Vascular US quantifies early carotid and femoral atherosclerotic plaque burden.  Appl Radiol. 

By Staff News Brief| January 09, 2018

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