Figure 1

Representative Doppler ultrasound appearances of carotid plaque. (A) Plaque with moderate echogenicity and a smooth surface; (B) Color-flow signals within the plaque region; (C) Plaque at the carotid bifurcation with a spectral Doppler trace; (D) Long-axis view of a plaque with sparse color-flow signals. Reproduced from Wang et al. [20]."

Table 1

Advanced ultrasound assessment of carotid plaque"

Figure 2

Contrast-enhanced ultrasound (CEUS) and histologic neovascularization in human carotid plaque. (A) Color Doppler ultrasound at the carotid bifurcation; the red dashed contour marks the plaque; (B) CEUS of the same region, with focal intraplaque enhancement outlined by the yellow box; dashed lines connect this region to the corresponding histology in panel C; (C) Anti-CD31 immunohistochemistry from the corresponding plaque region; arrows identify CD31-positive neovessels, and the scale bar is 500 μm. Reproduced from Schmidt et al. [25]."

Figure 3

Standard carotid ultrasound and superb microvascular imaging (SMI) in community participants at high stroke risk. (A-F) show transverse and longitudinal views with limited intraplaque vascular signal (SMI grade 1); (G-L) show multiple short linear or strip-like signals in transverse and longitudinal views (SMI grade 2), marked by arrows in the source. Reproduced from Wang et al. [33]."

Figure 4

Ultrasound localization microscopy (ULM) density and velocity maps in three patients with histologically detected carotid plaque neovessels. (A, C, and E) show localized-bubble density; (B, D, and F) show the corresponding tracked-bubble velocity. Blue dashed contours are the source study's plaque segmentations. Adapted from Leroy et al. [34]."

Figure 5

Multiparametric assessment of the same human carotid plaque. (A) Shear-wave elastography, (B) B-mode ultrasound, (C) computed tomography angiography, and (D) gross endarterectomy specimen in longitudinal view. In the source, the red arrow marks a hemorrhagic region corresponding to low stiffness, low echogenicity, and low computed-tomography density; the white arrow marks a fibrous calcified region corresponding to high stiffness, high echogenicity, and high density. Ci, internal carotid artery; Cc, common carotid artery. Reproduced from Goudot et al. [38]."

Table 2

Evidence linking plaque imaging, treatment, and response assessment"

Figure 6

Experimental molecular ultrasound with cyclic Arg-Gly-Asp-modified microbubbles (MBR) in mice. (A) Background-subtracted color-coded signal after MBR or control microbubbles (MBC) in C57BL/6 mice and ApoE−/− mice receiving a normal or high-cholesterol diet, with separate receptor-blocked groups; (B) Quantified video intensity (n = 6 per group); (C-F) Associations between MBR video intensity and endothelial or plaque glycoprotein IIb/IIIa, plaque vulnerability index, and necrotic-core/fibrous-cap ratio. Reproduced from Guo et al. [51]."

Figure 7

Plaque-directed delivery using platelet-membrane biomimetic rapamycin nanoparticles combined with ultrasound-targeted microbubble destruction (UTMD) in ApoE−/− mice. (A) Thirty-day treatment schedule; (B) En face Oil Red O-stained aortas; (C) Quantified aortic plaque area. Reproduced from Zhou et al. [65]."

Figure 8

Low-intensity focused-ultrasound-responsive nanoplatform for sonodynamic modulation of advanced rabbit femoral plaque. (A) Representative histopathology 28 days after treatment, including hematoxylin and eosin, CD31, Prussian blue, macrophage, Oil Red O, HIF-1α, Masson, smooth-muscle-cell, and endothelial staining. Red arrows in the source mark abnormal adventitial neovessels and white arrows mark intraplaque hemorrhage; (B-K) Quantification (n = 7; mean ± SD; analysis of variance with Dunnett post hoc comparisons as defined in the source). Reproduced from Yao et al. [70]."

Figure 9

Serial carotid ultrasound during lipid-lowering therapy in a prospective single-arm study. (A) Representative B-mode images at baseline and 6 months show little visible change in plaque morphology; (B) CEUS images and time–intensity curves from the same representative patient; (C, D) Cohort-level reductions in plaque-to-lumen area under the curve and enhanced-intensity ratios at 6 months; (E) Magnified plaque regions in the representative CEUS images; red arrows mark intraplaque vessels and blue arrows mark calcification in the source. Reproduced from Chen et al. [82]."