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Quantification of the Wall Inhomogeneity in B-mode Sonographic Images of the Carotid Artery

Center for Internal Medicine, Department of Rehabilitative and Preventative Sports Medicine, Freiburg University Hospital (M.S., D.S., A.S.-T.), and Computer Science Department, Freiburg University (D.C.), Freiburg, Germany.

Address correspondence and reprint requests to Arno Schmidt-Trucksäss, MD, Center for Internal Medicine, Department Rehabilitative and Preventative Sports Medicine, Freiburg University Hospital, Hugstetterstrasse 55, 79106 Freiburg, Germany.

Objective. The process of atherosclerosis has been assessed increasingly by sonography in B-mode images of the carotid arteries. Carotid artery atherosclerosis is thought to be associated with major atherosclerotic diseases in other regions of the arterial bed, especially the coronary arteries. In addition to the intima-media thickening as an established surrogate parameter of the atherosclerotic wall process, changes of the sonographic morphologic pattern of the intima-media layer might reflect this process. Methods. After automatic identification of the intimal and adventitial boundaries of the distal common carotid artery wall, the gray level inhomogeneity of the circumscribed intima-media area was quantified. Older subjects without cardiovascular disease (mean ± SD, 66.2 ± 3.8 years; n = 43) were compared with young subjects without cardiovascular disease (24.4 ± 5.3 years; n = 34) and patients with manifest coronary artery disease (65.0 ± 9.2 years; n = 69). Results. Patients with coronary artery disease had a significantly higher intima-media thickness (0.92 ± 0.21 mm; P < .05) and wall inhomogeneity (4.56 ± 0.97; P < .001) than the old group (0.86 ± 0.15 mm and 3.83 ± 0.62). Both parameters were lowest in the young group (0.56 ± 0.05 mm and 2.53 ± 0.76; P < .05 for both parameters and groups). Conclusions. Measurement of gray level wall inhomogeneity of the intima-media layer of the common carotid artery may help discriminate between subjects with high and low atherosclerotic burden and may show age-related changes of the intima-media layer. This new quantitative parameter is thought to reflect the atherosclerotic wall process in addition to the intima-media thickness measurement.

Key Words: atherosclerosis • common carotid artery • snake mechanism • sonography • wall inhomogeneity

Abbreviations: ANOVA, analysis of variance • CAD, coronary artery disease • CCA, common carotid artery • ECG, electrocardiogram • HDL, high-density lipoprotein • IMT, intima-media thickness • ISO, International Organization for Standardization • LDL, low-density lipoprotein • 3D, three-dimensional • WI, wall inhomogeneity

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