The aim of this study was to assess the consistency between the echogenicity and morphology of two-dimensional ultrasonography for the carotid atherosclerosis plaque and the morphological characteristics from the endarterectomy (CEA) specimen in same patient.

A total of 160 consecutive patients with severe carotid stenosis were enrolled into this study from January 2014 to May 2015. Each patient underwent ultrasonography in 0-48 hours before CEA. The longitudinal and cross-sectional images of carotid plaque in stenosis lumen were detected and recorded. The echogenicity, plaque surface morphology and the gray scale median (GSM) were recorded. After endareterectomy, the homogeneity and appearance characteristics of multi sections of the specimen were detected and images were stored by high resolution camera.

(1) The consistency of plaque morphology (regular or irregular) between two-dimensional sonogram and images obtained by high resolution camera was 93.1% (149/160). The sensitivity of the surface irregularity plaque diagnosed by two-dimensional sonography was 95.3%. The sensitivity and specificity of ulcer plaque diagnosed by two-dimensional sonography was 84.8% and 88.5%, retrospectively, and the overall accuracy was 86.2% (138/160). (2) Sixty-one of 64 isoechoic plaques (95.3%) were homogeneous tissue without large lipid core and necrosis. Thirty-eight of 44 hypoechoic plaques (86.3%, 38/44) had necrosis and hemorrhage in section images of specimen. The GSM of homogeneous plaques (55±19) was higher than those of the lipid core plaques (39±11, P<0.001) and hemorrhage plaques (29±10, P<0.001) . (3) Eight of 17 plaques with calcification near arterial wall had necrosis (47.1%, 8/17) and the incidence of intra-plaque hemorrhage was 52.9% (9/17). Twenty-nine plaques with mixed hypoechogenicity and isoechogenicity had micro-calcification and large necrosis (29, 100%).

Two-dimensional ultrasonography correlated well with specimen appearance for irregular plaque and ulcer plaque. The correlation between the echogenicity and specimen feature has important value for predicting plaque vulnerability. GSM provides additional information on plaque echogenicity which may be benefit to help identify vulnerable plaque and is recommended for use in future.