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Updated: May 10, 2026
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Published on: January 15, 2022
Automated analysis of intima-media thickness: analysis and performance of CARES 3.0
Luca Saba1, Roberto Montisci, Luca Famiglietti
1Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari-Polo di Monserrato, SS 554 Monserrato, 09045 Cagliari, Italy. lucasaba@tiscali.it
Objectives:
In recent years, the use of computer-based techniques has been advocated to improve intima-media thickness (IMT) quantification and its reproducibility. The purpose of this study was to test the diagnostic performance of a new IMT automated algorithm, CARES 3.0, which is a patented class of IMT measurement systems called AtheroEdge (AtheroPoint, LLC, Roseville, CA).
Methods:
From 2 different institutions, we analyzed the carotid arteries of 250 patients. The automated CARES 3.0 algorithm was tested versus 2 other automated algorithms, 1 semiautomated algorithm, and a reader reference to assess the IMT measurements. Bland-Altman analysis, regression analysis, and the Student t test were performed.
Results:
CARES 3.0 showed an IMT measurement bias ± SD of -0.022 ± 0.288 mm compared with the expert reader. The average IMT by CARES 3.0 was 0.852 ± 0.248 mm, and that of the reader was 0.872 ± 0.325 mm. In the Bland-Altman plots, the CARES 3.0 IMT measurements showed accurate values, with about 80% of the images having an IMT measurement bias ranging between -50% and +50%. These values were better than those of the previous CARES releases and the semiautomated algorithm. Regression analysis showed that, among all techniques, the best t value was between CARES 3.0 and the reader.
Conclusions:
We have developed an improved fully automated technique for carotid IMT measurement on longitudinal ultrasound images. This new version, called CARES 3.0, consists of a new heuristic for lumen-intima and media-adventitia detection, which showed high accuracy and reproducibility for IMT measurement.
