Related Experiment Video
Updated: Jun 17, 2026
A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application
Published on: July 9, 2020
CT Attenuation Analysis of Carotid Intraplaque Hemorrhage
L Saba1, M Francone2, P P Bassareo2
1From the Departments of Radiology (L.S.) lucasaba@tiscali.it.
Insights
Intraplaque hemorrhage in carotid plaques can be identified using CT attenuation values. A threshold of 25 HU after contrast administration offers high sensitivity and specificity for detecting this vulnerability marker.
Area of Science:
- Radiology
- Vascular Imaging
- Pathology
Background:
- Intraplaque hemorrhage is a key indicator of carotid plaque vulnerability.
- Accurate identification of intraplaque hemorrhage is crucial for risk assessment.
Purpose of the Study:
- To evaluate CT characteristics of intraplaque hemorrhage.
- To correlate CT findings with histopathology for definitive identification.
Main Methods:
- Retrospective analysis of 91 patients undergoing CT angiography and carotid endarterectomy.
- Histopathologic analysis for tissue characterization.
- Measurement of plaque attenuation values (Hounsfield units) using region of interest (ROI).
- Statistical analysis including ROC curve, Mann-Whitney, and Wilcoxon tests.
Main Results:
- Average attenuation values differed significantly between intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue.
- A CT attenuation threshold of 25 HU demonstrated 93.22% sensitivity and 92.73% specificity for intraplaque hemorrhage.
- Significant differences in attenuation were observed before and after contrast administration.
Conclusions:
- CT attenuation can effectively identify intraplaque hemorrhage in carotid plaques.
- A 25 HU threshold post-contrast is optimal for detection.
- Precise ROI selection is essential for accurate results.
Background And Purpose:
Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage.
Materials And Methods:
This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm2). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed.
Results:
A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively).
Conclusions:
The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.
More Related Videos
10:41Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound
Published on: June 3, 2021
09:36A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
Published on: August 12, 2025
