B-mode ultrasound images of the carotid artery wall: correlation of ultrasound with histological measurements

      This paper is only available as a PDF. To read, Please Download here.


      B-mode ultrasound is being used to assess carotid atherosclerosis in epidemiological studies and clinical trials. Recently the interpretation of measurements made from ultrasound images has been questioned. This study examines the anatomical correlates of B-mode ultrasound of carotid arteries in vitro and in situ in cadavers. Twenty-seven segments of human carotid artery were collected at autopsy, pressure perfusion fixed in buffered 2.5% gluteraldehyde and 4% paraformaldehyde and imaged using an ATL UM-8 (10 MHz single crystal mechanical probe). Each artery was then frozen, sectioned and stained with van Gieson or elastin van Gieson. The thickness of the intima, media and adventitia were measured to an accuracy of 0.01 mm from histological sections using a calibrated eye graticule on a light microscope. Shrinkage artifact induced by histological preparation was determined to be 7.8%. Digitised ultrasound images of the artery wall were analysed off-line. The distance from the leading edge of the first interface (LE1) to the leading edge of the second interface (LE2) was measured using a dedicated programme. LE1-LE2 measurements were correlated against histological measurements corrected for shrinkage. Mean values for the far wall were: ultrasound LE1-LE2 (0.97 mm, S.D. 0.26), total wall thickness (1.05 mm, S.D. 0.37), adventitia (0.35 mm, S.D. 0.16), media (0.61 mm, S.D. 0.18), intima (0.09 mm, S.D. 0.13). Ultrasound measurements corresponded best with total wall thickness, rather than elastin or the intima-media complex. Excision of part of the intima plus media or removal of the adventitia resulted in a corresponding decrease in the LE1-LE2 distance of the B-mode image. Furthermore, increased wall thickness due to intimal atherosclerotic thickening correlated well with LE1-LE2 distance of the B-mode images. B-mode images obtained from the carotid arteries in situ in four cadavers also corresponded best with total wall thickness measured from histological sections and not with the thickness of the intima plus media. In conclusion, the LE1-LE2 distance measured on B-mode images of the carotid artery best represents total wall thickness of intima plus media plus adventitia and not intima plus media alone.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bond M.G.
        • Insull W.
        • Gardin J.F.
        • Wilmoth S.K.
        Reliability of B-mode ultrasound in measuring small carotid artery plaques.
        Circulation. 1984; 70: II-162
        • Wofford J.L.
        • Kahl F.R.
        • Howard G.R.
        • McKinney W.M.
        • Toole J.F.
        • Crouse J.R.
        Relation of extent of extracranialcarotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis.
        Arterioscler. Thromb. 1991; 11: 1786
        • Crouse J.R.
        • Toole J.F.
        • McKinney W.M.
        • Dignan M.B.
        • Howard G.
        • Kahl F.R.
        • MacMahan M.R.
        • Harpold G.H.
        Risk factors for extracranial carotid artery atherosclerosis.
        Stroke. 1987; 18: 990
        • Craven T.E.
        • Ryu J.E.
        • Espeland M.A.
        • Kahl F.R.
        • McKinney W.M.
        • Toole J.F.
        • McMahan M.R.
        • Thompson C.J.
        • Heiss G.
        • Crouse J.R.
        Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis, a case-control study.
        Circulation. 1990; 82: 1230
        • Salonen J.T.
        • Salonen R.
        Ultrasonographically assessed carotid morphology and the risk of coronary heart disease.
        Arterioscler. Thromb. 1991; 11: 1245
        • Strandness D.E.
        Ultrasound in the study of atherosclerosis.
        Ultrasound Med. Biol. 1986; 12: 453
        • Bond M.G.
        • Ball M.
        Assessment of Ultrasound Bmode Imaging for Detection and Quantification of Atherosclerotic Lesions in Arteries of Animals.
        in: National Institutes of Health, Bethesda1986: 28
        • Pignoli P.
        • Tremoli E.
        • Poli A.
        • Oreste P.
        • Paoletti R.
        Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging.
        Circulation. 1986; 74: 1399
        • Poli A.
        • Tremoli E.
        • Colombo A.
        • Sirtori M.
        • Pignoli P.
        • Paoletti R.
        Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients a new model for the quantitation and follow-up of preclinical atherosclerosis in living human subjects.
        Atherosclerosis. 1988; 70: 253
        • Salonen R.
        • Salonen J.T.
        Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study.
        Atherosclerosis. 1990; 81: 33
        • Furberg C.D.
        • Byington R.P.
        • Borhani N.A.
        • The Midas Research Group
        Multicenter isradipine diuretic atherosclerosis study (MIDAS).
        Am. J. Med. 1989; 86: 37
        • Bond M.G.
        • Wilmoth S.K.
        • Enevold G.L.
        • Strickland H.L.
        Detection and monitoring of asymptomatic atherosclerosis in clinical trials.
        Am. J. Med. 1989; 86: 33
        • Borhani N.O.
        • Bond M.G.
        • Sowers J.R.
        • Canossa-Terris M.
        • Buckalew V.
        • Gibbons M.E.
        • Worthy A.J.
        The multicenter isradipine/diuretic atherosclerosis study: a study of the antiatherogenic properties of isradipine in hypertensive patients.
        J. Cardiol. Pharm. 1991; 18: S15
        • Nolsoe C.P.
        • Engel U.
        • Karstrup S.
        • Torp-Pedersen S.
        • Garre K.
        • Holm H.H.
        The aortic wall: an in vitro study of the double-line pattern in high-resolution US.
        Radiology. 1990; 175: 387
        • Wikstrand J.
        • Wiklund O.
        Frontiers in cardiovascular science: quantitative measurements of atherosclerosis manifestations in humans.
        Arterioscler. Thromb. 1992; 12: 114
        • Wendelhag I.
        • Gustavsson T.
        • Suurküla M.
        • Berglund G.
        • Wikstrand J.
        Ultrasound measurement of wall thickness in the carotid artery: fundamental principles and description of a computerized analysing system.
        Clin. Phys. 1991; 11: 565
        • Statistical Analysis Systems
        SAS/STAT Guide for Personal Computers.
        in: 6th Edition. SAS Institute Inc, Cary, NC1987: 1028
        • Chinn S.
        The assessment of methods of measurement.
        Stat. Med. 1990; 9: 351
        • Donner A.
        • Eliasziw M.
        Sample size requirements for reliability studies.
        Stat. Med. 1987; 6: 441
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorial data.
        Biometrics. 1977; 33: 159
        • Snedecor G.W.
        • Cochran W.G.
        Statistical Methods.
        in: 6th Edition. The Iowa State University Press, Ames, IA1967: 593
        • Webb J.G.
        • Yock P.G.
        • Slepian M.J.
        • White N.W.
        • Hui P.Y.
        • Rowe M.H.
        • Linker D.T.
        • Finkbeiner W.E.
        Intravascular ultrasound: significance of the three-layered appearance of normal muscular arteries.
        J. Am. Coll. Cardiol. 1990; 15: 17A
        • Mallery J.A.
        • Tobis J.M.
        • Griffith J.
        • Gessert J.
        • McRae M.
        • Moussabeck O.
        • Bessen M.
        • Moriuchi M.
        • Henry W.L.
        Assessment of normal and atherosclerotic arterial wall thickness with an intravascular ultrasound imaging catheter.
        Am. Heart J. 1990; 119: 1392
        • Dempsey R.J.
        • Moore R.W.
        Amount of smoking independently predicts carotid artery atherosclerosis severity.
        Stroke. 1992; 23: 693
        • Bonithon-Kopp C.
        • Scarabin P.
        • Taquet A.
        • Touboul P.
        • Malmejac A.
        • Guize L.
        Risk factors for early carotid atherosclerosis in middle-aged French women.
        Arterioscler. Thromb. 1991; 11: 966
        • Salonen R.
        • Salonen J.T.
        Determinants of carotid intima-media thickness: a population-based ultrasonography study in eastern Finnish men.
        J. Int. Med. 1991; 229: 225
        • Handa N.
        • Matsumoto M.
        • Maeda H.
        • Hougaku H.
        • Ogawa S.
        • Fukunaga R.
        • Yoneda S.
        • Kimura K.
        • Kamada T.
        Ultrasonic evaluation of early carotid atherosclerosis.
        Stroke. 1990; 21: 1567
        • Giral P.
        • Pithois-Merli L.
        • Filitti V.
        • Levenson J.
        • Plainfosse M.C.
        • Mainardi C.
        • Simon A.C.
        Risk factors and early extracoronary atherosclerotic plaques detected by three-site ultrasound imaging in hypercholesterolemic men.
        Arch. Intern. Med. 1991; 151: 950
        • Salonen R.
        • Seppänen K.
        • Rauramaa R.
        • Salonen J.T.
        Prevalence of carotid atherosclerosis and serum cholesterol levels in eastern Finland.
        Arteriosclerosis. 1988; 8: 788
        • Matsushima H.
        • Yamasaki Y.
        • Nao K.
        • Nishizawa H.
        • Kawamori R.
        • Kamada T.
        Ultrasonographic measurement of the carotid artery wall thickness in young and adult diabetics.
        Diabetes. 1991; 40: 550A
        • Wendelhag I.
        • Wiklund O.
        • Wikstrand J.
        Arterial wall thickness in familial hypercholesterolemia ultrasound measurement of intima media thickness in the common carotid artery.
        Arterioscler. Thromb. 1992; 12: 70
        • Giral P.
        • Filitti V.
        • Levenson J.
        • Pithois-Merti I.
        • Plainfosse M-C
        • Mainardi C.
        • Gold A.
        • Simon A.
        PCV Metra Group. Relation of risk factors for cardiovascular disease to early atherosclerosis detected by ultrasonography in middle-aged normotensive hypercholesterolemic men.
        Atherosclerosis. 1990; 85: 151
        • Lusiani L.
        • Visonà A.
        • Pagnan A.
        Noninvasive study of arterial hypertension and carotid atherosclerosis.
        Stroke. 1990; 21: 410
        • Barger A.C.
        • Beeuwkes R.
        Rupture of coronary vasa vasorum as a trigger of acute myocardial infarction.
        Am. J. Cardiol. 1990; 66: 41G
        • Yutani C.
        • Imakita M.
        • Ishibashi-Veda H.
        Hisptopathological study of aorto-coronary bypass grafts with special reference to fibrin deposits on grafted saphenous veins.
        Acta Pathol. Jpn. 1989; 39: 425