{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:34:32Z","timestamp":1791988472253,"version":"4.4.0"},"reference-count":52,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2015,5,5]],"date-time":"2015-05-05T00:00:00Z","timestamp":1430784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>A thrombotic occlusion of the vessel fed by ruptured coronary atherosclerotic plaque may result in unstable angina, myocardial infarction or death, whereas embolization from a plaque in carotid arteries may result in transient ischemic attack or stroke. The atherosclerotic plaque prone to such clinical events is termed high-risk or vulnerable plaque, and its identification in humans before it becomes symptomatic has been elusive to date. Ultrasonic tissue characterization of the atherosclerotic plaque is possible with different techniques\u2014such as vascular, transesophageal, and intravascular ultrasound\u2014on a variety of arterial segments, including carotid, aorta, and coronary districts. The image analysis  can be based on visual, video-densitometric or radiofrequency methods and identifies three  distinct textural patterns: hypo-echoic (corresponding to lipid- and hemorrhage-rich plaque), iso- or moderately hyper-echoic (fibrotic or fibro-fatty plaque), and markedly hyperechoic  with shadowing (calcific plaque). Hypoechoic or dishomogeneous plaques, with spotty microcalcification and large plaque burden, with plaque neovascularization and surface irregularities by contrast-enhanced ultrasound, are more prone to clinical complications than hyperechoic, extensively calcified, homogeneous plaques with limited plaque burden, smooth luminal plaque surface and absence of neovascularization. Plaque ultrasound morphology is important, along with plaque geometry, in determining the atherosclerotic prognostic burden in the individual patient. New quantitative methods beyond backscatter (to include speed  of sound, attenuation, strain, temperature, and high order statistics) are under development to evaluate vascular tissues. Although not yet ready for widespread clinical use, tissue characterization is listed by the American Society of Echocardiography roadmap to 2020 as one of the most promising fields of application in cardiovascular ultrasound imaging, offering unique opportunities for the early detection and treatment of atherosclerotic disease.<\/jats:p>","DOI":"10.3390\/ijms160510121","type":"journal-article","created":{"date-parts":[[2015,5,5]],"date-time":"2015-05-05T10:43:16Z","timestamp":1430822596000},"page":"10121-10133","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Ultrasound Tissue Characterization of Vulnerable Atherosclerotic Plaque"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2524-6288","authenticated-orcid":false,"given":"Eugenio","family":"Picano","sequence":"first","affiliation":[{"name":"Biomedicine Department, NU School of Medicine, Astana 010000, Kazakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Paterni","sequence":"additional","affiliation":[{"name":"CNR (Consiglio Nazionale Ricerche), Institute of Clinical Physiology, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2015,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/ejechocard\/jer021","article-title":"Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE\/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography","volume":"12","author":"Lang","year":"2011","journal-title":"Eur. 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