Ultrasound in medicine & biology · 2026
CP-RADS Grade 2 Carotid Plaques: The Association Between Ultrasound Features and the Risk of Ischemic Stroke.
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Jin YiWen, Huang Yunqian, Xu Jiatong, Chen Chuanjian, Xie YanChun, Zhang LiXia, Zhu WenQian, Di Hao, Zhu FengTing, Ding ZiNan, Chen Man
Аннотация
OBJECTIVE: To investigate whether the composite ultrasound feature-characterized by intraplaque punctate calcification with contrast enhancement-serves as an independent predictor for new ischemic stroke in these presumed "low-risk" plaques, and to develop and validate a nomogram prediction model that integrates clinical and imaging features.
METHODS: In this retrospective study, 3317 patients initially underwent carotid ultrasound. After stringent exclusions, 404 with CP-RADS grade 2 plaques were enrolled and randomly split 7:3 into training (n = 282) and validation (n = 121) sets. Three senior doctors, blinded to clinical data, independently assessed ultrasound features with excellent intra‑ and inter‑observer agreement (ICC > 0.80). Univariate and multivariate logistic regression identified independent risk factors, and a nomogram was developed. Model performance was evaluated using ROC analysis, calibration curves, and decision curve analysis (DCA).
RESULTS: The composite imaging feature (punctate calcification with contrast enhancement) was an independent predictor of new‑onset cerebral infarction (OR = 3.60, 95% CI: 1.33-9.77, p = 0.012). The nomogram showed excellent discrimination in the validation set (AUC = 0.84; sensitivity 79%, specificity 86%), with good calibration between predicted and actual risk.
CONCLUSION: The composite "active plaque" feature-intraplaque punctate calcification with contrast enhancement-serves as an independent predictor of new‑onset cerebral infarction in CP‑RADS grade 2 carotid plaques. Our nomogram demonstrates good predictive performance and clinical applicability, providing reliable imaging support for early risk stratification and individualized intervention in this presumed "low‑risk" population.
METHODS: In this retrospective study, 3317 patients initially underwent carotid ultrasound. After stringent exclusions, 404 with CP-RADS grade 2 plaques were enrolled and randomly split 7:3 into training (n = 282) and validation (n = 121) sets. Three senior doctors, blinded to clinical data, independently assessed ultrasound features with excellent intra‑ and inter‑observer agreement (ICC > 0.80). Univariate and multivariate logistic regression identified independent risk factors, and a nomogram was developed. Model performance was evaluated using ROC analysis, calibration curves, and decision curve analysis (DCA).
RESULTS: The composite imaging feature (punctate calcification with contrast enhancement) was an independent predictor of new‑onset cerebral infarction (OR = 3.60, 95% CI: 1.33-9.77, p = 0.012). The nomogram showed excellent discrimination in the validation set (AUC = 0.84; sensitivity 79%, specificity 86%), with good calibration between predicted and actual risk.
CONCLUSION: The composite "active plaque" feature-intraplaque punctate calcification with contrast enhancement-serves as an independent predictor of new‑onset cerebral infarction in CP‑RADS grade 2 carotid plaques. Our nomogram demonstrates good predictive performance and clinical applicability, providing reliable imaging support for early risk stratification and individualized intervention in this presumed "low‑risk" population.