Assessment of Carotid Plaque neovascularization in Patients Using 3D Ultrasound Localization Microscopy with a Row-Column Array

Atherosclerosis, a major cause of cardiovascular disease, often involves neovascularization within carotid plaques, contributing to their instability. However, conventional imaging methods usually lack the spatial resolution to visualize these small vessels. Ultrasound Localization Microscopy (ULM), based on imaging of microbubble contrast agents, has shown promising results to detect these neovessels with greater precision, but has so far only been investigated in 2D, being limited to one imaging plane. In this study, we extend ULM to 3D using a row-column addressed (RCA) probe, enabling volumetric imaging at ultrafast framerate in vivo in patients with carotid atherosclerotic plaques and compare our results against histological analysis of excised plaques during carotid endarterectomy (CEA). Our findings suggest that ULM can capture the presence of intraplaque neovessels, potentially offering a novel non-invasive tool for improved assessment of plaque vulnerability.