Inflammatory Indices as a Triage Tool for Contrast-Enhanced Ultrasound in Carotid Plaques

Abstract

This retrospective study evaluated a diagnostic framework integrating systemic inflammatory indices with contrast enhanced ultrasound for stratifying carotid plaque vulnerability. We included 322 patients with a mean age of 68.4 years who underwent imaging to grade intraplaque neovascularization as an established reference. The Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and pan-immune-inflammation value were analyzed alongside diagnostic performance using receiver operating characteristic curves and reclassification metrics. Results showed that higher levels of these indices were significantly associated with increased neovascularization severity. The combined model yielded an AUC of 0.822, which was comparable to that of SII alone (AUC = 0.821; DeLong P = .789). The pan-immune-inflammation value showed a high sensitivity of 88.6% for initial screening while the Systemic Inflammation Response Index demonstrated 78.3% specificity for confirming plaque instability. Adding SII to the baseline model improved reclassification and discrimination after bootstrap correction, with a continuous NRI of 0.949 (95% CI: 0.752-1.153) and an IDI of 0.266 (95% CI: 0.213-0.311). Integrating these accessible inflammatory indices with ultrasound may provide a cost-effective and noninvasive approach to vascular risk stratification, with potential value for the personalized management of patients with carotid atherosclerosis.