Application of high frame rate contrast-enhanced ultrasound in carotid plaque neovascularization: a preliminary inter-physician comparison study.

AIMS: To preliminarily evaluate the clinical value of high frame rate contrast-enhanced ultrasound (H-CEUS) for assessing intraplaque neovascularization (IPN) in carotid arteries among physicians with different levels of experience. METHODS: A total of 66 patients with 114 carotid plaques who underwent both CEUS and H-CEUS were enrolled. One senior physician and two beginners (A and B) performed semi-quantitative grading of the number and distribution of IPN. The inter-modality agreement between CEUS and H-CEUS was assessed. The consistency between the senior physician and the beginners was compared. Learning curves were used to analyze the beginners' proficiency progression in evaluating IPN using CEUS and H-CEUS. RESULTS: Assessment of IPN using the two contrast-enhanced ultrasound modes showed moderate interobserver agreement among senior physicians. With H-CEUS mode, the senior physician and two beginners demonstrated strong interobserver agreement in assessing both the number (p<0.001) and distribution (p<0.001) of IPN. The learning curve analysis further revealed that, H‑CEUS enabled beginners A and B to achieve competency faster and attain higher final concordance rates than CEUS. CONCLUSION: This technique provides clear visualization of intraplaque neovascularization, thereby offering a more objective basis for accurate assessment and demonstrating potential clinical value.