NEW YORK (Reuters Health), Jun 23 - Even though carotid intima media thickness (cIMT) independently predicts cardiovascular disease events, this parameter does not add useful information to traditional risk factor assessment in the general population, investigators in Germany report.
In fact, their study showed that compared with risk prediction of cardiovascular events based on Framingham risk factors alone, reclassification based on cIMT was wrong 70% of the time.
cIMT determination is encouraged by some professional guidelines as a measure of early atherosclerosis. However, the U.S. Preventive Services Task Force recently said that there is not enough evidence to warrant the use of nontraditional risk factors, including cIMT, for assessing cardiovascular risk. (See Reuters Health report of October 5, 2009.)
For their study, published online on June 8 in the European Heart Journal, researchers at Johann Wolfgang Goethe-University in Frankfurt used "state-of-the-art reclassification statistics" to further examine this issue.
Their data involved 4,904 asymptomatic subjects with no history of vascular disease from the CAPS study who had cIMT measured with high-resolution ultrasound. During follow-up averaging 8.5 years, 73 subjects had a myocardial infarction, 271 had angina pectoris or myocardial infarction, and 72 subjects died.
In 24 risk models with different end points, carotid segments, and explanatory variables, c-statistics improved only marginally when cIMT was added to traditional risk factors, lead author Dr. Matthias W. Lorenz and associates report.
In a model for angina or myocardial infarction using Framingham risk factors, addition of cIMT reclassified 357 subjects, but only 30% were correct based on actual outcomes over 10 years. In a model for death based on SCORE risk factors, 114 subjects were reclassified when cIMT was added; 61% were accurate.
All the models showed "a lack of convincing reclassification benefit by cIMT," the authors say.
They estimate that to prevent one cardiovascular disease event over 10 years, physicians would have to screen 2,410 subjects with cIMT measurement. Still, they hesitate to discourage use of cIMT as a screening tool until their findings are confirmed in other population-based studies.
http://eurheartj.oxfordjournals.org/content/early/2010/06/07/eurheartj.ehq189.abstract
Eur Heart J 2010.
Last Updated: 2010-06-23 9:00:09 -0400 (Reuters Health)
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B-mode US shines in measuring carotid atherosclerosis, September 19, 2008
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
