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PLAQUE CHARACTERIZATION AND COMPOSITION What is plaque character and composition? Plaque is either hypoechoic or hyperechoic, homogenous or heterogenous in character. For anatomic plaque evaluation the criteria of several authors provide a subjective diagnosis of plaque characteristics. There are different ways in which to categorize plaque. Plaque is considered homogenous if all of the echoes are of the same amplitude (hypoechoic or hyperechoic). There have been no documented cases of a hyperechoic lesion that appeared completely homogeneous. The plaque is heterogeneous if echoes are of unequal amplitudes (hypoechoic and hyperechoic). This type of lesion may be in the pre- complex stage of development. Plaque is characterized as complex when calcified formations involve the luminal arterial walls or the plaque itself. If any concave areas or craters measure at least 1mm by 2mm, they are considered complex and are suspicious of ulceration. If an anechoic area is present it must be considered complex also. Anechoic areas appear as an echolucent space between the intima and the plaque surfaces. The  longitudinal view should produce echogenic connections at the proximal and distal ends. If the proximal, distal, or both ends ail to have a complete echogenic connection to an adjacent structure it is labeled “lipping”. When plaque has both proximal and distal lipping, the presence of ulceration is highly probable, even if no crater or concaved area is present. This phenomenon has been reported in the literature in 1-15% stenosis and the 16-49% stenosis WHICH IS IMPORTANT, IF THE PATIENT IS SYMPTOMATIC. Here are some examples of complex plaque with ulceration, proximal and distal lipping. | 
