LAUSR

&NA; Features of vulnerable plaque include a high lipid content, an irregular shape, a thin fibrous cap, and neovascularization, but such lesions often fall into the category of nonstenotic, despite being at high risk for rupture, and therefore may be overlooked. In this review, the authors describe state‐of‐the‐art investigative ultrasound methods to assess the activity, quality, and morphology of atherosclerotic plaque to determine vulnerability. Specifically, the authors focus on carotid artery plaque, describing the assessment of plaque activity through the detection of neovascularization using contrast‐enhanced ultrasound, the characterization of plaque quality by advanced grayscale and integrated backscatter analysis methods, and the assessment of plaque morphology using three‐dimensional ultrasound. HighlightsIdentification of vulnerable plaque features is a growing priority.The authors review advances in carotid ultrasound methods that detect these features.Three‐dimensional ultrasound can quantify plaque size and shape.Grayscale and integrated backscatter analysis can characterize plaque composition.Contrast enhancement methods can image neovascularization and inflammation.