Assessment of carotid atherosclerotic disease using three-dimensional cardiovascular magnetic resonance vessel wall imaging: comparison with digital subtraction angiography

Abstract

Background: A three-dimensional (3D) cardiovascular magnetic resonance (CMR) vessel wall imaging (VWI) technique based on 3D T1 weighted (T1w) Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions (SPACE) has recently been used as a promising CMR imaging modality for evaluating extracranial and intra-cranial vessel walls. However, this technique is yet to be validated against the current diagnostic imaging standard. We therefore aimed to evaluate the diagnostic performance of 3D CMR VWI in characterizing carotid disease using intra-arterial digital subtraction angiography (DSA) as a reference. Methods: Consecutive patients with at least unilateral > 50% carotid stenosis on ultrasound were scheduled to undergo interventional therapy were invited to participate. The following metrics were measured using 3D CMR VWI and DSA: lumen diameter of the common carotid artery (CCA) and segments C1-C7, stenosis diameter, reference diameter, lesion length, stenosis degree, and ulceration. We assessed the diagnostic sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve of 3D CMR VWI, and used Cohen's kappa, the intraclass correlation coefficient (ICC), and Bland-Altman analyses to assess the diagnostic agreement between 3D CMR VWI and DSA. Results: The ICC (all ICCs ≥0.96) and Bland-Altman plots indicated excellent inter-reader agreement in all individual morphologic measurements by 3D CMR VWI. Excellent agreement in all individual morphologic measurements were also found between 3D CMR VWI and DSA. In addition, 3D CMR VWI had high sensitivity (98.4, 97.4, 80.0, 100.0%), specificity (100.0, 94.5, 99.1, 98.0%), and Cohen's kappa (0.99, 0.89, 0.84, 0.96) for detecting stenosis > 50%, stenosis > 70%, ulceration, and total occlusion, respectively, using DSA as the standard. The AUC of 3D CMR VWI for predicting stenosis > 50 and > 70% were 0.998 and 0.999, respectively. Conclusions: The 3D CMR VWI technique enables accurate diagnosis and luminal feature assessment of carotid artery atherosclerosis, suggesting that this imaging modality may be useful for routine imaging workups and provide comprehensive information for both the vessel wall and lumen.

High-Resolution MR for Follow-Up of Intracranial Steno-Occlusive Disease Treated by Endovascular Treatment

“…High-resolution magnetic resonance (HR-MR) imaging has been recently introduced as a minimally invasive-advanced imaging technique for directly identifying the intracranial arterial wall (11,12), which may correlate with luminal angiography (13)(14)(15). In the recent years, some studies have shown the feasibility of HR-MR in the evaluation and characterization of intracranial atherosclerosis and steno-occlusive lesions (12,16,17). However, data on follow-up after EVT based on HR-MR are limited.…”

Assessment of carotid atherosclerotic plaque using 3D motion- sensitized driven-equilibrium prepared rapid gradient echo: a comparative study

“…The suboptimal performance of DSA in detecting ulceration of symptomatic plaque has been previously reported (38)(39)(40). VW-MRI has high sensitivity, high specificity, and good agreement with DSA for detecting ulceration (29,31). In our study, the plaque ulcerations of some patients were validated by DSA and by histological examination after CEA.…”

“…The systematic differences in Max WT, Max VD, TVA, LA, and plaque volume might be due to the non-circular lumen shape, irregular shape of plaque, and different measurement habits in our study. Some systematic differences in diameter measurements, particularly for large-size vessel segments in other studies were noted (31). Nevertheless, these slight differences had no significant effect on the accuracy of diagnosis.…”

Symptomatic and Asymptomatic Chronic Carotid Artery Occlusion on High-Resolution MR Vessel Wall Imaging

“…VWI for the diagnosis of CCAO has been reported to have high accuracy and sensitivity using DSA as a reference. 15,22,23 A few studies have focused on the signal intensity of the occluded segment of the CCAO. Previous studies have reported a higher prevalence of heterogeneous intensity at the beginning of the occluded segment and a 47.5% presence of high signal intensity in the occluded segment.…”