MRI of carotid atherosclerosis: clinical implications and future directions

Underhill, Hunter R.; Hatsukami, Thomas S.; Fayad, Zahi A.; Fuster, Valentín; Yuan, Chun

doi:10.1038/nrcardio.2009.246

Cited by 144 publications

(123 citation statements)

References 107 publications

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“…Our observation of the change in focal enhancement was higher than the data reported by van der Kolk et al 7 (57% vs. 29%); there were differences in terms of numbers of patients (7 vs. 28), observation period (7 vs. 2 months), and MRI (3-vs. 7-Tesla).…”

Section: Discussioncontrasting

confidence: 56%

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Contrast-Enhanced High-Resolution MRI for Evaluating Time Course Changes in Middle Cerebral Artery Plaques

et al. 2018

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Background and Purpose: It is clinically important to evaluate time course changes in symptomatic middle cerebral artery (MCA) stenotic plaques because of likely recurrence. The objective of this study is to determine whether contrast-enhanced high-resolution magnetic resonance imaging (MRI) is a feasible method for this purpose.Methods: Contrast-enhanced, high-resolution, 3D turbo spin-echo images with low refocusing flip angle control (3D LOWRAT) applied to 7 patients with symptomatic MCA stenosis were evaluated at the initial (1 month after stroke onset) and follow-up (7 months after stroke onset) stages, and statistical variables, including plaque-to-thalamus signal intensity ratio, degree of stenosis, and stroke recurrence obtained at the 2 stages, were compared. Stenotic change at the initial stage was compared to that at the follow-up stage using MR angiography.Results: In 4 of the 7 patients, the signal intensity ratio measured at the follow-up stage was lower than that measured at the initial stage and in 1 patient, the stenosis subsequently improved. We used a ChiSquare Test. In the other 3 patients, the signal intensity ratios did not differ between the 2 stages, and ischemic stroke occurred in 2 of these 3 patients. Conclusion:Gadolinium contrast enhancement was found to be useful for effective evaluation of time course changes in the stability of symptomatic MCA stenotic plaques. (J Nippon Med Sch 2018; 85: 28 33)

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Section: Discussioncontrasting

confidence: 56%

“…These plaque characteristics will help clinicians to estimate the vulnerability of the culprit lesion, and possibly to predict future vascular events 7,8 . Little data so far support the prognostic value of MRI to predict future stroke.…”

Section: Introductionmentioning

confidence: 99%

Contrast-Enhanced High-Resolution MRI for Evaluating Time Course Changes in Middle Cerebral Artery Plaques

et al. 2018

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“…Third, MRI cannot provide an evaluation of vessel diameter due to poor image quality because of motion artifacts in approximately 5% of patients. Moreover, although the accuracy of highresolution MRI for CA plaque characterization has been firmly established, 30 such accuracy has not yet been established for evaluating the vessel outer wall. Expansive remodeling assessment with MRI requires further valida-tion by comparison studies with intraoperative vessel wall measurements and preoperative assessment of the ER ratio in patients undergoing CEA.…”

Section: Discussionmentioning

confidence: 99%

The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation

Yoshida

Fukumitsu

Kurosaki

et al. 2015

JNS

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OBJECT The purpose of the present study was to investigate the association between carotid artery (CA) expansive remodeling (ER) and symptoms of cerebral ischemia. METHODS One hundred twenty-two consecutive CAs scheduled for CA endarterectomy (CEA) or CA stent placement (CAS) were retrospectively studied. After excluding 22 CAs (2 were contraindicated for MRI, 8 had near-occlusion, 6 had poor image quality, and 6 had restenosis after CEA or CAS), there were 100 CAs (100 patients) included in the final analysis. The study included 50 symptomatic patients (mean age 73.6 ± 8.9 years, 6 women, mean stenosis 68.5% ± 21.3%) and 50 asymptomatic patients (mean age 72.0 ± 5.9 years, 5 women, mean stenosis 79.4% ± 8.85%). Expansive remodeling was defined as enlargement of the internal carotid artery (ICA) with outward plaque growth. The ER ratio was calculated by dividing the maximum distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA by the maximal luminal diameter of the distal ICA at a region unaffected by atherosclerosis using long-axis, high-resolution MRI. RESULTS The ER ratio of the atherosclerotic CA was significantly greater than that of normal physiological expansion (carotid bulb; p < 0.01). The ER ratio of symptomatic CA stenosis (median 1.94, interquartile range [IQR] 1.58–2.23) was significantly greater than that of asymptomatic CA stenosis (median 1.52, IQR 1.34–1.81; p = 0.0001). When the cutoff value of the ER ratio was set to 1.88, the sensitivity and specificity to detect symptoms were 0.6 and 0.78, respectively. The ER ratio of symptomatic patients was consistently high regardless of the degree of stenosis. CONCLUSIONS There was a significant correlation between ER ratio and ischemic symptoms. The ER ratio might be a potential indicator of vulnerable plaque, which requires further validation by prospective observational study of asymptomatic patients.

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“…Many efforts have been recently made using non-invasive techniques [8][9][10][11][12] for identifying plaques at high risk of disruption leading to thrombosis, generally defined as "vulnerable plaques" [13,14]. These latter lesions are characterized by a large necrotic core with an overlying thin cap rich in inflammatory cells.…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic carotid plaque rupture with unexpected thrombosis over a non-canonical vulnerable lesion

et al. 2011

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a b s t r a c tObjective: Several studies have demonstrated that carotid plaque rupture and thrombosis represent the most important factors correlated with the onset of acute cerebrovascular symptoms. Nevertheless, ruptured thrombotic plaques have been described also in asymptomatic patients. What still needs to be clarified is why a plaque rupture leads either to an acute ischemic syndrome or, in a minor group of patients, remains asymptomatic. The purpose of this study was to systematically compare the histologic features of thrombotic plaques both in asymptomatic and symptomatic patients in order to identify specific findings that could explain the peculiar clinical behavior that characterizes each of the clinical settings. Methods: A total of 157 thrombotic plaques from 60 asymptomatic patients and 97 with major stroke who consecutively underwent CEA were serially sectioned and studied by histology. Results: A minute cap disruption very frequently characterizes thrombotic plaques of asymptomatic patients and it was always smaller than large ulcers observed in thrombotic symptomatic plaques (651 ± 687 m vs. 4150 ± 3526, p = 0.001). In asymptomatics this typical feature was associated with fewer inflammatory cells (20.1 ± 8.8 vs. 33.9 ± 26.1 cells × hpf, p = 0.001), smaller lipidic-necrotic core (33.9% ± 2.9% vs. 42.0% ± 2.4%; p = 0.04) and larger calcification (16.2 ± 12.8% vs. 8.1 ± 12.2%, p = 0.02). Symptomatic patients with thrombotic plaques showed higher incidence of metabolic syndrome (p = 0.002) and moderate-high Framingham risk scores (p = 0.001) comparing to asymptomatic individuals. Conclusion: The transformation from a stable to a vulnerable plaque is a gradual process in the natural history of the disease and plaque rupture is an event not necessarily occurring at a late phase but also at earlier one. In this case, the rupture will be most likely smaller and clinically asymptomatic.

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MRI of carotid atherosclerosis: clinical implications and future directions

Cited by 144 publications

References 107 publications

Contrast-Enhanced High-Resolution MRI for Evaluating Time Course Changes in Middle Cerebral Artery Plaques

Contrast-Enhanced High-Resolution MRI for Evaluating Time Course Changes in Middle Cerebral Artery Plaques

The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation

Asymptomatic carotid plaque rupture with unexpected thrombosis over a non-canonical vulnerable lesion

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