Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct

Yang, Dandan; Liu, Y.; Han, Yongjun; Li, D.; Wang, W.; Li, Ronghao; Yuan, Chun; Zhao, Xihai

doi:10.3174/ajnr.a6498

Cited by 22 publications

(17 citation statements)

References 36 publications

(34 reference statements)

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“…Since NIRS-derived LCBI can detect only pure LCP without IPH, it might influence the correlation between NIRS-derived LCBI and TOF-SIR. In other words, the lipid component without IPH in TOF-SIR would be indistinguishable from fibrous tissue with low- or iso-SIR because of theoretical signal attenuation, that is, IPH-containing lipids would present high SIR values in TOF-SIR due to the IPH signal [19, 22]. These results suggested that MR plaque imaging might overestimate thromboembolic risk during CAS because the amount of lipid in plaques containing IPH would be masked.…”

Section: Discussionmentioning

confidence: 99%

Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging

Nakagawa¹,

Kotsugi²,

Park³

et al. 2021

Cerebrovasc Dis

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Introduction: Vulnerable plaques are a strong predictor of cerebrovascular ischemic events, and high lipid core plaques (LCPs) are associated with an increased risk of embolic infarcts during carotid artery stenting (CAS). Recent developments in magnetic resonance (MR) plaque imaging have enabled noninvasive assessment of carotid plaque vulnerability, and the lipid component and intraplaque hemorrhage (IPH) are visible as high signal intensity areas on T1-weighted MR images. Recently, catheter-based near-infrared spectroscopy (NIRS) has been shown to accurately distinguish LCPs without IPH. This study aimed to determine whether the results of assessment of high LCPs by catheter-based NIRS correlate with the results of MR plaque imaging. Methods: We recruited 82 consecutive symptomatic carotid artery stenosis patients who were treated with CAS under NIRS and MR plaque assessment. Maximum lipid core burden index (max-LCBI) at minimal luminal areas (MLA), defined as max-LCBIMLA, and max-LCBI for any 4-mm segment in a target lesion, defined as max-LCBIAREA, were assessed by NIRS. Correlations were investigated between max-LCBI and MR T1-weighted plaque signal intensity ratio (T1W-SIR) and MR time-of-flight signal intensity ratio (TOF-SIR) in the same regions as assessed by NIRS. Results: Both T1W-SIRMLA and T1W-SIRAREA were significantly lower in the high LCP group (max-LCBI >504, p < 0.001 for both), while TOF-SIRMLA and TOF-SIRAREA were significantly higher in the high LCP group (p < 0.001 and p = 0.004, respectively). A significant linear correlation was present between max-LCBIMLA and both TIW-SIRMLA and TOF-SIRMLA (r = −0.610 and 0.452, respectively, p < 0.0001 for both). Furthermore, logistic regression analysis revealed that T1W-SIRMLA and TOF-SIRMLA were significantly associated with a high LCP assessed by NIRS (OR, 44.19 and 0.43; 95% CI: 6.55–298.19 and 0.19–0.96; p < 0.001 and = 0.039, respectively). Conclusions: A high LCP assessed by NIRS correlates with the signal intensity ratio of MR imaging in symptomatic patients with unstable carotid plaques.

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Section: Discussionmentioning

confidence: 99%

Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging

Nakagawa¹,

Kotsugi²,

Park³

et al. 2021

Cerebrovasc Dis

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“…Vulnerable plaque in the carotid artery is a critical cause of many cardiovascular diseases like stroke and ischemic attacks (Schinkel et al, 2020). Neovascularization and IPH contribute significantly to the rupture of atherosclerotic plaques (Van der Veken et al, 2016;Demeure et al, 2017;Yang et al, 2020). Wang et al (2020) found that increased carotid neovascularization was significantly related to aggravated cerebral white matter lesions in 269 participants based on CEUS.…”

Section: Discussionmentioning

confidence: 99%

“…Camps-Renom et al (2020) demonstrated that neovascularization was an independent predictor of ischemic stroke recurrence, based on 78 patients with carotid atherosclerosis. Literatures (Mark et al, 2020a,b;Yang et al, 2020) discovered that IPH had a close connection with a high risk of cardiovascular diseases. In addition, Teng et al (2012) found that the computed parameters of stress and strain in a carotid artery plaque increased as the distance between the neovessel and the artery lumen decreased.…”

Section: Discussionmentioning

confidence: 99%

Studying the Factors of Human Carotid Atherosclerotic Plaque Rupture, by Calculating Stress/Strain in the Plaque, Based on CEUS Images: A Numerical Study

Wang

et al. 2020

Front. Neuroinform.

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Carotid plaque neovascularization is one of the major factors for the classification of vulnerable plaque, but the axial force effects of the pulsatile blood flow on the plaque with neovessel and intraplaque hemorrhage was unclear. Together with the severity of stenosis, the fibrous cap thickness, large lipid core, and the neovascularization followed by intraplaque hemorrhage (IPH) have been regarded as high-risk features of plaque rupture. In this work, the effects of these factors were evaluated on the progression and rupture of the carotid atherosclerotic plaques. Five geometries of carotid artery plaque were developed based on contrast-enhanced ultrasound (CEUS) images, which contain two types of neovessel and IPH, and geometry without neovessel and IPH. A one-way fluid-structure interaction model was applied to compute the maximum principal stress and strain in the plaque. For that hyper-elastic and non-linear material, Yeoh 3rd Order strain energy density function was used for components of the plaque. The simulation results indicated that the maximum principal stress of plaque in the carotid artery was higher when the degree of the luminal stenosis increased and the thickness of the fibrous cap decreased. The neovessels within the plaque could introduce a 2.5% increments of deformation in the plaque under the pulsatile blood flow pressure. The IPH also contributed to the increased risk of plaque rupture that a gain of stress was 8.983, 14.526, and 34.47 kPa for the plaque with 50, 65, and 75%, respectively, when comparing stress in the plaque with IPH distributed at the middle to the shoulder of the plaque. In conclusion, neovascularization in the plaque could reduce the stability of the plaque by increasing the stress within the plaque. Also, the risk of plaque rupture increased when large luminal stenosis, thin fibrous cap, and IPH were observed.

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“…It will need to be clarified to which extent the thickness and percent stenosis degree of a hemorrhagic plaque influence its propensity to embolize, and further attention will be drawn on morphological aspects like IPH volume and intensity. 38 It also seems necessary to determine to which degree a hemorrhagic plaque develops inflammatory changes, e.g. through iron deposition, and following endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Plaques in Mild Carotid Stenosis: The Risk of Stroke

Scheffler

Pellaton

Boto

et al. 2020

Can. J. Neurol. Sci.

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Objectives: Embolic ischemic strokes cause significant mortality and morbidity worldwide. It has been proposed that some of these strokes are due to unstable carotid plaques with intraplaque hemorrhage (IPH) but a low overall degree of stenosis. Our aim was to test a fat-saturated T1-weighted (T1WI) black-blood sequence on MRI for the detection of IPH in symptomatic individuals and to quantify the relation between IPH, severity of stenoses, and ischemic brain lesions. Materials and Methods: Sixty-two patients were examined by 3T MRI. Sequences included brain diffusion-weighted imaging (DWI) as well as 3D turbo spin echo (TSE) fat-saturated black-blood T1 of the carotid bifurcations, to detect IPH as a focal intraplaque hyperintensity. Both carotid arteries were analyzed in each patient. The North American Symptomatic Carotid Endarterectomy Trial scale was used for quantification of stenosis degree. Results: Thirty-six out of 62 patients (mean age, 74) showed brain ischemia on DWI. Fifteen of these 36 patients (42%) had associated ipsilateral IPH at the carotid bifurcation or the proximal internal carotid artery. Mean degree of stenosis in this group was 50%. In 21 patients with ischemia without IPH, the mean degree of stenosis was 44%. Conclusions: MRI with 3D TSE fat-saturated black-blood T1 technique is a safe, reliable, and noninvasive tool for the detection of IPH. A high percentage (42%) of ischemic events in patients with low- to moderate-degree stenosis were associated with IPH, an easily detectable imaging biomarker of plaque vulnerability. The ability to confirm IPH by MRI may help stratify patients into different risk and treatment groups in the future.

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Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct

Cited by 22 publications

References 36 publications

Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging

Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging

Studying the Factors of Human Carotid Atherosclerotic Plaque Rupture, by Calculating Stress/Strain in the Plaque, Based on CEUS Images: A Numerical Study

Hemorrhagic Plaques in Mild Carotid Stenosis: The Risk of Stroke

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