Subclinical Carotid Atherosclerosis: Short-term Natural History of Lipid-rich Necrotic Core—A Multicenter Study with MR Imaging

Sun, Jie; Balu, Niranjan; Hippe, Daniel S.; Xue, Yi; Dong, Li; Zhao, Xihai; Li, Feiyu; Xu, Dongxiang; Hatsukami, Thomas S.; Yuan, Chun

doi:10.1148/radiol.13121702

Cited by 57 publications

(40 citation statements)

References 45 publications

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“…With such a design, reader variability in drawing contours is reduced, and artifacts from unsuppressed flow or partial volume are more consistently interpreted. Consequently, biological differences on plaque composition between serial images can be detected more readily [6–8]. Additionally, our data indicated that smaller LRNCs were associated with lower kappa and larger CV, which was not shown in previous studies of smaller sample size.…”

Section: Discussioncontrasting

confidence: 44%

Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study

Sun

Zhao

Balu

et al. 2014

Int J Cardiovasc Imaging

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This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98–0.99) and compositional (ICC range 0.88–0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5–4.9 % for morphology, 36–44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.

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Section: Discussioncontrasting

confidence: 44%

Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study

Sun

Zhao

Balu

et al. 2014

Int J Cardiovasc Imaging

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“…Natural history studies showed that most ischemic strokes due to carotid atherosclerosis occurred in the presence of IPH, whereas the short-to-midterm stroke risk in the absence of IPH was minimal (6,27). Thus, the potential effect of IPH-targeted diagnosis and therapeutics on the residual cardiovascular risk under the current standard of care is considerable (28). …”

Section: Discussionmentioning

confidence: 99%

Carotid Intraplaque Hemorrhage Imaging with Quantitative Vessel Wall T1 Mapping: Technical Development and Initial Experience

Sun

Qiao

et al. 2018

Radiology

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Purpose To develop a three-dimensional (3D) high-spatial-resolution time-efficient sequence for use in quantitative vessel wall T1 mapping. Materials and Methods A previously described sequence, simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging, was extended by introducing 3D golden angle radial k-space sampling (GOAL-SNAP). Sliding window reconstruction was adopted to reconstruct images at different inversion delay times (different T1 contrasts) for voxelwise T1 fitting. Phantom studies were performed to test the accuracy of T1 mapping with GOAL-SNAP against a two-dimensional inversion recovery (IR) spin-echo (SE) sequence. In vivo studies were performed in six healthy volunteers (mean age, 27.8 years ± 3.0 [standard deviation]; age range, 24–32 years; five male) and five patients with atherosclerosis (mean age, 66.4 years ± 5.5; range, 60–73 years; five male) to compare T1 measurements between vessel wall sections (five per artery) with and without intraplaque hemorrhage (IPH). Statistical analyses included Pearson correlation coefficient, Bland-Altman analysis, and Wilcoxon rank-sum test with data permutation by subject. Results Phantom T1 measurements with GOAL-SNAP and IR SE sequences showed excellent correlation (R2 = 0.99), with a mean bias of −25.8 msec ± 43.6 and a mean percentage error of 4.3% ± 2.5. Minimum T1 was significantly different between sections with IPH and those without it (mean, 371 msec ± 93 vs 944 msec ± 120; P = .01). Estimated T1 of normal vessel wall and muscle were 1195 msec ± 136 and 1117 msec ± 153, respectively. Conclusion High-spatial-resolution (0.8 mm isotropic) time-efficient (5 minutes) vessel wall T1 mapping is achieved by using the GOAL-SNAP sequence. This sequence may yield more quantitative reproducible biomarkers with which to characterize IPH and monitor its progression.

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“…[4][5][6][7] Xu et al 12 reported that the occurrence rate of high-intensity signal was significantly different between symptomatic and asymptomatic MCAs. In our study, MR-positive IPHs within BA plaques were found in 30 patients (42.3%).…”

Section: Discussionmentioning

confidence: 99%

Association of Intraplaque Hemorrhage and Acute Infarction in Patients With Basilar Artery Plaque

Kwak

Chung

et al. 2015

Stroke

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Background and Purpose-High-resolution magnetic resonance imaging (HRMRI) is ideal for serial examination of diseased arterial walls because it is noninvasive and has superior capability of discriminating tissue characteristics. The aim of this study is to evaluate the prevalence and clinical relevance of intraplaque hemorrhage (IPH) in patients with basilar artery (BA) atherosclerosis using HRMRI. Methods-We analyzed HRMRI and clinical data from 74 patients (45 symptomatic and 29 asymptomatic), all of whom had >50% BA stenosis. High-signal intensity within a BA plaque on magnetization-prepared rapid acquisition with gradientecho was defined as an area with an intensity that was >150% of the signal from the adjacent muscle. The relationship between IPH within a BA plaque region and clinical presentation was analyzed. Results-Thirty patients were positive for IPH on HRMRI (42.3%, 24 symptomatic and 6 asymptomatic). Symptomatic lesions in the MR-positive IPH group were significantly more prevalent than in the MR-negative group (80.0% versus 48.8%; P<0.01). Also, MR-predicted IPH was significantly more prevalent in the high-grade stenosis group (P<0.001) than in the low-grade group. The relative risk of an acute focal stroke event among patients who were magnetizationprepared rapid acquisition with gradient-echo-positive for IPH compared with patients who were magnetization-prepared rapid acquisition with gradient-echo-negative was 1.64. Conclusions--IPH within a BA plaque region on HRMRI is highly prevalent and is associated with acute stroke.

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Subclinical Carotid Atherosclerosis: Short-term Natural History of Lipid-rich Necrotic Core—A Multicenter Study with MR Imaging

Cited by 57 publications

References 45 publications

Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study

Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study

Carotid Intraplaque Hemorrhage Imaging with Quantitative Vessel Wall T1 Mapping: Technical Development and Initial Experience

Association of Intraplaque Hemorrhage and Acute Infarction in Patients With Basilar Artery Plaque

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