Comparison of symptomatic and asymptomatic atherosclerotic carotid plaques using parallel imaging and 3 T black-blood in vivo CMR

Journal of Cardiovascular Magnetic Resonance

Tobias Saam³  Konstantin Nikolaou⁵  Caroline Freilinger²  Martin Dichgans⁴  Maximilian F Reiser⁵  Chun Yuan¹  Fabian Bamberg⁵  Clemens C Cyran⁵  Tobias Freilinger²  Andreas Schindler⁵  Jochen M Grimm⁵ 

[1] Department of Radiology, University of WashingtonSchool of Medicine, Seattle, USA;Department of Neurology, Ludwig-Maximilians-University Hospital, Munich, Germany;Institute of Clinical Radiology, University of Munich, Pettenkoferstr 8a, Munich, 80336, Germany;Institute for Stroke and Dementia Research, Ludwig-Maximilians-UniversityHospital, Munich, Germany;Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany

关键词: Atherosclerosis;    Vulnerable plaque;    Ischemic stroke;    Cardiovascular MR;    Plaque imaging;   

Others  :  829301
DOI  :  10.1186/1532-429X-15-44

 received in 2012-11-22, accepted in 2013-04-15,  发布年份 2013

【 摘 要 】

Background

To determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients.

Methods

In this prospective monocentric observational study 34 patients (24 males; 70 ±9.3 years) with symptomatic carotid disease defined as ischemic brain lesions in one internal carotid artery territory on diffusion weighted images underwent a carotid bb-CMR at 3 T with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques (PAT factor = 2) within 10 days after symptom onset. All patients underwent extensive clinical workup (lab, brain MR, duplex sonography, 24-hour ECG, transesophageal echocardiography) to exclude other causes of ischemic stroke. Prevalence of American Heart Association lesion type VI (AHA-LT6), status of the fibrous cap, presence of hemorrhage/thrombus and area measurements of calcification, necrotic core and hemorrhage were determined in both carotid arteries in consensus by two reviewers who were blinded to clinical information. McNemar and Wilcoxon's signed rank tests were use for statistical comparison. A p-value <0.05 was considered statistically significant.

Results

Symptomatic plaques showed a higher prevalence of AHA-LT6 (67.7% vs. 11.8%; p < 0.001; odds ratio = 12.5), ruptured fibrous caps (44.1% vs. 2.9%; p < 0.001; odds ratio = 15.0), juxtaluminal thrombus (26.5 vs. 0%; p < 0.01; odds ratio = 7.3) and intraplaque hemorrhage (58.6% vs. 11.8%; p = 0.01; odds ratio = 3.8). Necrotic core and hemorrhage areas were greater in symptomatic plaques (14.1 mm² vs. 5.5 mm² and 13.6 mm² vs. 5.3 mm²; p < 0.01, respectively).

Conclusion

3 T bb-CMR is able to differentiate between symptomatic and asymptomatic carotid plaques, demonstrating the potential of bb-CMR to differentiate between stable and vulnerable lesions and ultimately to identify patients with low versus high risk for cardiovascular complications. Best predictors of the symptomatic side were a ruptured fibrous cap, AHA-LT 6, juxtaluminal hemorrhage/thrombus, and intraplaque hemorrhage.

【 授权许可】

   
2013 Grimm et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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