Diagnostic Value of Magnetic Resonance Imaging in Evaluating Carotid Artery Atherosclerotic Plaque Morphology

Yıl 2022, Cilt: 5 Sayı: 1, 1 - 8, 01.01.2022

Feyza Sönmez Topcu , Süleyman Men Merih Durak

https://doi.org/10.19127/bshealthscience.926670

Öz

Magnetic Resonance Imaging has the ability to describe vessel wall thickness, plaque structure, distinguish fibrotic, fatty, calcific or hemorrhagic plaque contents with excellent soft tissue contrast. Our aim in this study is to determine symptomatic and asymptomatic carotid plaque morphology and imaging properties. We tried to understand whether plaque components in images match with histopathological sections. MRI was performed in 37 patients known to have carotid stenosis and endarterectomy decision has been taken. 24 patients were symptomatic and 13 were asymptomatic for carotid disease. A surface coil used in MRI; 5 cm of carotid segment was imaged with the carotid bifurcation in the middle. Necrotic core, fibrous cap, hemorrhage, calcification and intraluminal thrombus were determined in MR images. After surgery, the specimens were evaluated by a pathologist who was blind to the radiological findings. All plaque contents (necrotic core, hemorrhage, calcification and fibrous cap) can be imaged and separated from each-other with MRI. Necrotic core was detected in 87.9% of patients on MR images. No significant difference was found between symptomatic and asymptomatic cases in terms of the rate and dimensions of necrotic core on MRI. The presence of calcification did not show a significant difference between symptomatic and asymptomatic cases. The sensitivity of MRI in detecting in-plaque hemorrhage was calculated as 82.3% and specificity as 68.75%. The calculated rates were interpreted as MRI is significant in distinguishing cases without bleeding. Fibrous cap was more preserved in asymptomatic patients. The structure of the atheroma plaque can be imaged and distinguished from each other with MRI. The statistical results did not show the expected performance mainly due to the small number of asymptomatic cases, which was the main limitation of the study.

Anahtar Kelimeler

Carotid plaque, Plaque morphology, Vulnerable plaque, Magnetic resonance imaging

Kaynakça

• Bassiouny HS, Sakaguchi Y, Mikucki SA. 1997. Juxtalumenal location of plaquenecrosis and neoformation in symptomatic carotid stenosis. J Vasc Surg, 26: 585-594.
• Caliste X, Laser AR, Darling I, Cea C. 2020. Stent in patients with acute strokes: are they equally effective? J Cardiovasc Surg, 61(2):133-142.
• Chu B, Kampschulte A, Ferguson MS. 2004. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke, 35: 1079-1084.
• Edelman RR, Mattle HP, Wallner B, Bajakian R, Kleefield J, Kent C, Skillman JJ, Mendel JB, Atkinson DJ. 1990. Extracranial carotid arteries: evaluation with ‘black blood’ MR angiography. Radiology, 177: 45-50.
• Falk E. 1992. Why do plaques rupture? Circulation, 86(6): III30–III42.
• Fayad ZA. 2002. Noncoronary and coronary atherothrombotic plaque imaging and monitoring of therapy by MRI. Neuroimag Clin, 12: 461-471.
• Gronholdt ML, Nordestgaard BG, Schroeder TV. 2001. Ultrasonic echolucent carotid plaques predict future strokes. Circulation, 104: 68-73.
• Hatsukami TS, Ross R, Polissar NL, Yuan C. 2000. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation, 102: 959-964.
• Hayes CE, Mathis CM, Yuan C. 1996. Surface coil phased arrays for high resolution imaging of the carotid arteries. J Magn Reson Imag, 6: 109-112.
• Jackson MR, Chang AS, Robles HA, Gillespie DL, Olsen SB, Kaiser WJ, Goff JM, O’Donnell SD, Rich NM. 1998. Determination of 60% or greater carotid stenosis: a prospective comparison of magnetic resonance angiography and duplex ultrasound with conventional angiography. Ann Vasc Surg, 12: 236-243.
• Jianming C, Thomas S, Hatsukami S. 2005. In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology. Circulation, 112: 3437-3444.
• Kampschulte A, Ferguson MS, Kerwin WS. 2004. Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging. Circulation, 110: 3239-3244.
• Kerwin W, Xu D, Liu F, Saam T, Underhill H, Norihide T, Chu B, Hatsukami T, Yuan C. 2007. Magnetic resonance imaging of carotid atherosclerosis plaque analysis. Top Magn Reson Imag, 18: 371-378.
• Kolodgie FD, Nakazawa G, Sangiorgi G, Ladich E, Burke AP, Virmani R. 2007. Pathology of atherosclerosis and stenting. Neuroimag Clin North America, 2007: 285-301.
• Redgrave NE, Lovett JK, Gallagher PJ. Rothwell PM. 2006. Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: The Oxford plaque study. Circulation, 113: 2320-2328.
• Roemer PB, Edelstein WA, Hayes CE, Souza SP, Mueller OM. 1990. The NMR phased array. Magn Reson Med, 16: 192-225.
• Rosamond W, Flegal K, Friday G. 2007. Heart disease and stroke statistics 2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 115: 165-171.
• Saam T, Ferguson MS, Yarnykh VL. 2005. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol, 25: 234-239.
• Saam T, Cai J, Ma L. 2006a. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology, 240(2): 464-472.
• Saam T, Jianming C, Ma L, Cai YQ, Ferguson MS, Polissar NL, Hatsukami TS, Yuan C. 2006b. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology, 240: 464-472.
• Simonetti OP, Finn JP, White RD, Laub G, Henry DA. 1996. “Black blood” T2-weighted inversion-recovery MR imaging of the heart. Radiology, 1996: 49-57.
• Takaya N, Yuan C, Chu B. 2006. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRIVinitial results. Stroke, 37: 818-823.
• Thom T, Haase N, Rosamond W. 2006. Heart disease and stroke statistics–2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 113: e85-e151.
• Townsend TC, Saloner D, Pan XM, Rapp JH. 2003. Contrast material-enhanced MRA overestimates severity of carotid stenosis, compared with 3D time-of-flight MRA. J Vasc Surg, 38: 36-40.
• URL1: http://strokecenter.org (access date: October 07, 2019).
• Wasserman BA, Smith WI, Trout HH III, Cannon RO III, Balaban RS, Arai AE. 2002. Carotid artery atherosclerosis: in vivo morphologic characterization with gadolinium-enhanced double-oblique MR imaging initial results. Radiology, 223: 566-573.
• Yamada N, Higashi M, Otsubo R. 2007. Association between signal hyperintensity on T1-weighted MR imaging of carotid plaques and ipsilateral ischemic events. AJNR Am J Neuroradiol, 28: 287-292.
• Yuan C, Mitsumori LM, Ferguson MS. 2001. In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. Circulation, 104: 2051-2056.
• Yuan C, Zhang SX, Polissar NL. 2002. Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation, 105: 181-185.