Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity

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OBJECT

Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity.

METHODS

Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI< 1.40 and ERR ≥ 1.66; Group C = rSI 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group.

RESULTS

Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01).

CONCLUSIONS

In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, which should be validated by a prospective, randomized study of asymptomatic patients.

ABBREVIATIONSBB = black blood; CAS = carotid artery stenting; CE = contrast enhanced; CEA = carotid endarterectomy; ERR = expansive remodeling ratio; ICA = internal carotid artery; IPH = intraplaque hemorrhage; rSI = relative plaque signal intensity; VD = vessel diameter.

Article Information

Correspondence Yoshitaka Kurosaki, Department of Neurosurgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki City, Okayama 710-8602, Japan. email: kurosaki0106@gmail.com.

INCLUDE WHEN CITING Published online September 11, 2015; DOI: 10.3171/2015.2.JNS142783.

Disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Measurement of rSI in the carotid artery (CA) using axial, high-resolution MRI. The rSI is measured with the region of interest drawn over the whole plaque except for the lumen with reference to the sternocleidomastoid muscle (SCM). The rSI in this symptomatic patient is 1.73.

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    Measurement of the ERR in the carotid artery using long-axis, high-resolution MRI. The ERR is calculated as the ratio of the maximal outside diameter of the atherosclerotic ICA near the carotid bulb (a) and the maximal outside diameter of the ICA well beyond the plaque (b). The ERR in this symptomatic patient is 2.79.

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    Grouping based on rSI and ERR.

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    Relationships among the 4 groups with respect to the numbers of patients with ipsilateral ischemic events within 6 months. The number of patients with ipsilateral ischemic events was significantly higher in Group A than in Group D (p = 0.01), and it was relatively higher in Group A than in Groups B (p = 0.058) and C (p = 0.056).

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