Discriminating carotid atherosclerotic lesion severity by luminal stenosis and plaque burden: A comparison utilizing high-resolution magnetic resonance imaging at 3.0 tesla

Xihai Zhao, Hunter R. Underhill, Qian Zhao, Jianming Cai, Feiyu Li, Minako Oikawa, Li Dong, Hideki Ota, Thomas S. Hatsukami, Baocheng Chu, Chun Yuan

Research output: Contribution to journalArticlepeer-review

54 Citations (Scopus)

Abstract

Background and Purpose- To determine associations between stenosis, measures of plaque burden, and compositional features of carotid atherosclerosis, including high-risk features of intraplaque hemorrhage (IPH) and surface disruption. Methods- Institutional Review Board approval and informed consent for all participants were obtained before study initiation. Patients with either carotid stenosis >50% by duplex ultrasound or suspected coronary artery disease underwent multi-contrast carotid MRI at 3.0 T. For each artery, stenosis, percent wall volume (PWV=100%×wall volume/total vessel volume), and mean wall thickness (MWT) were measured. Presence or absence of a lipid-rich necrotic core, calcification, IPH, and surface disruption were recorded. Results- One hundred eighty-one patients were included in the final analysis. The area under the curve (AUC) calculated from receiver-operating- characteristics analysis found the presence of IPH was similarly classified by stenosis (AUC=0.82), PWV (AUC=0.88), and MWT (AUC=0.88). Notably, IPH was present in the lowest category of each parameter. Prevalence of IPH in arteries with 0% stenosis was 4.4%. In arteries with PWV <40%, prevalence was 3.2%; in arteries with MWT <1.0 mm, prevalence was 2.3%. Strength of classification for surface disruption was similarly classified by stenosis (AUC=0.87), PWV (AUC=0.93), and MWT (AUC=0.94). Conclusions- Measures of plaque burden do not substantially improve disease assessment compared to stenosis. The finding of IPH in all categories of stenosis and plaque burden suggests that direct characterization of plaque composition and surface status is necessary to fully discriminate disease severity.

Original languageEnglish
Pages (from-to)347-353
Number of pages7
JournalStroke
Volume42
Issue number2
DOIs
Publication statusPublished - 2011 Feb
Externally publishedYes

Keywords

  • atherosclerosis
  • carotid artery
  • magnetic resonance imaging
  • plaque burden
  • stenosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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