Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: An in vivo 3T MRI study

Hideki Ota, Wei Yu, Hunter R. Underhill, Minako Oikawa, Li Dong, Xihai Zhao, Nayak L. Polissar, Blazej Neradilek, Tianli Gao, Zhuo Zhang, Zixu Yan, Miao Guo, Zhaoqi Zhang, Thomas S. Hatsukami, Chun Yuan

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)


OBJECTIVE-: Histological studies suggest associations between hemorrhage and large lipid-rich/necrotic cores with thin or ruptured fibrous caps in advanced atherosclerosis. We investigated these associations in carotid arteries with mild to severe stenosis by in vivo 3T MRI. METHODS AND RESULTS-: Seventy-seven patients with ≥50% carotid stenosis in at least one side by duplex ultrasound underwent bilateral multi-contrast carotid MRI scans. Measurements for wall and lipid-rich/necrotic core sizes, presence of hemorrhage, and fibrous cap status (classified as intact thick, intact thin or ruptured) were recorded. Arteries with poor image quality, occlusion, or no detectable lipid-rich/necrotic core were excluded. For the 798 MRI slices included, multivariate ordinal regression analysis demonstrated larger %lipid-rich/necrotic core (odds ratio for 10% increase, 1.49; P=0.02) and presence of hemorrhage (odds ratio, 5.91; P<0.001) were independently associated with a worse (intact thin or ruptured) stage of fibrous cap status. For artery-based multivariate analysis, a larger maximum %lipid-rich/necrotic core and presence of hemorrhage independently associated with worse fibrous cap status (P<0.001, for both). No hemorrhage was detected in arteries with thick fibrous caps. CONCLUSION-: Hemorrhage and larger %lipid-rich/necrotic core were independently associated with a thin or ruptured fibrous cap status at an early to advanced stage of carotid atherosclerosis.

Original languageEnglish
Pages (from-to)1696-1701
Number of pages6
JournalArteriosclerosis, thrombosis, and vascular biology
Issue number10
Publication statusPublished - 2009 Oct
Externally publishedYes


  • Carotid artery
  • Fibrous cap rupture
  • Hemorrhage
  • Lipid-rich necrotic core
  • MRI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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