High-Resolution MRI of Carotid Plaque With a Neurovascular Coil and Contrast-Enhanced MR Angiography: One-Stop Shopping for the Comprehensive Assessment of Carotid Atherosclerosis

The objective of our study was to assess a protocol of study of carotid atherosclerosis coupling vascular wall imaging and luminal imaging in the same examination and to evaluate the accuracy of high-resolution MRI with a neurovascular coil in carotid plaque characterization. Thirty-two consecutive...

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Bibliographic Details
Published in:	American journal of roentgenology (1976) Vol. 196; no. 5; pp. 1164 - 1171
Main Authors:	TARTARI, Stefano, RIZZATI, Roberto, RIGHI, Riccardo, DELEDDA, Anna, CAPELLO, Katia, SOVERINI, Riccardo, BENEA, Giorgio
Format:	Journal Article
Language:	English
Published:	Reston, VA American Roentgen Ray Society 01-05-2011
Subjects:	Aged Aged, 80 and over Atherosclerosis (general aspects, experimental research) Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cardiovascular system Carotid Artery Diseases - diagnosis Carotid Artery Diseases - surgery Contrast Media Feasibility Studies Female Gadolinium Humans Investigative techniques, diagnostic techniques (general aspects) Magnetic Resonance Imaging - instrumentation Magnetic Resonance Imaging - methods Male Medical sciences Middle Aged Organometallic Compounds Plaque, Atherosclerotic - diagnosis Plaque, Atherosclerotic - surgery Predictive Value of Tests Prospective Studies Radiodiagnosis. Nmr imagery. Nmr spectrometry Reproducibility of Results High resolution MRI Cardiovascular disease plaque imaging carotid arteries Nuclear magnetic resonance imaging Artery Coil Vascular disease diffusion-weighted imaging Blood vessel Carotid Atherosclerosis Medical imagery THRIVE sequence Circulatory system NMR angiography
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Summary:	The objective of our study was to assess a protocol of study of carotid atherosclerosis coupling vascular wall imaging and luminal imaging in the same examination and to evaluate the accuracy of high-resolution MRI with a neurovascular coil in carotid plaque characterization. Thirty-two consecutive patients with 34 carotid artery stenoses were prospectively enrolled. MRI was performed on a 1.5-T unit. Plaque assessment was performed starting with a diffusion-weighted sequence and followed by a fat-suppressed T1-weighted sequence; after contrast-enhanced MR angiography (CE-MRA), all patients were evaluated with a T1-weighted 3D high-resolution sequence. Carotid plaques were classified as type A, having a large lipid-necrotic core; type B, being a complex fibrotic-calcified plaque with soft content (mixed plaque); or type C, being a fibrotic-calcified plaque (hard). Additional features indicative of vulnerable plaque such as intraplaque hemorrhage (IPH), ulceration, and severe stenosis were registered. MR findings were compared with surgical specimens. MRI correctly identified 11 of 13 type A, eight of 11 type B, and eight of 10 type C plaques (sensitivity, 84.6%, 72.7%, and 80%, respectively). In the identification of lipid-necrotic core plaque, MRI showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.6%, 100%, 100%, and 91.3%, respectively (κ = 0.87). For reordering all plaques in two groups (i.e., soft vs nonsoft) in the identification of soft plaques, MRI had a sensitivity, specificity, PPV, and NPV of 83.3%, 80%, 90.9%, and 66.7%, respectively (κ = 0.59). IPH, ulcers, and severe stenosis were detected in eight of eight, 11 of 13, and 25 of 25 cases, respectively. In patients with carotid atherosclerosis, ongoing CE-MRA with a neurovascular coil for the simultaneous detection of unstable plaques is feasible. Our MR protocol accurately identifies the major features of vulnerable plaque.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0361-803X 1546-3141
DOI:	10.2214/AJR.10.4751