Carotid plaque composition and cerebral infarction: MR imaging study
Mohamed Ouhlous1, H Zwenneke Flach, Thomas T de Weert
1Department of Radiology, Erasmus MC, Rotterdam, the Netherlands.
Insights
Atherosclerotic plaque composition, particularly lipid cores, is linked to ischemic cerebral lesions in patients with carotid artery stenosis. MR imaging can assess plaque characteristics and their association with stroke risk.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Carotid artery stenosis severity is a known stroke risk factor.
- Atherosclerotic plaque composition also influences cerebral symptom development.
- Understanding plaque characteristics is crucial for assessing stroke risk.
Purpose of the Study:
- To investigate the relationship between carotid artery bifurcation plaque composition and ipsilateral ischemic cerebral lesions.
- To determine if MR imaging can identify plaque features associated with stroke.
Main Methods:
- 41 patients with >70% symptomatic carotid artery stenosis were studied.
- Black-blood, fast spin-echo MR imaging of carotid arteries and t-FLAIR MR imaging of the brain were performed.
- Lipid cores were identified by signal intensity changes on MR imaging; infarcts were assessed on brain MRIs.
Main Results:
- Lipid cores were present in 25 patients (61%).
- Ipsilateral infarcts occurred in 54% of patients, frequently in the centrum semiovale.
- Patients with lipid cores had a significantly higher incidence of ipsilateral infarcts (68% vs. 31%, P = .03).
Conclusions:
- Ischemic cerebral lesions are prevalent in symptomatic carotid artery disease.
- MR imaging assessment of carotid plaque composition is related to the presence and extent of ischemic cerebral lesions.
- Plaque lipid content is a significant imaging marker for stroke risk in carotid stenosis.
Background And Purpose:
Besides the severity of carotid artery stenosis, atherosclerotic plaque composition is an important determinant of cerebral symptoms. We analyzed the relationship between the composition of the atherosclerotic plaque at the carotid artery bifurcation and ipsilateral ischemic cerebral lesions on MR imaging.
Methods:
Forty-one patients with symptomatic carotid artery stenosis (>70%) underwent black-blood, fast spin-echo imaging of the carotid artery and turbo fluid-attenuated inversion recovery (t-FLAIR) imaging of the brain. Plaque regions with a relative decrease in signal intensity in the plaque from proton density-weighted (TE = 14 ms) to T2-weighted (TE = 50 ms) imaging were considered to be lipid cores. We assessed the number and location of infarcts in the ipsilateral cortex, basal ganglia, and centrum semiovale, and hyperintense white matter lesions on t-FLAIR images.
Results:
Lipid in the atherosclerotic plaque at the carotid bifurcation was seen in 25 patients. Ipsilateral infarctions were seen in 22 (54%); most often, it involved the centrum semiovale. Patients with a lipid core had an ipsilateral infarct more often than patients without a lipid core (68% vs. 31%; P = .03). Centrum semiovale infarcts were more frequent (56% vs. 25%, P = .06) and the median number of centrum semiovale infarcts was higher P = .04) in patients with a lipid core than in patients without a lipid core.
Conclusion:
Ischemic cerebral lesions were common in patients with symptomatic carotid artery disease. Plaque composition, as assessed with MR imaging, is related to the presence and extent of ischemic cerebral lesions.
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