High-resolution magnetic resonance imaging for detection of carotid plaques
Masaru Honda1, Naoki Kitagawa, Keisuke Tsutsumi
1Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan. mhonda@net.nagasaki-u.ac.jp
Objective:
We report our experience using high-resolution magnetic resonance imaging (MRI) to identify carotid plaques and also discuss these MRI findings while comparing them with carotid endarterectomy specimens.
Methods:
Eighteen carotid plaques from 17 different patients were observed using plaque MRI. The patients included 14 men and 3 women, aged 53 to 75 years (mean, 68.6 yr). Eight patients experienced a stroke and four patients experienced transient ischemic attack. The remaining five patients did not experience any neurological symptoms. Two-dimensional time-of-flight (TOF) MR angiography; T1-weighted imaging; fat-suppressed, cardiac gated, black-blood proton density imaging; and T2-weighted imaging were obtained with a 1.5-T MRI.
Results:
Symptomatic plaques showed either vast or partially dotted high signals for each contrast. The high signal intensity on time-of-flight and T2-weighted imaging predicted the instability of the plaques (100% sensitivity and specificity). In particular, time-of-flight imaging predicted intraplaque hemorrhaging with 100% sensitivity and 80% specificity. MRI revealed that three of four asymptomatic lesions were unstable plaques.
Conclusion:
High-resolution MRI was able to detect various signal patterns related to the plaque components, and it was thus considered to be very useful for evaluating plaque instability. The application of plaque MRI therefore may positively affect the decision-making process when selecting optimal therapeutic strategies to treat with carotid plaques.
Insights
High-resolution magnetic resonance imaging (MRI) effectively identifies carotid plaque components and instability. This advanced imaging technique aids in assessing plaque vulnerability, potentially guiding treatment decisions for carotid artery disease.
Area of Science:
- Vascular Imaging
- Neurology
- Cardiology
Background:
- Carotid plaques are a significant risk factor for stroke.
- Accurate identification of plaque instability is crucial for risk stratification.
- Current imaging methods have limitations in characterizing plaque components.
Purpose of the Study:
- To evaluate the utility of high-resolution magnetic resonance imaging (MRI) in identifying carotid plaques.
- To compare MRI findings of carotid plaques with surgical specimens.
- To assess MRI's capability in detecting plaque instability and intraplaque hemorrhage.
Main Methods:
- Seventeen patients with eighteen carotid plaques underwent plaque MRI using a 1.5-T scanner.
- Imaging sequences included 2D time-of-flight (TOF) MR angiography, T1-weighted, fat-suppressed proton density, and T2-weighted imaging.
- Comparison was made between MRI findings and carotid endarterectomy specimens.
Main Results:
- High signal intensity on TOF and T2-weighted imaging correlated with plaque instability (100% sensitivity and specificity).
- TOF imaging demonstrated high sensitivity (100%) and specificity (80%) for intraplaque hemorrhage.
- MRI identified unstable plaques in three of four asymptomatic lesions.
Conclusions:
- High-resolution MRI effectively detects signal patterns indicative of carotid plaque components.
- MRI is highly valuable for assessing carotid plaque instability.
- Plaque MRI can inform therapeutic strategy decisions for carotid plaque management.
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