MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic
Lorena Esposito-Bauer1, Tobias Saam, Iman Ghodrati
1Department of Neurology, Technische Universität München, Munich, Germany. lorenaesposito@web.de
Purpose:
The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I-VIII). Within these lesion types, lesion types IV-V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones.
Methods:
Eighty-three consecutive patients (45 male (54.2%); age 54-88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50-99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I-VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance.
Results:
Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV-V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001).
Conclusions:
MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.
Insights
Magnetic Resonance Imaging (MRI) plaque imaging can identify high-risk carotid artery stenosis in asymptomatic patients. This imaging technique helps predict future cerebral events, improving patient selection for therapy.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Asymptomatic carotid artery stenosis poses a risk for cerebrovascular events.
- Current methods for risk stratification may not be fully adequate.
- Advanced imaging techniques are needed to identify high-risk plaques.
Purpose of the Study:
- To prospectively evaluate if MRI plaque imaging can identify asymptomatic carotid stenosis patients at increased risk for future cerebral events.
- To correlate specific MRI-defined plaque lesion types with the occurrence of ipsilateral ischemic events.
Main Methods:
- Eighty-three patients with 50-99% asymptomatic carotid stenosis were recruited.
- Patients underwent 1.5-T MRI with T1-, T2-, time-of-flight-, and proton-density weighted sequences.
- Plaques were classified into lesion types I-VIII; lesion types IV-V and VI were considered high-risk (rupture-prone).
- Clinical endpoints (ischemic stroke, TIA, amaurosis fugax) were tracked over a mean follow-up of 41.1 months.
Main Results:
- Of 77 analyzed patients, 9 (11.7%) experienced ipsilateral ischemic cerebrovascular events during follow-up.
- All events occurred in patients with high-risk lesion types IV-V and VI.
- No events were observed in patients with stable lesion types III, VII, and VIII (P<0.0001).
Conclusions:
- MRI plaque imaging effectively identifies asymptomatic carotid stenosis patients at high risk for future cerebral ischemia.
- This imaging modality shows potential to refine selection criteria for invasive therapies.
- MRI plaque characterization offers a valuable tool for stroke risk assessment.
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