Optimal Prediction of Carotid Intraplaque Hemorrhage Using Clinical and Lumen Imaging Markers
M S McLaughlin1, P J Hinckley1, S M Treiman1
1From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research.
Insights
Clinical and imaging factors like plaque thickness, stenosis, and ulceration can predict intraplaque hemorrhage (IPH) when MR imaging is unavailable. This model aids in identifying IPH risk and understanding its causes.
Area of Science:
- Vascular imaging
- Neurology
- Radiology
Background:
- Magnetic resonance (MR) imaging accurately detects intraplaque hemorrhage (IPH) using specific sequences.
- MR imaging is not universally accessible, leading to the use of computed tomography angiography (CTA) as an alternative.
- Identifying predictors of IPH is crucial for stroke work-up and understanding pathogenesis.
Purpose of the Study:
- To identify key clinical and lumen imaging predictors of carotid intraplaque hemorrhage.
- To develop a model for predicting IPH in patients undergoing stroke evaluation.
Main Methods:
- Retrospective analysis of 726 carotid plaques from patients undergoing MR imaging/MRA for stroke work-up.
- Evaluation of imaging predictors: percentage diameter and millimeter stenosis, plaque thickness, ulceration, intraluminal thrombus.
- Multivariable logistic regression and receiver operating characteristic (ROC) analysis to identify essential predictors.
Main Results:
- Plaque thickness (OR=2.20), ulceration (OR=4.25), age (OR=1.11), and male sex (OR=3.23) were significant predictors of IPH.
- Millimeter stenosis (OR=0.46) was inversely associated with IPH.
- The final model demonstrated excellent discriminatory power (AUC=0.932), outperforming models based on individual factors.
Conclusions:
- A combination of plaque thickness, millimeter stenosis, ulceration, age, and male sex effectively predicts carotid intraplaque hemorrhage.
- These predictors offer high discriminatory power and insights into IPH pathogenesis.
- This predictive model is valuable when MR imaging is contraindicated.
Background And Purpose:
MR imaging detects intraplaque hemorrhage with high accuracy by using the magnetization-prepared rapid acquisition of gradient echo sequence. Still, MR imaging is not readily available for all patients, and many undergo CTA instead. Our goal was to determine essential clinical and lumen imaging predictors of intraplaque hemorrhage, as indicators of its presence and clues to its pathogenesis.
Materials And Methods:
In this retrospective cross-sectional study, patients undergoing stroke work-up with MR imaging/MRA underwent carotid intraplaque hemorrhage imaging. We analyzed 726 carotid plaques, excluding vessels with non-carotid stroke sources (n = 420), occlusions (n = 7), or near-occlusions (n = 3). Potential carotid imaging predictors of intraplaque hemorrhage included percentage diameter and millimeter stenosis, plaque thickness, ulceration, and intraluminal thrombus. Clinical predictors were recorded, and a multivariable logistic regression model was fitted. Backward elimination was used to determine essential intraplaque hemorrhage predictors with a thresholded 2-sided P < .10. Receiver operating characteristic analysis was also performed.
Results:
Predictors of carotid intraplaque hemorrhage included plaque thickness (OR = 2.20, P < .001), millimeter stenosis (OR = 0.46, P < .001), ulceration (OR = 4.25, P = .020), age (OR = 1.11, P = .001), and male sex (OR = 3.23, P = .077). The final model discriminatory value was excellent (area under the curve = 0.932). This was significantly higher than models using only plaque thickness (area under the curve = 0.881), millimeter stenosis (area under the curve = 0.830), or ulceration (area under the curve= 0.715, P < .001).
Conclusions:
Optimal discrimination of carotid intraplaque hemorrhage requires information on plaque thickness, millimeter stenosis, ulceration, age, and male sex. These factors predict intraplaque hemorrhage with high discriminatory power and may provide clues to the pathogenesis of intraplaque hemorrhage. This model could be used to predict the presence of intraplaque hemorrhage when MR imaging is contraindicated.
More Related Videos
06:53A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application
Published on: July 9, 2020
13:10Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016