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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

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Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraparenchymal Hemorrhage: A Preliminary

L Saba¹, G Lanzino², P Lucatelli³

¹From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy lucasaba@tiscali.it.

AJNR. American Journal of Neuroradiology

|August 10, 2019

Insights

Intraplaque hemorrhage (IPH) in carotid arteries is dangerous. Patients with bilateral IPH had larger plaques with more IPH on the symptomatic side, indicating higher stroke risk.

Area of Science:

Vascular Neurology
Radiology
Cardiovascular Imaging

Background:

Intraplaque hemorrhage (IPH) is a critical indicator of cerebrovascular event risk.
Characterizing plaque composition in patients with bilateral IPH is crucial for understanding stroke mechanisms.

Purpose of the Study:

To analyze CT characteristics of carotid artery plaques in symptomatic patients with bilateral intraplaque hemorrhage.
To compare plaque volume and composition between symptomatic and asymptomatic sides.

Main Methods:

Retrospective analysis of 343 patients with recent ischemic events and carotid CT.
Identification of 21 patients with bilateral intraplaque hemorrhage.
Semiautomated plaque volume measurement and component classification based on CT attenuation values.

Main Results:

Symptomatic plaques were significantly larger than asymptomatic ones (28 vs. 22 mm³).
Higher intraplaque hemorrhage volume and percentage were observed in symptomatic plaques (P < .001).
The intraplaque hemorrhage/lipid ratio was significantly higher on the symptomatic side (P = .001).

Conclusions:

In patients with bilateral IPH, the symptomatic plaque exhibits greater volume and increased intraplaque hemorrhage.
These findings highlight the role of plaque characteristics in ipsilateral cerebrovascular events.

Read full analysis

Abstract

Background And Purpose:

The presence of IPH is considered the most dangerous feature because it is significantly associated with clinical ipsilateral cerebrovascular events. Our aim was to explore the characterization of plaque with CT in symptomatic subjects with bilateral intraplaque hemorrhage.

Materials And Methods:

Three-hundred-forty-three consecutive patients with recent anterior circulation ischemic events (<2 weeks) and CT of the carotid arteries (performed within 14 days of the cerebrovascular event) evaluated between June 2012 and September 2017 were analyzed for plaque volume composition to identify all subjects with bilateral intraplaque hemorrhage. Plaque volume was semiautomatically measured, and tissue components were classified according to the attenuation values such as the following: calcified (for values of ≥130 HU), mixed (for values of ≥60 and <130 HU), lipid (for values of ≥25 and <60 HU), and intraplaque hemorrhage (for values of <25 HU). Twenty-one subjects (15 men; mean age, 70 ± 11 years; range, 44-87 years) had bilateral intraplaque hemorrhage and were included in the analysis.

Results:

Volume measurement revealed significantly larger plaques on the symptomatic side compared with the asymptomatic one (mean, 28 ± 9 versus 22 ± 8 mm, P = .007). Intraplaque hemorrhage volume and percentage were also significantly higher in the plaque ipsilateral to the cerebrovascular event (P < .001 and < .001, respectively). The volume of other plaque components did not show a statically significant association except for lipid and lipid + intraplaque hemorrhage percentages (23% versus 18% and 11% versus 15%), which were significantly different between the symptomatic and the asymptomatic sides (.016 and .011, respectively). The intraplaque hemorrhage/lipid ratio was higher on the symptomatic side (0.596 versus 0.171, P = .001).

Conclusions:

In patients with bilateral intraplaque hemorrhage and recent ischemic symptoms, the plaque ipsilateral to the symptomatic side has significantly larger volume and a higher percentage of intraplaque hemorrhage compared with the contralateral, asymptomatic side.

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