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Histologically Validated Ex Vivo Characterization of Intraplaque Hemorrhage and Lipid Components Using Quantitative
Ayano Ishiyama1, Hideki Ishimaru2, Shinji Okano1
1From the Department of Radiological Sciences (A.I., H.I., R.T.), Department of Pathology (S.O.), Nagasaki University Graduate School of Biomedical Sciences; Center for Cause of Death investigation (Y.I.), Faculty of Medicine, Hokkaido University; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (Y.M.), Showa Medical University School of Medicine; Department of Radiology (M.M.), Nagasaki University Hospital and Department of Radioisotope Medicine (R.I.), Atomic Bomb Disease Institute, Nagasaki University.
Quantitative susceptibility mapping (QSM) effectively differentiates intraplaque hemorrhage (IPH) from lipid-rich necrotic cores (LRNCs) in carotid plaques. This advanced MRI technique offers superior characterization for stroke risk assessment compared to conventional MRI.
Area of Science:
- Neuroimaging
- Cardiovascular Research
- Medical Physics
Background:
- Accurate characterization of carotid plaque components is crucial for assessing stroke risk.
- Intraplaque hemorrhage (IPH) indicates plaque vulnerability but can be difficult to distinguish from lipid-rich necrotic cores (LRNCs) on conventional MRI due to overlapping signal characteristics.
Purpose of the Study:
- To compare the efficacy of quantitative susceptibility mapping (QSM) against conventional MRI in differentiating IPH and lipid components within carotid plaques.
- To validate imaging findings with ex vivo histologic analysis.
Main Methods:
- Ex vivo MRI at 3T was performed on 24 carotid plaque specimens.
- Conventional MRI sequences (T1WI, T2WI, FLASH) and QSM were acquired.
- Histologic staining (H&E, immunohistochemistry) was used for validation.
- Signal intensities (CNRs) and magnetic susceptibility values (rSVs) were measured in regions of interest (ROIs) corresponding to IPH and LRNCs.
Main Results:
- No significant difference in contrast-to-noise ratio (CNR) between IPH and LRNCs was found on T1WI or FLASH sequences.
- Histopathology revealed erythrocyte remnants in many LRNCs, explaining signal overlap.
- Quantitative susceptibility mapping (QSM) showed significantly higher relative susceptibility values (rSVs) for IPH compared to LRNCs and foam-cell aggregates (P < .01).
Conclusions:
- Many LRNCs contain erythrocyte remnants, contributing to their similar appearance to IPH on conventional MRI.
- QSM effectively captures susceptibility differences caused by erythrocytes, providing complementary information for plaque characterization.
- QSM enhances the differentiation of vulnerable plaque components, aiding in stroke risk assessment.
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