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Can high frequency ultrasound and MRI diagnose malignant atheromatous plaque in vitro?
S Yoshida1, M S Nieminen, T Paananen
1Department of Ultrasound & Medical Diagnosis, Sapporo Medical University, Japan.
Abstract:
It remains a vital clinical issue how to diagnose malignant atheromatous plaques consisting of ulcerative plaque and hemorrhagic plaque, which are potential risks for thrombosis and the arterial spasm. This study proposes further investigations to develop methods in order to detect this type of lesions by echocardiography. In this study, we tested high frequency (7.5 MHz) US and 1.0 T MRI (T1 weighted SE, STIR; short time inversion recovery sequence, and T1 weighted fat suppression technique) for their precision in the diagnosis of atheromatous plaque as malignant or benign in post mortem human aorta. Ten hemorrhagic plaques were imaged as heterogeneous echo- pattern in the shoulder of plaques covered with high-echo capsule with US; however, these findings were also obtained from 2 of 16 non-hemorrhagic plaques. With T1SE, hemorrhagic plaques were revealed as mixed areas of reduced intensity and high intensity which were differentiated from fatty deposition with T1 weighted fat suppression technique. Ulcerative plaques were revealed as concave shaped plaques and diagnosed correctly with both methods. US was superior to MRI from the viewpoints of examination time and measuring wall thickness. US indicated intimal plus medial thickness of hemorrhagic plaque and non-hemorrhagic plaque at 4.3 + 1.1 mm and 3.0 + 1.0 mm (p < 0.05) respectively. MRI was vulnerable to artifacts and its image was poorer in quality due to its lower resolution: however, probably because of its superior ability to distinguish fatty deposition from hemorrhage, MRI ultimately enabled more accurate diagnosis than US, as long as its image was fairly clear. The overall accuracies were 80% with US and 85.7% with MRI as confirmed by histological tests. From these results, the careful analysis of the two images obtained from US and MRI enables clinical diagnosis of malignant atheromatous plaques.
Insights
Diagnosing malignant atheromatous plaques is crucial for preventing thrombosis. This study compared ultrasound (US) and magnetic resonance imaging (MRI) for detecting ulcerative and hemorrhagic plaques, finding MRI slightly more accurate.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Atherosclerosis Research
Background:
- Malignant atheromatous plaques, characterized by ulceration and hemorrhage, pose significant risks for thrombosis and arterial spasm.
- Accurate diagnosis of these high-risk plaques remains a critical clinical challenge.
Purpose of the Study:
- To evaluate the diagnostic precision of high-frequency ultrasound (US) and 1.0 T magnetic resonance imaging (MRI) in differentiating malignant from benign atheromatous plaques.
- To compare the effectiveness of US and MRI in identifying ulcerative and hemorrhagic plaque characteristics in post-mortem human aortas.
Main Methods:
- Post-mortem human aortas with atheromatous plaques were imaged using 7.5 MHz US and 1.0 T MRI (T1 weighted SE, STIR, and T1 weighted fat suppression).
- Diagnostic accuracy was assessed by comparing imaging findings with histological confirmation.
- Key imaging features of hemorrhagic and ulcerative plaques were analyzed for both modalities.
Main Results:
- Ultrasound identified hemorrhagic plaques with heterogeneous patterns, though with some overlap with non-hemorrhagic plaques.
- MRI, particularly with fat suppression techniques, effectively differentiated hemorrhage from fatty deposition, crucial for diagnosing hemorrhagic plaques.
- While US offered faster examination and superior wall thickness measurement, MRI achieved higher overall diagnostic accuracy (85.7% vs. 80% for US) when images were clear.
Conclusions:
- Both US and MRI can aid in diagnosing malignant atheromatous plaques, with MRI showing a slight advantage in accuracy due to better differentiation of hemorrhage.
- Careful, combined analysis of US and MRI findings can improve the clinical diagnosis of high-risk atheromatous plaques.
- Further investigation into advanced imaging techniques is warranted for precise plaque characterization.