Abstract
BackgroundCoronary high intensity plaques (CHIPs) detected using cardiovascular magnetic resonance (CMR) coronary atherosclerosis T1-weighted characterization with integrated anatomical reference (CATCH) have been shown to be positively associated with high-risk morphology observed on intracoronary optical coherence tomography (OCT). This study sought to validate whether CHIPs detected on CATCH indicate the presence of intraplaque hemorrhage (IPH) through ex vivo imaging of carotid and coronary plaque specimens, with histopathology as the standard reference.MethodsTen patients scheduled to undergo carotid endarterectomy underwent CMR with the conventional T1-weighted (T1w) sequence. Eleven carotid atherosclerotic plaques removed at carotid endarterectomy and six coronary artery endarterectomy specimens removed from patients undergoing coronary artery bypass grafting (CABG) were scanned ex vivo using both the conventional T1w sequence and CATCH. Both in vivo and ex vivo images were examined for the presence of IPH. The sensitivity, specificity, and Cohen Kappa (k) value of each scan were calculated using matched histological sections as the reference. k value between each scan in the discrimination of IPH was also computed.ResultsA total of 236 in vivo locations, 328 ex vivo and matching histology locations were included for the analysis. Sensitivity, specificity, and k value were 76.7%, 95.3%, and 0.75 for in vivo T1w imaging, 77.2%, 97.4%, and 0.78 for ex vivo T1w imaging, and 95.0%, 92.1%, and 0.84 for ex vivo CATCH, respectively. Moderate agreement was reached between in vivo T1w imaging, ex vivo T1w imaging, and ex vivo CATCH for the detection of IPH: between in vivo T1w imaging and ex vivo CATCH (k = 0.68), between ex vivo T1w imaging and ex vivo CATCH (k = 0.74), between in vivo T1w imaging and ex vivo T1w imaging (k = 0.83). None of the coronary artery plaque locations showed IPH.ConclusionThis study demonstrated that carotid CHIPs detected by CATCH can be used to assess for IPH, a high-risk plaque feature.
Highlights
Coronary high intensity plaques (CHIPs) detected using cardiovascular magnetic resonance (CMR) coronary atherosclerosis T1-weighted characterization with integrated anatomical reference (CATCH) have been shown to be positively associated with high-risk morphology observed on intracoronary optical coherence tomography (OCT)
This is the first study to demonstrate that CHIPs detected by CATCH on ex vivo plaques are indicative of the presence of intraplaque hemorrhage (IPH) with histological validation
Assessment of HIPs on CATCH In previous studies of coronary plaque imaging with T1w images, plaque to muscle ratio (PMR) value defined as the highest signal intensity of coronary plaque to adjacent left ventricular cardiac muscle was introduced as a quantitative measure of CHIPs
Summary
Coronary high intensity plaques (CHIPs) detected using cardiovascular magnetic resonance (CMR) coronary atherosclerosis T1-weighted characterization with integrated anatomical reference (CATCH) have been shown to be positively associated with high-risk morphology observed on intracoronary optical coherence tomography (OCT). A novel three dimensional (3D) whole-heart imaging technique, coronary atherosclerosis T1-weighted characterization with integrated anatomical reference (CATCH) was developed to address the aforementioned limitations for coronary atherosclerotic plaque characterization [5]. It used IR-prepared spoiled gradient echo acquisition and could simultaneously obtain T1w images along with reference bright-blood coronary CMR angiogram with 100% respiratory gating efficiency. The purpose of this work was to investigate the association between CHIPs on CATCH and the presence of IPH through ex vivo imaging of carotid and coronary plaque specimens
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