Abstract
BackgroundTo determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients.MethodsIn this prospective monocentric observational study 34 patients (24 males; 70 ±9.3 years) with symptomatic carotid disease defined as ischemic brain lesions in one internal carotid artery territory on diffusion weighted images underwent a carotid bb-CMR at 3 T with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques (PAT factor = 2) within 10 days after symptom onset. All patients underwent extensive clinical workup (lab, brain MR, duplex sonography, 24-hour ECG, transesophageal echocardiography) to exclude other causes of ischemic stroke. Prevalence of American Heart Association lesion type VI (AHA-LT6), status of the fibrous cap, presence of hemorrhage/thrombus and area measurements of calcification, necrotic core and hemorrhage were determined in both carotid arteries in consensus by two reviewers who were blinded to clinical information. McNemar and Wilcoxon's signed rank tests were use for statistical comparison. A p-value <0.05 was considered statistically significant.ResultsSymptomatic plaques showed a higher prevalence of AHA-LT6 (67.7% vs. 11.8%; p < 0.001; odds ratio = 12.5), ruptured fibrous caps (44.1% vs. 2.9%; p < 0.001; odds ratio = 15.0), juxtaluminal thrombus (26.5 vs. 0%; p < 0.01; odds ratio = 7.3) and intraplaque hemorrhage (58.6% vs. 11.8%; p = 0.01; odds ratio = 3.8). Necrotic core and hemorrhage areas were greater in symptomatic plaques (14.1 mm2 vs. 5.5 mm2 and 13.6 mm2 vs. 5.3 mm2; p < 0.01, respectively).Conclusion3 T bb-CMR is able to differentiate between symptomatic and asymptomatic carotid plaques, demonstrating the potential of bb-CMR to differentiate between stable and vulnerable lesions and ultimately to identify patients with low versus high risk for cardiovascular complications. Best predictors of the symptomatic side were a ruptured fibrous cap, AHA-LT 6, juxtaluminal hemorrhage/thrombus, and intraplaque hemorrhage.
Highlights
To determine if black-blood 3 T cardiovascular magnetic resonance can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients
Findings of our study demonstrated that 3 T high resolution in vivo cardiovascular magnetic resonance (CMR) using parallel imaging and dedicated surface coils is a reliable, fast and robust technique, which allows to non-invasively depict significant differences between symptomatic and asymptomatic carotid plaques in patients with acute ischemic stroke
Prevalence of a complicated American heart association (AHA) lesion type VI, which is characterized by hemorrhage, thrombus or a ruptured fibrous cap, was a comparably potent predictor for the symptomatic side with an OR of 12.5
Summary
To determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients. A wide range of diagnostic methods like ultrasound, CT angiography and cardiovascular magnetic resonance (CMR) are currently in use to detect and characterize atherosclerotic plaques. Plaque CMR is one of the most promising techniques. It is non-invasive and - with 3 T scanners becoming widely available delivers excellent high resolution plaque images. In vivo CMR plaque characterization at high detail has become a tool to investigate the relationship of certain plaque features with clinical symptoms. An increasing number of studies have addressed this issue, hypothesizing that certain plaque features like intraplaque hemorrhage, rupture of the fibrous cap, ulceration of plaque surface and formation of thrombi at the plaque surface are associated with cerebrovascular incidents [10,15,16,17,18]
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