Abstract
Arterial remodeling may enable atherosclerotic disease without luminal stenosis. We sought to assess the prevalence and characteristics of atherosclerosis in angiographically normal carotid arteries. Forty-six arteries with 0% stenosis by MRA were evaluated with multicontrast carotid MR imaging at 3T. For each artery, the percentage wall volume (wall volume/[lumen volume + wall volume] x 100%) and the presence versus absence of an LRNC, calcification, IPH, and fibrous cap rupture were recorded. In addition, the relative size of each plaque component (eg, percentage LRNC = LRNC volume/wall volume x 100%), when present, was calculated. The mean of percentage wall volume in arteries with 0% stenosis was 43.0 +/- 6.9% with a range from 31.6% to 60.1%. An LRNC was present in 67.4% (31/46) of arteries, calcification was present in 65.2% (30/46), IPH was present in 8.7% (4/46), and fibrous cap rupture was present in 4.3% (2/46). In arteries with an LRNC (n = 31), the average percentage LRNC volume was 8.8 +/- 7.3% with a range from 1.0% to 31.5%. For calcification (n = 30), the mean percentage calcification volume was 3.8 +/- 4.2% with a range of 0.1%-17.4%. The mean percentage IPH volume (n = 4) was 2.7 +/- 1.7% with a range of 0.5%-4.1%. These findings indicate that stenosis by MRA may underestimate the presence of carotid atherosclerosis, and they demonstrate the need for improved methods for accurately identifying carotid atherosclerotic plaque severity.
Highlights
AND PURPOSE: Arterial remodeling may enable atherosclerotic disease without luminal stenosis
An LRNC was present in 67.4% (31/46) of arteries, calcification was present in 65.2% (30/46), IPH was present in 8.7% (4/46), and fibrous cap rupture was present in 4.3% (2/46)
The mean percentage IPH volume (n ϭ 4) was 2.7 Ϯ 1.7% with a range of 0.5%– 4.1%. These findings indicate that stenosis by MRA may underestimate the presence of carotid atherosclerosis, and they demonstrate the need for improved methods for accurately identifying carotid atherosclerotic plaque severity
Summary
Forty-six arteries with 0% stenosis by MRA were evaluated with multicontrast carotid MR imaging at 3T. Study Population Individuals with at least 1 carotid artery with Ͼ50% stenosis by duplex sonography were serially recruited for MR imaging of their bilateral carotid arteries. At the time of MR imaging, all participants provided answers to a standardized health questionnaire, had their height and weight measured, and underwent phlebotomy. A standardized MR imaging protocol[9] adapted for imaging at 3T10 was used to acquire transverse images of the carotid artery centered at the bifurcation of the artery with greater duplex stenosis. Imaging parameters for each weighting were as follows: T1-weighted (TR/TE, 800/11 ms; ETL, 10; 16 sections; scanning time, 5 minutes 58 seconds), T2weighted and PDW (TR/TE, 3500/70 and 12 ms; ETL, 12; 16 sections; scanning time, 3 minutes 40 seconds), and TOF (TR/TE, 21/2.9 ms; flip angle, 15°; 48 sections; scanning time, 2 minutes 4 seconds). A CE T1-weighted sequence[11] was acquired 5 minutes after administration of 0.2mmoL/kg gadopentetate dimeglumine (Magnevist; Bayer Schering Pharma, Berlin, Germany) was injected intravenously by using a power injector at 3 mL/s followed by a 20-mL saline bolus at the same speed
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