Abstract
BackgroundPlaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics.Methods191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available.ResultsEleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis.ConclusionDM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients.See Commentary: http://www.biomedcentral.com/1741-7015/8/78/abstract
Highlights
Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis
Our results showed that in a cohort of patients presenting with carotid artery stenosis, patients with type 2 diabetes in particular were at higher risk than nondiabetic patients of presenting vulnerable, carotid plaques: the high-risk lesion types IV-V and VI were clearly overrepresented in diabetic patients compared with nondiabetics
We have previously shown that the high-risk MRI-defined lesion types IV-V and VI are overrepresented in symptomatic stenosis [16], underlining the hypothesis that the MRI-defined lesion types IV-V and VI represent high risk, rupture-prone plaques associated with a higher incidence of postprocedural neurological deficits
Summary
Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Based on histological American Heart Association (AHA) criteria, modified for MRI use, a classification was introduced by Cai and co-workers [4] that allows categorization of carotid plaques noninvasively into distinct lesion types (I-VIII). According to this modified classification, plaque lesions characterized by a. Studies analyzing carotid plaque morphology based on MRI plaque imaging in relation to type 2 diabetes (DM 2) are rare
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