Abstract
BackgroundMulti-contrast weighted imaging is a commonly used cardiovascular magnetic resonance (CMR) protocol for characterization of carotid plaque composition. However, this approach is limited in several aspects including low slice resolution, long scan time, image mis-registration, and complex image interpretation. In this work, a 3D CMR technique, named Multi-contrast Atherosclerosis Characterization (MATCH), was developed to mitigate the above limitations.MethodsMATCH employs a 3D spoiled segmented fast low angle shot readout to acquire data with three different contrast weightings in an interleaved fashion. The inherently co-registered image sets, hyper T1-weighting, gray blood, and T2-weighting, are used to detect intra-plaque hemorrhage (IPH), calcification (CA), lipid-rich necrotic core (LRNC), and loose-matrix (LM). The MATCH sequence was optimized by computer simulations and testing on four healthy volunteers and then evaluated in a pilot study of six patients with carotid plaque, using the conventional multi-contrast protocol as a reference.ResultsOn MATCH images, the major plaque components were easy to identify. Spatial co-registration between the three image sets with MATCH was particularly helpful for the reviewer to discern co-existent components in an image and appreciate their spatial relation. Based on Cohen’s kappa tests, moderate to excellent agreement in the image-based or artery-based component detection between the two protocols was obtained for LRNC, IPH, CA, and LM, respectively. Compared with the conventional multi-contrast protocol, the MATCH protocol yield significantly higher signal contrast ratio for IPH (3.1 ± 1.3 vs. 0.4 ± 0.3, p < 0.001) and CA (1.6 ± 1.5 vs. 0.7 ± 0.6, p = 0.012) with respect to the vessel wall.ConclusionsTo the best of our knowledge, the proposed MATCH sequence is the first 3D CMR technique that acquires spatially co-registered multi-contrast image sets in a single scan for characterization of carotid plaque composition. Our pilot clinical study suggests that the MATCH-based protocol may outperform the conventional multi-contrast protocol in several respects. With further technical improvements and large-scale clinical validation, MATCH has the potential to become a CMR method for assessing the risk of plaque disruption in a clinical workup.
Highlights
Multi-contrast weighted imaging is a commonly used cardiovascular magnetic resonance (CMR) protocol for characterization of carotid plaque composition
The most commonly used CMR technique for plaque characterization is multi-contrast weighted imaging that involves a series of scans (e.g. T1- and T2-weighted [T1-w, T2-w] black-blood turbo spin-echo [TSE], and bright-blood time-of-flight [TOF]) to differentiate major plaque components, including lipid-rich necrotic core (LRNC), intra-plaque hemorrhage (IPH), calcification (CA), loose matrix (LM), and fibrous tissue [9,10,11,12,13,14]
Despite numerous successes in previous studies, the multi-contrast approach has four major limitations: (a) limited slice resolution associated with two-dimensional (2D) TSE imaging and potential repositioning error when used in serial studies; (b) long acquisition time; (c) image mis-registration due to inter-scan subject motion; (d) complex image interpretation for differentiating various components based on their signal patterns on multi-contrast weightings
Summary
Multi-contrast weighted imaging is a commonly used cardiovascular magnetic resonance (CMR) protocol for characterization of carotid plaque composition. This approach is limited in several aspects including low slice resolution, long scan time, image mis-registration, and complex image interpretation. The most commonly used CMR technique for plaque characterization is multi-contrast weighted imaging that involves a series of scans (e.g. T1- and T2-weighted [T1-w, T2-w] black-blood turbo spin-echo [TSE], and bright-blood time-of-flight [TOF]) to differentiate major plaque components, including lipid-rich necrotic core (LRNC), intra-plaque hemorrhage (IPH), calcification (CA), loose matrix (LM), and fibrous tissue [9,10,11,12,13,14]. While continued technical improvements and research efforts have been made during the past decade, routine application of CMR for plaque characterization in clinical workup has not become standard practice [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
