Non-contrast T1-weighted Magnetic Resonance Imaging Research Articles

S1 vertebral bone quality score independently predicts pedicle screw loosening following surgery in patients with adult degenerative scoliosis

BACKGROUND CONTEXTMRI-based vertebral bone quality (VBQ) score is an effective predictor of pedicle screw loosening after lumbar fusion surgery and has been recognized as a valuable tool for assessing preoperative bone quality. Due to the lateral curvature of lumbar spine of degenerative scoliosis, accurate measurement of VBQ score by conventional measurement methods that capture MRI signal intensity at L1–4 may be limited under certain conditions. To this end, a new simplified S1 VBQ score method has been proposed, which is comparable to the previous L1–4 VBQ score or S1 Hounsfield unit (HU) value, and has high accuracy and reliability. PURPOSETo evaluate the predictive value of MRI-based S1 VBQ score for pedicle screw loosening following surgery for adult degenerative scoliosis (ADS). STUDY DESIGN/SETTINGRetrospective single-center cohort. PATIENT SAMPLEWe reviewed 92 patients who underwent posterior lumbar interbody fusion (PLIF) with pedicle screw fixation for ADS between January 2017 and January 2020. OUTCOME MEASURESAssociation between S1 VBQ score and pedicle screw loosening following surgery for ADS. METHODSWe retrospectively reviewed the records of all patients who performed PLIF between January 2017 and January 2020. The clear zone around pedicle screws≥1 mm can be identified as screw loosening. The S1 VBQ score is calculated from the S1 central-based noncontrast T1-weighted magnetic resonance imaging (MRI). The signal intensity (SI) of the cerebrospinal fluid (CSF) was then measured using ROI placed at the L3 level to normalize the results. Multivariate logistic regression analysis was performed to identify independent risk factors for screw loosening. Then, constructed a receiver operating characteristic (ROC) curve and determined the threshold (cut-off) of VBQ score with high sensitivity and specificity based on Youden Index. RESULTSA total of 92 patients were included, including 34 males and 58 females. The mean age of the patients was 61.23±1.23 years old. At 1-year follow-up, the screw loosening rate was 56.5% (52/92). The age and levels of fixation were higher in the loosening group than in the nonloosening group (p=.036, p=.025). Patients in the loosening group had a greater VBQ score compared to patients in the nonloosening group (3.31±0.41 vs 3.01±0.28, p=.001). Multivariate logistic regression analysis showed that advanced age (OR, 1.090; 95% CI 1.005–1.183; p=.039) and higher VBQ score (OR, 5.778; 95% CI 2.889–16.177; p=.001) were independent risk factors for screw loosening. In addition, the ROC curve were created to assess the role of VBQ score as predictors of screw loosening with a diagnostic accuracy of 74.6% (95% CI 64.2%–85.1%).The most suitable threshold for the VBQ score as determined by the Youden Index was 3.175 (sensitivity: 76.0%, specificity: 83.3%). CONCLUSIONSHigher S1 VBQ score was significantly associated with pedicle screw loosening following surgery for ADS. The S1 VBQ score can be used as an effective preoperative predictor, which has the potential clinical application.

Evaluation of fractional flow reserve and atherosclerotic plaque characteristics on coronary non-contrast T1-weighted magnetic resonance imaging

Background and aimsThe relationship between high-risk coronary plaque characteristics regardless of the severity of lesion stenosis and myocardial ischemia remains unsettled. High-intensity plaques (HIPs) on non-contrast T1-weighted magnetic resonance imaging (T1WI) have been characterized as high-risk coronary plaques. We sought to elucidate whether the presence of coronary HIPs on T1WI influences fractional flow reserve (FFR) in the distal segment of the vessel. MethodsWe retrospectively analyzed 281 vessels in 231 patients with chronic coronary syndrome who underwent invasive FFR measurement and coronary T1WI using a multicenter registry. The plaque-to-myocardial signal intensity ratio (PMR) of the most stenotic lesion was evaluated; a coronary plaque with PMR ≥1.4 was defined as a HIP. ResultsThe median PMR of coronary plaques on T1WI in vessels with FFR ≤0.80 was significantly higher than that of plaques with FFR >0.80 (1.17 [interquartile range (IQR): 0.99–1.44] vs. 0.97 [IQR: 0.85–1.09]; p < 0.001). Multivariable analysis showed that an increase in PMR of the most stenotic segment was associated with lower FFR (beta-coefficient, −0.050; p < 0.001). The presence of coronary HIPs was an independent predictor of FFR ≤0.80 (odds ratio (OR), 6.18; 95% confidence interval (CI), 1.93–19.77; p = 0.002). Even after adjusting for plaque composition characteristics based on computed tomography angiography, the presence of coronary HIPs was an independent predictor of FFR ≤0.80 (OR, 4.48; 95% CI, 1.19–16.80; p = 0.026). ConclusionsCoronary plaques with high PMR are associated with low FFR in the corresponding vessel, indicating that plaque morphology might influence myocardial ischemia severity.

Multi-modality imaging of high-intensity plaques on non-contrast T1-weighted magnetic resonance imaging: a case report

Multi-modality imaging of high-intensity plaques on non-contrast T1-weighted magnetic resonance imaging: a case report

Detection of Cholesterol Crystals in Progressive High-Intensity Plaque With the Use of T1-Weighted Magnetic Resonance Imaging.

A 53-year-old man presented to our department with unstable angina pectoris. Coronary computed tomography (CCT) showed severe stenosis in the mid left anterior descending (LAD) artery (Figure 1A), mild stenosis with a napkin-ring sign, positive remodeling, and a low-attenuation plaque in the proximal right coronary artery (RCA) (Figure 1B). Non-contrast T1-weighted magnetic resonance imaging (T1WI MRI) revealed a high-intensity plaque (HIP) in the same RCA lesion (Figure 1C, Supplemental Video S1).

High-risk calcified plaque preoperatively detected by non-contrast T1-weighted magnetic resonance imaging and electrocardiogram-gated computed tomography.

High-risk calcified plaque preoperatively detected by non-contrast T1-weighted magnetic resonance imaging and electrocardiogram-gated computed tomography.

Additional Effect of Coronary High-Intensity Plaque on T1-Weighted Magnetic Resonance Imaging With Circulating Malondialdehyde-Modified Low-Density Lipoprotein on Cardiac Events.

Although elevated levels of oxidized low-density lipoprotein (LDL) could play a critical role in vulnerable plaque, there are no studies that have compared coronary high-intensity plaque (HIP) and circulating malondialdehyde-modified (MDA)-LDL levels for the prediction of cardiac events. A total of 139 patients with coronary artery stenosis (>70%) were examined with non-contrast T1-weighted magnetic resonance imaging (MRI) (HIP: n=64, non-HIP: n=75). Scheduled percutaneous coronary intervention (PCI) for culprit lesions was performed within 48 h after MRI. HIP was defined as a signal intensity of coronary plaque to cardiac muscle ratio (PMR) ≥1.4. We evaluated the subsequent major adverse cardiac events (MACE) during the follow-up period (5.6±1.3 years). MDA-LDL levels were independently associated with the presence of HIP (P<0.0001). The incidence of MACE was 15%, and it was significantly higher in patients with HIP (27%) than in those without HIP (5%; P=0.011). Cox proportional hazard analysis showed MDA-LDL levels (P=0.007) and PMR (P=0.016) were significantly associated with MACE. For MACE prediction, C-statistic values for MDA-LDL, PMR, and PMR+MDA-LDL were 0.724, 0.791, and 0.800, respectively. Compared with MDA-LDL alone, the addition of PMR to MDA-LDL increased net reclassification improvement by 0.78 (P=0.012). MDA-LDL levels might be associated with the presence of HIP in patients with coronary artery disease. Furthermore, adding PMR to MDA-LDL levels markedly improved prediction of subsequent MACE after PCI.

Association of coronary high-intensity plaque on T1-weighted magnetic resonance imaging and circulating malondialdehyde-modified low-density lipoprotein levels with cardiac events

Abstract Background Although elevated oxidized low-density lipoprotein could play critical roles in vulnerable plaque, there are no studies that compared coronary high-intensity plaque (HIP) on non-contrast T1-weighted magnetic resonance imaging (T1WI_MRI) and circulating malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels for the prediction of cardiac events. Methods and results A total of 139 patients with coronary artery stenosis (&amp;gt;70%) were examined with non-contrast T1WI using a 1.5-T MRI (HIP: n=63, non-HIP: n=76). Scheduled percutaneous coronary intervention (PCI) for culprit lesions was performed within 48 h after MRI. HIP was defined as a signal intensity of coronary plaque to cardiac muscle ratio (PMR) of ≥1.4. At admission, circulating levels of MDA-LDL and other lipid-related markers were measured. We evaluated the subsequent cardiac events, which were defined as major adverse cardiac events (MACE; cardiac death, myocardial infarction, and/or ischemia-driven PCI) during follow-up periods (5.6±1.3 years). Circulating MDA-LDL levels were significantly higher in patients with HIP than in those without HIP (p&amp;lt;0.0001). MDA-LDL levels were significantly correlated with PMR (r=0.490, p&amp;lt;0.0001). In multivariable logistic regression analysis, MDA-LDL levels were independently associated with the presence of HIP (OR 1.05; 95% CI, 1.02–1.08, p&amp;lt;0.0001). The incidence of MACE was significantly higher in patients with HIP (27%) than in those without HIP (5%; p=0.011 by the log-rank test). In the multivariable Cox proportional hazard analysis, the MDA-LDL levels (HR 1.03; 95% CI:1.01–1.05, p=0.007) and PMR (HR 2.39; 95% CI:1.19–4.65, p=0.016) were significantly associated with MACE. For MACE prediction, the C-statistic values for MDA-LDL, PMR, and PMR+MDA-LDL were 0.724, 0.791, and 0.800, respectively. Compared with MDA-LDL alone, the addition of PMR to MDA-LDL increased the net reclassification improvement by 0.78 (p=0.012). Conclusions MDA-LDL levels might be associated with the presence of HIP in patients with coronary artery disease. Furthermore, adding PMR to MDA-LDL levels markedly improved MACE prediction. Funding Acknowledgement Type of funding source: None

P3098Association with coronary high-intensity plaque on T1-weighted magnetic resonance imaging and circulating levels of malondialdehyde-modified low-density lipoprotein

Abstract Objectives This study aimed to evaluate the association with coronary high-intensity plaque (HIP) on non-contrast T1-weighted magnetic resonance imaging (T1WI) and circulating levels of malondialdehyde-modified low-density lipoprotein (MDA-LDL). Methods A total of 139 patients with coronary artery stenosis (&gt;70%) were imaged with non-contrast T1WI by using a 1.5-T magnetic resonance system (HIP: n=60, non-HIP: n=79). HIP was defined as a signal intensity of coronary plaque to cardiac muscle ratio (PMR) of ≥1.4. At admission, circulating levels of MDA-LDL and other lipid-related markers (triglyceride, HDL, LDL, Lp(a), RLP-C, and EPA/AA) were measured. Results Circulating levels of MDA-LDL (p=0.001) and LDL (p=0.041) were significantly higher in patients with HIP than those without, whereas the other lipid-related markers were not significantly different between both groups. In multivariable logistic regression analysis, MDA-LDL levels were independently associated with the presence of HIP (OR 1.03; 95% CI, 1.00–1.06, p=0.015) after adjusting for cofounding factors (age, sex, triglyceride, LDL, Lp(a), RLP-C, and EPA/AA). The optimal MDA-LDL threshold for predicting coronary HIP was 90.4 U/L, identified by the receiver operating characteristic curve. Conclusion MDA-LDL levels might be associated with the presence of HIP in patients with coronary artery disease.

Abstract 236: Magnetic Resonance T1 High Signal Intensity in Coronary Atherosclerotic Plaques Reflects Intraplaque Hemorrhage-derived Erythrocyte Content

Objective: Acute myocardial infarction is triggered by plaque disruption and thrombus formation, therefore, it is important to detect high thrombotic risk plaque non-invasively. Coronary high signal intensity plaque (HIP) on T1 weighted magnetic resonance imaging (T1WI) was associated with future coronary events. The aim of this study is to identify pathological findings reflecting HIPs using hearts obtained from autopsy cases and blood samples. Approach and Results: Formalin-fixed hearts (n=7) were imaged with non-contrast T1WI with a 1.5 T magnetic resonance system. We defined HIPs (n=11) or non-HIPs (n=25) as a coronary plaque to myocardial signal intensity ratio (PMR) of √ 1.4 or √ 1.4, respectively. The corresponding histological sections were histologically and immunohistochemically analyzed. Plaque and necrotic core areas or frequency of intraplaque hemorrhage in HIPs were significantly larger or higher than those in non-HIPs. The high intensity portion in large coronary plaque was immunopositive for CD68, CD163, glycophorin A, and fibrin. Glycophorin A-, matrix metalloprotease (MMP) 9-, tissue factor-immunopositive areas were larger in HIPs than those in non-HIPs. Glycophorin A-, fibrin-, MMP9-, and tissue factor-immunopositive areas were positively correlated with PMR. We calculated T1 relaxation time of venous blood, plasma, and erythrocyte-rich blood in vitro. Blood coagulation shortened T1 relaxation time of the blood and plasma, and T1 relaxation times in coagulated whole blood and erythrocyte-rich blood were significantly shorter than those in plasma. Conclusions: Majority of coronary HIPs may reflect intraplaque hemorrhage-derived erythrocyte content, and may be a novel marker for plaque instability and thrombogenic potential.

Optical coherence tomography-verified morphological correlates of high-intensity coronary plaques on non-contrast T1-weighted magnetic resonance imaging in patients with stable coronary artery disease.

AimsCoronary high-intensity plaques (HIPs) with a high plaque-to-myocardial signal intensity ratio (PMR) on non-contrast T1-weighted imaging in patients with stable coronary artery disease (CAD) are associated with future coronary events. To characterize the morphological substrate of HIP, we performed a correlative optical coherence tomography (OCT) study.Methods and resultsWe examined 137 lesions in 105 patients with stable angina pectoris or silent myocardial ischaemia scheduled for percutaneous coronary intervention (PCI) using a 3 T magnetic resonance scanner. Pre-interventional OCT was performed for PCI target lesions. HIP was defined as PMR ≥ 1.4. Of the 137 lesions, 34% were HIP and 66% were non-HIP. The prevalence of lipid-rich plaque (96% vs. 70%, P < 0.001), macrophage accumulation (65% vs. 46%, P = 0.046), cholesterol crystals (46% vs. 22%, P = 0.006), and healed plaque rupture (multiple layers of different optical densities overlaying a large lipid accumulation, 72% vs. 18%, P < 0.001) was significantly higher in the HIP group than the non-HIP group; no significant differences were observed for the presence of thin cap fibroatheroma, intracoronary thrombus, and plaque rupture between the two groups. Multivariable stepwise logistic regression analysis showed that HIP was significantly associated with the presence of healed plaque rupture [odds ratio (OR) 9.32; 95% confidence interval (95% CI) 4.05–22.71; P < 0.001] and lipid-rich plaque (OR 4.38; 95% CI 1.08–29.77; P = 0.038).ConclusionsThe significant association between HIP- and OCT-derived healed plaque rupture and large lipid core provides new insights into the characteristics of high-risk plaques, even in clinically stable CAD.

Optimal Conditions for 3D Non-contrast T1-weighted Magnetic Resonance Imaging Segmented Turbo Fast Low-angle Shot for Tissue Characterization of Coronary Plaques

In three-dimensional (3D) T1-weighted magnetic resonance imaging used for tissue characterization of coronary plaques, the contrast for electrocardiographic synchronization may vary according to the R-R interval (RR). The coronary artery plaque image shows suppression of the fluid compartment signal for the coronary artery luminal blood as well as the fat signal in the region of interest; in addition, it is necessary to ensure that the value of the plaque-to-muscle signal intensity ratio (PMR) does not change according to the difference in RR. In the current study, the phantom review and clinical data suggested that the PMR changes that occur due to the differences in RR can be minimized by adjusting the inversion time (TI) in the range of the required black blood effect. Moreover, the signal-to-noise ratio (SNR), which varies according to the difference between the RR and the TI, was determined to identify the maximum value flip angle (FA) value that would lead to improvement in the SNR. Thus, signal suppression of the PMR, SNR, and the fluid compartment of the coronary artery luminal blood can be controlled using different RRs with the relational expressions for calculating optimal TI and FA.

Characterization of high-intensity plaques on noncontrast T1-weighted magnetic resonance imaging by coronary angioscopy

BackgroundA recent study showed that coronary high-intensity plaques (HIPs) visualized by noncontrast T1-weighted imaging (T1WI) in cardiac magnetic resonance were associated with coronary events. We used coronary angioscopy to analyze HIP plaque morphology. Methods and resultsA total 17 lesions from 17 patients with stable or unstable angina pectoris were evaluated at the culprit lesion by noncontrast T1WI using 1.5-T magnetic resonance; of them, nine (53%) were HIPs and eight (47%) were non-HIPs, and all were analyzed by coronary angioscopy. We assessed the existence of thrombus and plaque yellow color grade (YG). YG was assessed visually according to a four-grade scale: 0, white; 1, light yellow; 2, yellow; 3, intense yellow. The frequency of thrombus was significantly higher in HIPs than in non-HIPs (89% vs. 25%, respectively; p=0.007). YG was significantly more frequent in HIPs than in non-HIPs (2.2±0.4 vs. 0.7±0.7, respectively; p=0.01). ConclusionsThese data indicated that HIPs on noncontrast T1WI were associated with the presence of high-grade yellow plaque with thrombus.

The Clinical Value of High-Intensity Signals on the Coronary Atherosclerotic Plaques: Noncontrast T1-Weighted Magnetic Resonance Imaging

Over the past several decades, significant progress has been made in the pathohistological assessment of vulnerable plaques and in invasive intravascular imaging techniques. However, the assessment of plaque morphology by invasive modalities is of limited value for the detection of subclinical coronary atherosclerosis and the subsequent prediction or prevention of acute cardiovascular events. Recently, magnetic resonance (MR) imaging technology has reached a sufficient level of spatial resolution, which allowed the plaque visualization of large and static arteries such as the carotids and aorta. However, coronary wall imaging by MR is still challenging due to the small size of coronary arteries, cardiac and respiratory motion, and the low contrast-to-noise ratio between the coronary artery wall and the surrounding structures. Following the introduction of carotid plaque imaging with noncontrast T1-weighted imaging (T1WI), some investigators have reported that coronary artery high-intensity signals on T1WI are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although there are several limitations and issues that need to be resolved, this novel MR technique for coronary plaque imaging could influence treatment strategies for atherothrombotic disease and may be useful for understanding the pathophysiological mechanisms of atherothrombotic plaque formation.

Effect of Intensive Statin Therapy on Coronary High-Intensity Plaques Detected by Noncontrast T1-Weighted Imaging: The AQUAMARINE Pilot Study

BackgroundCoronary high-intensity plaques detected by noncontrast T1-weighted imaging may represent plaque instability. High-intensity plaques can be quantitatively assessed by a plaque-to-myocardium signal-intensity ratio (PMR). ObjectivesThis pilot, hypothesis-generating study sought to investigate whether intensive statin therapy would lower PMR. MethodsProspective serial noncontrast T1-weighted magnetic resonance imaging and computed tomography angiography were performed in 48 patients with coronary artery disease at baseline and after 12 months of intensive pitavastatin treatment with a target low-density lipoprotein cholesterol level <80 mg/dl. The control group consisted of coronary artery disease patients not treated with statins that were matched by propensity scoring (n = 48). The primary endpoint was the 12-month change in PMR. Changes in computed tomography angiography parameters and high-sensitivity C-reactive protein levels were analyzed. ResultsIn the statin group, 12 months of statin therapy significantly improved low-density lipoprotein cholesterol levels (125 to 70 mg/dl; p < 0.001), PMR (1.38 to 1.11, an 18.9% reduction; p < 0.001), low-attenuation plaque volume, and the percentage of total atheroma volume on computed tomography. In the control group, the PMR increased significantly (from 1.22 to 1.49, a 19.2% increase; p < 0.001). Changes in PMR were correlated with changes in low-density lipoprotein cholesterol (r = 0.533; p < 0.001), high-sensitivity C-reactive protein (r = 0.347; p < 0.001), percentage of atheroma volume (r = 0.477; p < 0.001), and percentage of low-attenuation plaque volume (r = 0.416; p < 0.001). ConclusionsStatin treatment significantly reduced the PMR of high-intensity plaques. Noncontrast T1-weighted magnetic resonance imaging could become a useful technique for repeated quantitative assessment of plaque composition. (Attempts at Plaque Vulnerability Quantification with Magnetic Resonance Imaging Using Noncontrast T1-weighted Technique [AQUAMARINE]; UMIN000003567)

High-Intensity Signals in Coronary Plaques on Noncontrast T1-Weighted Magnetic Resonance Imaging as a Novel Determinant of Coronary Events

The aim of this study was to determine whether coronary high-intensity plaques (HIPs) visualized by noncontrast T1-weighted imaging can predict future coronary events. Coronary HIPs are associated with characteristics of vulnerable plaques, including positive remodeling, lower Hounsfield units, and ultrasound attenuation. However, it remains unclear whether the presence of HIPs is associated with increased risk for coronary events. The signal intensity of coronary plaques was prospectively examined in 568 patients with suspected or known coronary artery disease (CAD) who underwent noncontrast T1-weighted imaging to determine the plaque-to-myocardium signal intensity ratio (PMR). During the follow-up period (median 55 months), coronary events were observed in 55 patients. Receiver-operating characteristic curve analysis identified a PMR of 1.4 as the optimal cutoff for predicting prognosis. Multivariate Cox regression analysis identified the presence of plaques with PMRs ≥1.4 as the significant independent predictor of coronary events (hazard ratio: 3.96; 95% confidence interval: 1.92 to 8.17; p < 0.001) compared with the presence of CAD (hazard ratio: 3.56; 95% confidence interval: 1.76 to 7.20; p < 0.001) and other traditional risk factors. Among the 4 groups based on PMR cutoff and the presence of CAD, coronary event-free survival was lowest in the group with PMRs ≥1.4 and CAD and highest in the group with PMRs <1.4 but no CAD. Importantly, the group with PMRs ≥1.4 and no CAD had an intermediate rate of coronary events, similar to the group with PMRs <1.4 and CAD. HIPs identified in a noninvasive, quantitative manner are significantly associated with coronary events and may thus represent a novel predictive factor.

A prospective natural-history study of coronary hyper-intense plaques detected by non-contrast T1-weighted magnetic resonance imaging

Background: We previously showed that coronary hyperintense plaques (HIPs) detected with noncontrast T1-weighted imaging (T1WI) are strongly associated with positive coronary remodeling, remarkably lower Hounsfield units, and ultrasound attenuation. It remains unclear, however, whether the presence of coronary HIPs is associated with an increased risk of coronary events. Methods: We examined the signal intensity of coronary plaques using noncontrast T1WI in 568 high-risk patients 55 years of age or older who had evidence of coronary artery disease (CAD) or diabetes plus one other cardiovascular risk factor. A coronary HIP was defined as a signal that is ≥140% of the adjacent myocardium. All patients were divided into 4 groups according to the presence or absence of HIPs and CAD, i.e., HIP-positive + CAD (n=90), HIP-positive + no CAD (n=46), HIP-negative + CAD (n=111), and HIP-negative + no CAD (n=321). The median follow-up duration was 3.9 years. The primary end point was a composite of cardiac death, myocardial infarction, cardiac troponin T-positive unstable angina, and percutaneous coronary intervention due to progressive angina. Results: Compared to the non-HIP group, patients with HIPs were significantly more likely to experience a cardiovascular event (log-rank p<0.001, Figure). Multivariate Cox regression analysis identified the presence of HIPs as the strongest independent predictor of cardiovascular events (hazard ratio, 3.35; 95% confidence interval, 1.77–6.36; p < 0.001), compared to a history of CAD (hazard ratio, 2.03; 95% confidence interval, 1.15–3.59; p=0.01) and other coronary risk factors. ![Figure][1] Figure 1 Conclusions: Compared with patients without HIPs, patients with coronary HIPs are at a higher risk of cardiovascular events developing over time. [1]: pending:yes

Basal Ganglia Hyperintensity on T1-weighted Imaging of a Patient with Central Nervous System Metastasis Producing Carcinoembryonic Antigens

We herein report unusual basal ganglia hyperintense lesions on noncontrast T1-weighted magnetic resonance imaging in a patient with central nervous system metastasis from lung adenocarcinoma that was treated with gefitinib. T2*-weighted magnetic resonance imaging showed no hypointense lesions, thereby excluding the possibility of calcification or haemorrhage. A stereotactic brain biopsy of the left basal ganglia lesions revealed atypical cells, some of which formed a glandular lumen with a micropapillary pattern. These cells were immunopositive for markers of lung adenocarcinoma, thereby confirming the diagnosis of metastasis. We speculate that proteins, including carcinoembryonic antigens from the adenocarcinoma cells in the basal ganglia, may have contributed to the hyperintensity observed on noncontrast T1-weighted magnetic resonance imaging.

Detection of Intramural Hematoma and Serial Non-Contrast T1-Weighted Magnetic Resonance Imaging Findings in a Female Patient With Spontaneous Coronary Artery Dissection

Detection of Intramural Hematoma and Serial Non-Contrast T1-Weighted Magnetic Resonance Imaging Findings in a Female Patient With Spontaneous Coronary Artery Dissection

Hyperintense Plaque With Noncontrast T1-Weighted Magnetic Resonance Coronary Plaque Imaging Leading to Acute Coronary Syndrome

A 73-year-old diabetic man underwent multislice computed tomography (MSCT) and noncontrast T1-weighted (T1W) magnetic resonance imaging (MRI) for the evaluation of atypical chest discomfort after an exercise ECG was nondiagnostic. The MSCT demonstrated a low-density positive remodeling plaque and spotty calcification without significant stenosis in the proximal segment of the right coronary artery (Figure 1A and 1B). Noncontrast T1W MRI, using a 1.5-T MR system (Intera, Philips Medical Systems, Best, the Netherlands), revealed a hyperintense plaque (HIP) in the right coronary artery in an area corresponding to …