Skip to main content

Advertisement

Log in

Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98–0.99) and compositional (ICC range 0.88–0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5–4.9 % for morphology, 36–44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Corti R, Fayad ZA, Fuster V, Worthley SG, Helft G, Chesebro J, Mercuri M, Badimon JJ (2001) Effects of lipid-lowering by simvastatin on human atherosclerotic lesions: a longitudinal study by high-resolution, noninvasive magnetic resonance imaging. Circulation 104:249–252

    Article  CAS  PubMed  Google Scholar 

  2. Lima JA, Desai MY, Steen H, Warren WP, Gautam S, Lai S (2004) Statin-induced cholesterol lowering and plaque regression after 6 months of magnetic resonance imaging-monitored therapy. Circulation 110:2336–2341

    Article  CAS  PubMed  Google Scholar 

  3. Yonemura A, Momiyama Y, Fayad ZA, Ayaori M, Ohmori R, Higashi K, Kihara T, Sawada S, Iwamoto N, Ogura M, Taniguchi H, Kusuhara M, Nagata M, Nakamura H, Tamai S, Ohsuzu F (2005) Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques detected by noninvasive magnetic resonance imaging. J Am Coll Cardiol 45:733–742

    Article  CAS  PubMed  Google Scholar 

  4. Lee JM, Wiesmann F, Shirodaria C, Leeson P, Petersen SE, Francis JM, Jackson CE, Robson MD, Neubauer S, Channon KM, Choudhury RP (2008) Early changes in arterial structure and function following statin initiation: quantification by magnetic resonance imaging. Atherosclerosis 197:951–958

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Underhill HR, Yuan C, Zhao XQ, Kraiss LW, Parker DL, Saam T, Chu B, Takaya N, Liu F, Polissar NL, Neradilek B, Raichlen JS, Cain VA, Waterton JC, Hamar W, Hatsukami TS (2008) Effect of rosuvastatin therapy on carotid plaque morphology and composition in moderately hypercholesterolemic patients: a high-resolution magnetic resonance imaging trial. Am Heart J 155:581–584

    Article  Google Scholar 

  6. Boussel L, Arora S, Rapp J, Rutt B, Huston J, Parker D, Yuan C, Bassiouny H, Saloner D (2009) Atherosclerotic plaque progression in carotid arteries: monitoring with high-spatial-resolution MR imaging–multicenter trial. Radiology 252:789–796

    Article  PubMed Central  PubMed  Google Scholar 

  7. Zhao XQ, Dong L, Hatsukami T, Phan BA, Chu B, Moore A, Lane T, Neradilek MB, Polissar N, Monick D, Lee C, Underhill H, Yuan C (2011) MR imaging of carotid plaque composition during lipid-lowering therapy: a prospective assessment of effect and time course. J Am Coll Cardiovasc Imaging 4:977–986

    Article  Google Scholar 

  8. Sun J, Balu N, Hippe DS, Xue Y, Dong L, Zhao X, Li F, Xu D, Hatsukami TS, Yuan C (2013) Subclinical carotid atherosclerosis: short-term natural history of lipid-rich necrotic core–a multicenter study with MR imaging. Radiology 268:61–68

    Article  PubMed  Google Scholar 

  9. Fayad ZA, Mani V, Woodward M, Kallend D, Abt M, Burgess T, Fuster V, Ballantyne CM, Stein EA, Tardif JC, Rudd JH, Farkouh ME, Tawakol A (2011) Safety and efficacy of dalcetrapib on atherosclerotic disease using novel non-invasive multimodality imaging (dal-PLAQUE): a randomised clinical trial. Lancet 378:1547–1559

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Kawahara T, Nishikawa M, Kawahara C, Inazu T, Sakai K, Suzuki G (2013) Atorvastatin, etidronate, or both in patients at high risk for atherosclerotic aortic plaques: a randomized, controlled trial. Circulation 127:2327–2335

    Article  CAS  PubMed  Google Scholar 

  11. Cai JM, Hatsukami TS, Ferguson MS, Kerwin WS, Saam T, Chu BC, Takaya N, Polissar NL, Yuan C (2005) In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology. Circulation 112:3437–3444

    Article  PubMed  Google Scholar 

  12. Trivedi RA, U-King-Im JM, Graves MJ, Horsley J, Goddard M, Kirkpatrick PJ, Gillard JH (2004) MRI-derived measurements of fibrous-cap and lipid-core thickness: the potential for identifying vulnerable carotid plaques in vivo. Neuroradiology 46:738–743

    Article  PubMed  Google Scholar 

  13. Cappendijk VC, Heeneman S, Kessels AG, Cleutjens KB, Schurink GW, Welten RJ, Mess WH, van Suylen RJ, Leiner T, Daemen MJ, van Engelshoven JM, Kooi ME (2008) Comparison of single-sequence T1w TFE MRI with multisequence MRI for the quantification of lipid-rich necrotic core in atherosclerotic plaque. J Magn Reson Imaging 27:1347–1355

    Article  PubMed  Google Scholar 

  14. Alizadeh DR, Doornbos J, Tamsma JT, Stuber M, Putter H, van der Geest RJ, Lamb HJ, de Roos A (2007) Assessment of the carotid artery by MRI at 3T: a study on reproducibility. J Magn Reson Imaging 25:1035–1043

    Article  Google Scholar 

  15. Syed MA, Oshinski JN, Kitchen C, Ali A, Charnigo RJ, Quyyumi AA (2009) Variability of carotid artery measurements on 3-Tesla MRI and its impact on sample size calculation for clinical research. Int J Cardiovasc Imaging 25:581–589

    Article  PubMed  Google Scholar 

  16. Duivenvoorden R, de Groot E, Elsen BM, Lameris JS, van der Geest RJ, Stroes ES, Kastelein JJ, Nederveen AJ (2009) In vivo quantification of carotid artery wall dimensions: 3.0-Tesla MRI versus B-mode ultrasound imaging. Circ Cardiovasc Imaging 2:235–242

    Article  CAS  PubMed  Google Scholar 

  17. Reig S, Sánchez-González J, Arango C, Castro J, González-Pinto A, Ortuño F, Crespo-Facorro B, Bargalló N, Desco M (2009) Assessment of the increase in variability when combining volumetric data from different scanners. Hum Brain Mapp 30:355–368

    Article  PubMed  Google Scholar 

  18. Saam T, Hatsukami TS, Yarnykh VL, Hayes CE, Underhill H, Chu BC, Takaya N, Cai JM, Kerwin WS, Xu DX, Polissar NL, Neradilek B, Hamar WK, Maki J, Shaw DW, Buck RJ, Wyman B, Yuan C (2007) Reader and platform reproducibility for quantitative assessment of carotid atherosclerotic plaque using 1.5T Siemens, Philips, and General Electric scanners. J Magn Reson Imaging 26:344–352

    Article  PubMed  Google Scholar 

  19. The AIM-HIGH Investigators (2011) The role of niacin in raising high-density lipoprotein cholesterol to reduce cardiovascular events in patients with atherosclerotic cardiovascular disease and optimally treated low-density lipoprotein cholesterol Rationale and study design. The Atherothrombosis Intervention in Metabolic syndrome with low HDL/high triglycerides: impact on Global Health outcomes (AIM-HIGH). Am Heart J 161:471–477

    Article  PubMed Central  Google Scholar 

  20. Balu N, Yarnykh VL, Scholnick J, Chu BC, Yuan C, Hayes C (2009) Improvements in carotid plaque imaging using a new eight-element phased array coil at 3T. J Magn Reson Imaging 30:1209–1214

    Article  PubMed Central  PubMed  Google Scholar 

  21. Kerwin WS, Xu D, Liu F, Saam T, Underhill HR, Takaya N, Chu BC, Hatsukami TS, Yuan C (2007) Magnetic resonance imaging of carotid atherosclerosis: plaque analysis. Top Magn Reson Imaging 18:371–378

    Article  PubMed  Google Scholar 

  22. Liu F, Xu DX, Ferguson MS, Chu BC, Saam T, Takaya N, Hatsukami TS, Yuan C, Kerwin WS (2006) Automated in vivo segmentation of carotid plaque MRI with morphology-enhanced probability maps. Magn Reson Med 55:659–668

    Article  PubMed  Google Scholar 

  23. Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46

    Article  Google Scholar 

  24. Pinheiro JC, Bates DM (2000) Mixed-effects models in S and S-PLUS. Springer, New York, NY

    Book  Google Scholar 

  25. Friedman L, Glover GH (2006) Report on a multicenter fMRI quality assurance protocol. J Magn Reson Imaging 23:827–839

    Article  PubMed  Google Scholar 

  26. Vidal A, Bureau Y, Wade T, Spence JD, Rutt BK, Fenster A, Parraga G (2008) Scan-rescan and intra-observer variability of magnetic resonance imaging of carotid atherosclerosis at 1.5 T and 3.0 T. Phys Med Biol 53:6821–6835

    Article  PubMed  Google Scholar 

  27. Saam T, Kerwin WS, Chu BC, Cai JM, Kampschulte A, Hatsukami TS, Zhao XQ, Polissar NL, Neradilek B, Yarnykh VL, Flemming K, Huston J, Insull W, Morrisett JD, Rand SD, Demarco KJ, Yuan C (2005) Sample size calculation for clinical trials using magnetic resonance imaging for the quantitative assessment of carotid atherosclerosis. J Cardiovasc Magn Reson 7:799–808

    Article  PubMed  Google Scholar 

  28. Li F, Yarnykh VL, Hatsukami TS, Chu B, Balu N, Wang J, Underhill HR, Zhao X, Smith R, Yuan C (2010) Scan-rescan reproducibility of carotid atherosclerotic plaque morphology and tissue composition measurements using multicontrast MRI at 3T. J Magn Reson Imaging 31:168–176

    Article  CAS  PubMed  Google Scholar 

  29. Wasserman BA, Astor BC, Sharrett AR, Swingen C, Catellier D (2010) MRI measurements of carotid plaque in the atherosclerosis risk in communities (ARIC) study: methods, reliability and descriptive statistics. J Magn Reson Imaging 31:406–415

    Article  PubMed Central  PubMed  Google Scholar 

  30. Takaya N, Cai JM, Ferguson MS, Yarnykh VL, Chu BC, Saam T, Polissar NL, Sherwood J, Cury RC, Anders RJ, Broschat KO, Hinton D, Furie KL, Hatsukami TS, Yuan C (2006) Intra- and interreader reproducibility of magnetic resonance imaging for quantifying the lipid-rich necrotic core is improved with gadolinium contrast enhancement. J Magn Reson Imaging 24:203–210

    Article  PubMed  Google Scholar 

  31. Touze E, Toussaint JF, Coste J, Schmitt E, Bonneville F, Vandermarcq P, Gauvrit JY, Douvrin F, Meder JF, Mas JL, Oppenheim C (2007) Reproducibility of high-resolution MRI for the identification and the quantification of carotid atherosclerotic plaque components: consequences for prognosis studies and therapeutic trials. Stroke 38:1812–1819

    Article  CAS  PubMed  Google Scholar 

  32. Kerwin WS, Liu F, Yarnykh V, Underhill H, Oikawa M, Yu W, Hatsukami TS, Yuan C (2008) Signal features of the atherosclerotic plaque at 3.0 Tesla versus 1.5 Tesla: Impact on automatic classification. J Magn Reson Imaging 28:987–995

    Article  PubMed Central  PubMed  Google Scholar 

  33. Liu W, Balu N, Sun J, Zhao X, Chen H, Yuan C, Zhao H, Xu J, Wang G, Kerwin WS (2012) Segmentation of carotid plaque using multicontrast 3D gradient echo MRI. J Magn Reson Imaging 35:812–819

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a Grant from the Foundation for the National Institutes of Health Biomarkers Consortium made possible by funds from Merck, Pfizer, and Abbott, and by R01HL088214. Carotid coils were provided by GE Healthcare and Philips Healthcare. This manuscript represents the views of the authors and not necessarily those of the National Institutes of Health or the United States government.

Conflict of interest

Xue-Qiao Zhao reported research grants from Abbvie, Kowa, Merck, and Pfizer. Daniel S. Hippe reported grant support for analysis of unrelated data from GE Healthcare, Philips Healthcare, Society of Interventional Radiology, and RSNA Research and Education Foundation. Thomas S. Hatsukami reported research grants from Philips Healthcare. Michael T. Klimas is an employee of Merck. Robert J. Padley is an employee of Abbvie and reported stocks of Abbvie. Bradley T. Wyman was a former employee of Pfizer and reported stocks of Pfizer. Chun Yuan reported research grants from NIH, VP Diagnostics, Philips Healthcare, and consulting fees from Bristol Myers Squibb Medical Imaging and Philips Healthcare. The remaining authors reported no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Jie Sun or Chun Yuan.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 1166 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, J., Zhao, XQ., Balu, N. et al. Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study. Int J Cardiovasc Imaging 31, 95–103 (2015). https://doi.org/10.1007/s10554-014-0532-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-014-0532-7

Keywords

Navigation