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Histological validation of simultaneous non-contrast angiography and intraplaque hemorrhage imaging (SNAP) for characterizing carotid intraplaque hemorrhage

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study sought to validate the performance of simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging in characterizing carotid IPH by histology.

Methods

Thirty-five patients with carotid atherosclerotic disease (symptomatic 50–70% stenosis or > 70% stenosis) scheduled for carotid endarterectomy underwent 3.0-T carotid MR imaging by acquiring SNAP and magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) sequences. Presence and area of IPH were separately evaluated on SNAP and MP-RAGE images. Presence and area of IPH were also assessed on histology. Agreement between SNAP/MP-RAGE and histology was determined in identify and quantify IPH using Cohen kappa, Spearman correlation, and Bland-Altman analyses.

Results

Of all 35 patients (mean age: 63.1 ± 8.8 years; 27 males), 128 slices with successful registration were eligible for analysis. The accuracy, sensitivity, specificity, and positive and negative predictive values were 86.7%, 85%, 89.6%, 93.2%, and 78.2% for SNAP, and 76.6%, 75%, 79.2%, 85.7%, and 65.5% for MP-RAGE in identification of IPH, respectively. In identification of IPH, the kappa value between SNAP and histology and between MP-RAGE and histology was 0.725 and 0.520, respectively. The correlation between SNAP and histology (r = 0.805, p < 0.001) was stronger than that between MP-RAGE and histology (r = 0.637, p < 0.001) in measuring IPH area. Bland-Altman analysis showed that, in measuring IPH area, the bias of SNAP (1.4 mm2, 95% CI: − 0.016 to 2.883) was smaller than that of MP-RAGE (1.7 mm2, 95% CI: − 0.039 to 3.430) compared with histology.

Conclusions

This validation study by histology demonstrates that SNAP sequence better identifies and quantifies carotid intraplaque hemorrhage compared with traditional MP-RAGE sequence.

Key Points

• SNAP imaging showed better agreement with histology compared with MP-RAGE imaging, especially for the IPHs with small size.

• SNAP sequence is a more effective tool to identify and quantify carotid IPH than traditional sequence of MP-RAGE that can help clinicians to optimizing the treatment strategy.

• The plaque components of rich lipid pools or loose matrix and chronic/old IPH (cholesterol crystals) can lead to false positive and false negative results in SNAP and MP-RAGE imaging for identifying IPH.

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Abbreviations

CEA:

Carotid endarterectomy

IPH:

Intraplaque hemorrhage

MP-RAGE:

Magnetization-prepared rapid acquisition gradient-echo

PSIR:

Phase-sensitive inversion-recovery reconstruction

SNAP:

Simultaneous non-contrast angiography and intraplaque hemorrhage

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Funding

This study is supported by grants of Ministry of Science and Technology of China (2017YFC1307904), National Natural Science Foundation of China (81771825, U1801681), and Beijing Municipal Science and Technology Commission (D171100003017003), the Key Areas Research and Development Program of Guangdong (2019B020235001), Guangdong Province Universities, and Colleges Pearl River Scholar Funded Scheme (2017).

Author information

Author notes

  1. Jun Shen and Xihai Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China

    Dongye Li & Jun Shen

  2. Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China

    Huiyu Qiao, Yongjun Han, Hualu Han, Dandan Yang & Xihai Zhao

  3. Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China

    Yongjun Han & Dandan Yang

  4. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Jingli Cao

  5. Department of Radiology, Peking University Third Hospital, Beijing, China

    Huimin Xu

  6. Department of Neurosurgery, Peking University Third Hospital, Beijing, China

    Tao Wang

  7. Department of Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing, China

    Yajie Wang

Authors
  1. Dongye Li
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  2. Huiyu Qiao
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  8. Tao Wang
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  10. Jun Shen
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  11. Xihai Zhao
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Corresponding authors

Correspondence to Jun Shen or Xihai Zhao.

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Guarantor

The scientific guarantor of this publication is Xihai Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• multicenter study

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Li, D., Qiao, H., Han, Y. et al. Histological validation of simultaneous non-contrast angiography and intraplaque hemorrhage imaging (SNAP) for characterizing carotid intraplaque hemorrhage. Eur Radiol 31, 3106–3115 (2021). https://doi.org/10.1007/s00330-020-07352-0

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  • DOI: https://doi.org/10.1007/s00330-020-07352-0

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