Advertisement

Neuroradiology

, Volume 46, Issue 9, pp 738–743 | Cite as

MRI-derived measurements of fibrous-cap and lipid-core thickness: the potential for identifying vulnerable carotid plaques in vivo

  • Rikin A. Trivedi
  • Jean-Marie U-King-Im
  • Martin J. Graves
  • Jo Horsley
  • Martin Goddard
  • Peter J. Kirkpatrick
  • Jonathan H. GillardEmail author
Diagnostic Neuroradiology

Abstract

Vulnerable plaques have thin fibrous caps overlying large necrotic lipid cores. Recent studies have shown that high-resolution MR imaging can identify these components. We set out to determine whether in vivo high-resolution MRI could quantify this aspect of the vulnerable plaque. Forty consecutive patients scheduled for carotid endarterectomy underwent pre-operative in vivo multi-sequence MR imaging of the carotid artery. Individual plaque constituents were characterised on MR images. Fibrous-cap and lipid-core thickness was measured on MRI and histology images. Bland-Altman plots were generated to determine the level of agreement between the two methods. Multi-sequence MRI identified 133 corresponding MR and histology slices. Plaque calcification or haemorrhage was seen in 47 of these slices. MR and histology derived fibrous cap–lipid-core thickness ratios showed strong agreement with a mean difference between MR and histology ratios of 0.02 (±0.04). The intra-class correlation coefficient between two readers for measurements was 0.87 (95% confidence interval, 0.73 and 0.93). Multi-sequence, high-resolution MR imaging accurately quantified the relative thickness of fibrous-cap and lipid-core components of carotid atheromatous plaques. This may prove to be a useful tool to characterise vulnerable plaques in vivo.

Keywords

Carotid MRI Atheroma Vulnerable plaque Quantitative 

Notes

Acknowledgements

The study was funded in part by the Stroke Association (UK)

References

  1. 1.
    Yuan C, Mitsumori LM, Beach KW, Maravilla KR (2001) Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology 221:285–299PubMedGoogle Scholar
  2. 2.
    Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, Rosenfeld ME, Schwartz CJ, Wagner WD, Wissler RW (1995) A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 92:1355–1374PubMedGoogle Scholar
  3. 3.
    Virmani R, Burke AP, Kolodgie FD, Farb A (2002) Vulnerable plaque: the pathology of unstable coronary lesions. J Interv Cardiol 15:439–446PubMedGoogle Scholar
  4. 4.
    Yuan C, Mitsumori LM, Ferguson MS, Polissar NL, Echelard D, Ortiz G, Small R, Davies JW, Kerwin WS, Hatsukami TS (2001). In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. Circulation 104:2051–2056PubMedGoogle Scholar
  5. 5.
    Yuan C, Beach KW, Smith LH Jr, Hatsukami TS (1998) Measurement of atherosclerotic carotid plaque size in vivo using high resolution magnetic resonance imaging. Circulation 98:2666–2671PubMedGoogle Scholar
  6. 6.
    Luo Y, Polissar N, Han C, Yarnykh V, Kerwin WS, Hatsukami TS, Yuan C (2003) Accuracy and uniqueness of three in vivo measurements of atherosclerotic carotid plaque morphology with black blood MRI. Magn Reson Med 50:75–82CrossRefPubMedGoogle Scholar
  7. 7.
    U-King-Im J, Graves MJ, Kirkpatrick PJ, Gillard JH (2003) Limitations of high-resolution black-blood cross-sectional magnetic resonance imaging in the assessment of carotid stenosis. Stroke 34:258 [Abstract]CrossRefGoogle Scholar
  8. 8.
    Kang X, Polissar NL, Han C, Lin E, Yuan C (2000) Analysis of the measurement precision of arterial lumen and wall areas using high-resolution MRI. Magn Reson Med 44:968–972CrossRefPubMedGoogle Scholar
  9. 9.
    Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275PubMedGoogle Scholar
  10. 10.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453PubMedGoogle Scholar
  11. 11.
    Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) (1998) Lancet 351:1379-1387PubMedGoogle Scholar
  12. 12.
    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421–1428PubMedGoogle Scholar
  13. 13.
    Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316:1371–1375PubMedGoogle Scholar
  14. 14.
    Coulden RA, Moss H, Graves MJ, Lomas DJ, Appleton DS, Weissberg PL (2000). High resolution magnetic resonance imaging of atherosclerosis and the response to balloon angioplasty. Heart 83:188–191CrossRefPubMedGoogle Scholar
  15. 15.
    Hatsukami TS, Ross R, Polissar NL, Yuan C (2000) Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation 102:959–964PubMedGoogle Scholar
  16. 16.
    Pasterkamp G, Schoneveld AH, van der Wal AC, Hijnen DJ, van Wolveren WJ, Plomp S, Teepen HL, Borst C (1999) Inflammation of the atherosclerotic cap and shoulder of the plaque is a common and locally observed feature in unruptured plaques of femoral and coronary arteries. Arterioscler Thromb Vasc Biol 19:54–58PubMedGoogle Scholar
  17. 17.
    Morrisett J, Vick W, Sharma R, Lawrie G, Reardon M, Ezell E, Schwartz J, Hunter G, Gorenstein D (2003) Discrimination of components in atherosclerotic plaques from human carotid endarterectomy specimens by magnetic resonance imaging ex vivo (1). Magn Reson Imaging 21:465–474CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Rikin A. Trivedi
    • 1
    • 3
  • Jean-Marie U-King-Im
    • 1
  • Martin J. Graves
    • 1
  • Jo Horsley
    • 2
  • Martin Goddard
    • 2
  • Peter J. Kirkpatrick
    • 3
  • Jonathan H. Gillard
    • 1
    • 4
    Email author
  1. 1.University Department of RadiologyAddenbrooke’s HospitalCambridgeUK
  2. 2.Department of HistopathologyPapworth HospitalPapworth EverardUK
  3. 3.Academic Department of NeurosurgeryAddenbrooke’s HospitalCambridgeUK
  4. 4.Addenbrooke’s HospitalCambridgeUK

Personalised recommendations