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Bilateral symmetry of human carotid artery atherosclerosis: a multi-contrast weighted MR study

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Abstract

The systemic nature of atherosclerotic disease may entail an association in disease severity between left and right carotid arteries. However, the etiology of plaque features in high-risk lesions is presumably attributed to local risk factors. We explored the symmetry of plaque morphology and composition across a broad range of atherosclerotic disease severities. All participants underwent carotid MR imaging on a 3.0 T scanner with a bilateral four-element phased-array surface coil. Vessel boundary and plaque components [calcification, lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH)] of bilateral carotid arteries were outlined. Normalized wall index (NWI) was calculated as follows: NWI = wall volume/total vessel volume. Carotid atherosclerosis score (CAS) was computed for plaque risk stratification. Associations of volume measurements between sides were evaluated using Pearson’s correlation. Cohen’s kappa was used to assess agreement between dichotomous variables. In the 177 participants with images of sufficient quality, there were very strong correlations between left and right lumen volumes (r = 0.85), total vessel volumes (r = 0.88), and strong correlations between wall volumes (r = 0.79), mean wall thickness (r = 0.66) and NWI (r = 0.71), and a moderate correlation between max wall thickness (r = 0.56) (all P < 0.001). There were moderate between-side agreements for the presence of calcification (κ = 0.54) and LRNC (κ = 0.49), but only fair agreement for IPH (κ = 0.31). The correlation of volume between left and right carotid arteries was strong for calcification (r = 0.62, P < 0.001) and weak for LRNC (r = 0.39, P < 0.001), but there was no significant correlation for IPH (r = 0.01, P = 0.99). Fair agreement (κ = 0.34) for CAS between paired carotid arteries was observed. Only 16 of 47 participants with CAS = 4 on at least one side had the same CAS on the contralateral side. Plaque morphology, calcification, and LRNC may develop symmetrically, but there is a relatively poor correlation for lipid content between sides. The weak symmetry of IPH and CAS indicates that the development of atherosclerosis into high-risk lesions may be regulated by local rather than systemic factors.

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Abbreviations

NWI:

Normalized wall index

CAS:

Carotid atherosclerosis score

LRNC:

Lipid-rich necrotic core

IPH:

Intraplaque hemorrhage

IMT:

Intima-medial thickness

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Acknowledgments

We thank Xiaodong Zhang, Hongxia Sun, Rui Li and Wei Li for their technical assistance.

Author contribution

FL study design, data acquisition and analysis, manuscript drafting; XW study design, manuscript drafting and revising.

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Authors and Affiliations

  1. Department of Radiology, Peking University First Hospital, No. 8 Xishiku St., Xicheng District, Beijing, 100034, China

    Feiyu Li & Xiaoying Wang

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  1. Feiyu Li
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Correspondence to Feiyu Li.

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Authors Feiyu Li and Xiaoying Wang declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving animal studies

This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Li, F., Wang, X. Bilateral symmetry of human carotid artery atherosclerosis: a multi-contrast weighted MR study. Int J Cardiovasc Imaging 32, 1219–1226 (2016). https://doi.org/10.1007/s10554-016-0890-4

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  • DOI: https://doi.org/10.1007/s10554-016-0890-4

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