Circulation. 2003;107:3047-3052
Published online before print June 9, 2003, doi: 10.1161/01.CIR.0000074222.61572.44
Published online before print June 9, 2003, doi: 10.1161/01.CIR.0000074222.61572.44
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(Circulation. 2003;107:3047.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Characterization of Complicated Carotid Plaque With Magnetic Resonance Direct Thrombus Imaging in Patients With Cerebral Ischemia
From the Department of Academic Radiology, Medical School (A.R.M., R.E.M., P.S.M., A.L.M., G.S.D., S.A.), the Department of Vascular Surgery (S.T.M., W.G.T.), the Ageing and Disability Research Unit (J.G.), and the Department of Neuropathology (J.L.), University Hospital, Nottingham, and the Department of Haematology, Guy’s and St Thomas’s Trust, London (B.J.H.), UK.
Correspondence to Dr Alan Moody, Department of Medical Imaging (Office AG57), Sunnybrook and Women’s College Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada, M4N 3 M5. E-mail alan.moody{at}sw.ca
Background— Thromboembolic disease secondary to complicated carotid atherosclerotic plaque is a major cause of cerebral ischemia. Clinical management relies on the detection of significant (>70%) carotid stenosis. A large proportion of patients suffer irreversible cerebral ischemia as a result of lesser degrees of stenosis. Diagnostic techniques that can identify nonstenotic high-risk plaque would therefore be beneficial. High-risk plaque is defined histologically if it contains hemorrhage/thrombus. Magnetic resonance direct thrombus imaging (MRDTI) is capable of detecting methemoglobin within intraplaque hemorrhage. We assessed this as a marker of complicated plaque and compared its accuracy with histological examination of surgical endarterectomy specimens.
Methods and Results— Sixty-three patients underwent successful MRDTI and endarterectomy with histological examination. Of these, 44 were histologically defined as complicated (type VI plaque). MRDTI demonstrated 3 false-positive and 7 false-negative results, giving a sensitivity and specificity of 84%, negative predictive value of 70%, and positive predictive value of 93%. The interobserver (
=0.75) and intraobserver (=0.9) agreement for reading MRDTI scans was good.
Conclusions— MRDTI of the carotid vessels in patients with cerebral ischemia is an accurate means of identifying histologically confirmed complicated plaque. The high contrast generated by short T1 species within the plaque allows for ease of interpretation, making this technique highly applicable in the research and clinical setting for the investigation of carotid atherosclerotic disease.
Key Words: thrombus • plaque • carotid arteries • imaging • cerebral ischemia
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