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(Circulation. 2003;108:2542.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Visualization of the Ruptured Plaque by Magnetic Resonance Imaging

Frank Wiesmann, MD; Matthew D. Robson, PhD; Jane Francis, DCR; Steffen E. Petersen, MD; C. Paul Leeson, PhD, MRCP; Keith M. Channon, MD, MRCP; Stefan Neubauer, MD, MRCP

From the Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, UK.

Correspondence to Frank Wiesmann, MD, Department of Cardiovascular Medicine, John Radcliffe Hospital, Headley Way, Oxford OX 3 9 DU, UK. E-mail frank.wiesmann{at}cardiov.ox.ac.uk

A 61-year-old man at risk of generalized arteriosclerosis due to heavy long-term smoking (60 pack-years) but no other risk factors was enrolled in a research study of atherosclerosis by noninvasive vascular MRI. The patient reported an episode of amaurosis fugax of the right eye 4 months before the scan but had no other clinical symptoms.

MRI of the neck vessels revealed a pronounced bilateral increase in wall thickness of internal carotid arteries as well as of the common carotid and vertebral arteries on both sides (Figure 1A and 1B). Immediately below the carotid bifurcation, the right common carotid artery showed significant thickening of the vessel wall with an appearance consistent with two atherosclerotic plaques (Figure 1B). On enlargement of the region of interest, both plaques showed a dark, lipid-rich core covered by a thin fibrous cap (Figure 1C). One lesion was suggestive of a ruptured plaque showing discontinuity of the fibrous cap (arrow). However, there was no evidence of significant luminal narrowing.

View larger version (41K): [in this window] [in a new window]   Figure 1. Magnetic resonance T2-weighted turbo-spin-echo images in transverse orientation revealing increased wall thickness of the carotid and vertebral arteries. A, Note the pronounced thickening of the posterior arterial wall in both the right and left internal carotid artery. B, Significantly thickened vessel wall in the left carotid bifurcation (LCAbif). Also shown are two arteriosclerotic lesions in the right common carotid artery (RCCA) with dark lipid core and thin fibrous cap. C, Close-up of right common carotid artery suggestive of plaque rupture with discontinuity of the thin fibrous cap (arrow). ECG-gated MRI (double-inversion recovery turbo-spin echo) was performed on a 1.5-T clinical scanner by use of a paired surface coil phase array for signal reception. Imaging parameters were the following: TR, 2 cardiac cycles; TE, 81 ms; field of view, 12 cm; in-plane resolution, 0.47x0.47 mm2; and slice thickness, 3 mm. RECA indicates right external carotid artery; RICA, right internal carotid artery; LECA, left external carotid artery; LICA, left internal carotid artery; RVA, right vertebral artery; and LVA, left vertebral artery.

Vascular ultrasound confirmed these findings with evidence of irregular atheroma around the carotid bifurcation (Figure 2). Bilateral Doppler recordings displayed velocities within normal range.

View larger version (84K): [in this window] [in a new window]   Figure 2. Ultrasound image of the right carotid bifurcation showing irregular atheroma (arrows).

This case likely represents a ruptured carotid plaque leading to an episode of amaurosis fugax.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wiesmann, F. Articles by Neubauer, S. Search for Related Content PubMed PubMed Citation Articles by Wiesmann, F. Articles by Neubauer, S. Related Collections Pathophysiology Imaging CT and MRI Computerized tomography and Magnetic Resonance Imaging Other Vascular biology