Circulation. 2005;112:e3-e4
doi: 10.1161/CIRCULATIONAHA.104.494419
(Circulation. 2005;112:e3-e4.)
© 2005 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Detection of Carotid Atherosclerotic Plaque Ulceration, Calcification, and Thrombosis by Multicontrast Weighted Magnetic Resonance Imaging
Baocheng Chu, MD, PhD;
Marina S. Ferguson, MT;
Hunter Underhill, MD;
Norihide Takaya, MD, PhD;
Jianming Cai, MD, PhD;
Michel Kliot, MD;
Chun Yuan, PhD;
Thomas S. Hatsukami, MD
From the Departments of Radiology (B.C., M.S.F., H.U., N.T., J.C., C.Y.) and Surgery (M.K., T.S.H.), University of Washington, Seattle, and VA Puget Sound Health Care System (T.S.H.), Seattle, Wash.
Correspondence to Baocheng Chu, MD, PhD, Department of Radiology, Box 357115, University of Washington, 1959 NE Pacific St, Seattle, WA 98195. E-mail chubc{at}u.washington.edu
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Introduction
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A 62-year-old man presented to the emergency department with
a chief complaint of severe headache and decreased vision in
his left eye. Initial physical examination demonstrated a new-onset
left homonymous hemianopsia, which warranted a stroke workup.
The patient’s head CT was significant for a 2.3
x3.7-cm
acute hemorrhage in the right posterior parietal and occipital
lobes. Conventional angiography was performed and interpreted
as >90% stenosis of both internal carotid arteries without
ulceration. The remainder of the work-up, including echocardiogram,
was negative. An ensuing carotid magnetic resonance examination
with a phased-array carotid coil and high-resolution (0.3
x0.3
mm pixel size) multicontrast weighted sequences confirmed the
stenosis and demonstrated ulceration and calcification in both
carotids and mural thrombus formation in the left carotid (
Figures 1 and 2 
). After completely recovering from the stroke, the patient
underwent staged bilateral carotid endarterectomy. Histological
examination of the specimens confirmed the MRI findings of bilateral
ulceration and left mural thrombus formation (
Figure 3).
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Figure 1. 3-D time-of-flight (TOF) image shows a surface ulcer (long arrow) in the distal right common carotid artery. Black-blood, fast-spin echo, T1-weighted (T1W), postcontrast-enhanced T1W (T1W-CE), proton density weighted (PDW), and T2-weighted (T2W) images confirm surface discontinuity. The hypointense areas on all 4 weightings correspond to calcifications (short arrows).
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Figure 2. All weightings of the left carotid artery show a distinct ulcer (long arrows) and a small calcification (short arrows). The striking hyperintensity on the ulcer surface in the T2-weighted (T2W) image indicates the presence of a mural thrombus. Focal contrast enhancement on postcontrast-enhanced T1W (T1W-CE) indicates vasculature at the base of the thrombus.
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Figure 3. H&E stain of right and left carotid endarterectomy specimens. The right plaque contained extensive calcifications and fibrosis. A well-defined penetrating ulcer extends 4 mm from the lumen surface through a fibrotic matrix. A penetrating ulcer with mural thrombus formation is seen in the left carotid endarterectomy specimen. Asterisks are placed in the lumen of the common and the internal arteries of both carotids. Location indicators are millimeter distance to the bifurcation. + indicates locations in the internal carotid artery; –, locations in the common carotid artery.
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Disclosure
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Dr Kliot is cofounder of a company, UltraImage Corp, which is
now part of Pathway Medical Technologies and develops and makes
MRI phase-array coils similar to those used in this article.
Related Article:
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Issue Highlights
Circulation 2005 112: 1.
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Introduction
Disclosure