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(Circulation. 2004;109:1016-1021.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Magnetic Resonance Imaging Identifies the Fibrous Cap in Atherosclerotic Abdominal Aortic Aneurysm

Christopher M. Kramer, MD; Lisa A. Cerilli, MD; Klaus Hagspiel, MD; Joseph M. DiMaria, BA; Frederick H. Epstein, PhD; John A. Kern, MD

From the Departments of Radiology (C.M.K., K.H., J.M.D., F.H.E.), Medicine (Cardiovascular Division) (C.M.K.), Surgery (Thoracic and Cardiovascular) (J.A.K.), and Pathology (L.A.C.), University of Virginia Health System, Charlottesville, Va.

Correspondence to Christopher M. Kramer, MD, University of Virginia Health System, Departments of Medicine and Radiology, Lee Street, Box 800170, Charlottesville, VA 22908. E-mail ckramer{at}virginia.edu

Received October 17, 2002; de novo received August 11, 2003; revision received November 13, 2003; accepted November 17, 2003.

Background— MRI can distinguish components of atherosclerotic plaque. We hypothesized that contrast enhancement with gadolinium-DTPA (Gd-DTPA) could aid in the differentiation of plaque components in abdominal aortic aneurysm (AAA).

Methods and Results— Twenty-three patients (19 males, age 70±8 years) with AAA underwent MRI on a 1.5-T clinical scanner 3±3 days before surgical grafting. T1- and T2-weighted (W) black blood spin echo imaging was performed in 1 axial slice, and the T1-W imaging was repeated after a Gd-DTPA–enhanced 3D magnetic resonance angiogram. A section of the aorta at the site of imaging was resected at surgery for histopathologic examination of tissue components and inflammatory cells. Signal-to-noise and contrast-to-noise ratios (CNR) were measured in visualized plaque components from multispectral MRI, and percent enhancement after contrast on T1-W imaging was calculated. The value for agreement between pathology and MRI for the number of tissue components was 0.785. T2-W imaging identified thrombus as regions of high signal and lipid core as low signal, with a CNR of 6.43±3.41. Nine patients had a fibrous cap pathologically, which was visualized as a discrete area of uniform increased signal on T2-W imaging with a CNR of 4.52±1.93 compared with lipid core. Within the cap, the percent enhancement after Gd-DTPA on T1-W imaging was 91±63%.

Conclusions— Higher signal on T2-W MRI identifies the fibrous cap and thrombus within AAA. Contrast enhancement improves delineation of the fibrous cap. The addition of contrast to MRI plaque imaging may enhance identification of vulnerable plaque.

Key Words: magnetic resonance imaging • atherosclerosis • contrast media • inflammation • plaque

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