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Characterisation of carotid atheroma in symptomatic and asymptomatic patients using high-resolution MRI
  1. Jean Marie U-King-Im (jmksu{at}radiol.cam.ac.uk)
  1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
    1. Tjun Y Tang
    1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
      1. Andrew Patterson
      1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
        1. Martin J Graves
        1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
          1. Simon Howarth
          1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
            1. Zhi Yong Li
            1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
              1. Rikin Trivedi
              1. University department of Neurosurgery, Addenbrooke's Hospital, United Kingdom
                1. David Bowden
                1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
                  1. Peter J Kirkpatrick
                  1. University department of Neurosurgery, Addenbrooke's Hospital, United Kingdom
                    1. Michael E Gaunt
                    1. University department of Vascular Surgery, Addenbrooke's Hospital, United Kingdom
                      1. Elizabeth A Warburton
                      1. University department of Stroke Medicine, Addenbrooke's Hospital, United Kingdom
                        1. Nagui M Antoun
                        1. University department of Radiology, Addenbrooke's Hospital, United Kingdom
                          1. Jonathan H Gillard (jhg21{at}cam.ac.uk)
                          1. University department of Radiology, Addenbrooke's Hospital, United Kingdom

                            Abstract

                            Background and Purpose: To prospectively evaluate differences in carotid plaque characteristics in symptomatic and asymptomatic patients using high-resolution MRI.

                            Methods: 20 symptomatic and 20 asymptomatic patients, with at least 50% carotid stenosis as determined by Doppler ultrasound, underwent pre-operative in vivo multi-spectral MRI of the carotid arteries. Studies were analysed both qualitatively and quantitatively in a randomised manner by two experienced readers in consensus, blinded to clinical status, and plaques were classified according to the modified American Heart Association (AHA) criteria.

                            Results: After exclusion of poor quality images, a total of 109 MRI sections in 18 symptomatic and 19 asymptomatic patients were available for analysis. There were no significant differences in mean luminal stenosis severity (72.9 % vs 67.6 %, p = 0.09) and plaque burden (median plaque areas 50 mm2 vs 50 mm2, p = 0.858) between the symptomatic and asymptomatic groups. However, symptomatic lesions had a higher incidence of ruptured fibrous caps (36.5 % vs 8.7%, p = 0.004), haemorrhage or thrombus (46.5 % vs 14.0 %, p < 0.001), large necrotic lipid cores (63.8 % vs 28.0 %, p = 0.002) and complicated Type VI AHA lesions (61.5% vs 28.1%, p=0.001) compared to asymptomatic lesions. The MRI findings of plaque haemorrhage or thrombus had an odds ratio of 5.25 (95 % CI: 2.08 – 13.24) while thin or ruptured fibrous cap (as opposed to a thick fibrous cap) had an odds ratio of 7.94 (95 % CI: 2.93 – 21.51) for prediction of symptomatic clinical status.

                            Conclusions: There are significant differences in plaque characteristics between symptomatic and asymptomatic carotid atheroma and these can be detected in vivo by high-resolution MRI.

                            • atheroma
                            • carotid artery disease
                            • magnetic resonance imaging

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