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MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients.

Esposito-Bauer L, Saam T, Ghodrati I, Pelisek J, Heider P, Bauer M, Wolf P, Bockelbrink A, Feurer R, Sepp D, Winkler C, Zepper P, Boeckh-Behrens T, Riemenschneider M, Hemmer B, Poppert H - PLoS ONE (2013)

Bottom Line: The following results were obtained by analyzing the remaining 77 patients.Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001).MRI could improve selection criteria for invasive therapy in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Technische Universität München, Munich, Germany. lorenaesposito@web.de

ABSTRACT

Purpose: The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I-VIII). Within these lesion types, lesion types IV-V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones.

Methods: Eighty-three consecutive patients (45 male (54.2%); age 54-88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50-99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I-VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance.

Results: Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV-V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001).

Conclusions: MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.

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Example of lesion type IV–V in the right internal carotid artery.Lesion type IV–V is characterized by a lipid-rich necrotic core; (←) indicates carotid plaque. The lipid-rich necrotic core shows low- to iso-signal intensity on TOF, T1w, PDw, and T2w images. Original magnification ×25.
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pone-0067927-g001: Example of lesion type IV–V in the right internal carotid artery.Lesion type IV–V is characterized by a lipid-rich necrotic core; (←) indicates carotid plaque. The lipid-rich necrotic core shows low- to iso-signal intensity on TOF, T1w, PDw, and T2w images. Original magnification ×25.

Mentions: Lesion type III was found in two carotid plaques (2.6%); lesion type IV–V was found in 16 carotid plaques (20.8%); lesion type VI was found in 21 carotid plaques (27.3%); lesion type VII was found in 35 carotid plaques (45.5%); and lesion type VIII was found in 3 carotid plaques (3.9%). Figure 1 shows a representative case of lesion type IV–V. Figure 2 shows a representative case of lesion type VI.


MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients.

Esposito-Bauer L, Saam T, Ghodrati I, Pelisek J, Heider P, Bauer M, Wolf P, Bockelbrink A, Feurer R, Sepp D, Winkler C, Zepper P, Boeckh-Behrens T, Riemenschneider M, Hemmer B, Poppert H - PLoS ONE (2013)

Example of lesion type IV–V in the right internal carotid artery.Lesion type IV–V is characterized by a lipid-rich necrotic core; (←) indicates carotid plaque. The lipid-rich necrotic core shows low- to iso-signal intensity on TOF, T1w, PDw, and T2w images. Original magnification ×25.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3722215&req=5

pone-0067927-g001: Example of lesion type IV–V in the right internal carotid artery.Lesion type IV–V is characterized by a lipid-rich necrotic core; (←) indicates carotid plaque. The lipid-rich necrotic core shows low- to iso-signal intensity on TOF, T1w, PDw, and T2w images. Original magnification ×25.
Mentions: Lesion type III was found in two carotid plaques (2.6%); lesion type IV–V was found in 16 carotid plaques (20.8%); lesion type VI was found in 21 carotid plaques (27.3%); lesion type VII was found in 35 carotid plaques (45.5%); and lesion type VIII was found in 3 carotid plaques (3.9%). Figure 1 shows a representative case of lesion type IV–V. Figure 2 shows a representative case of lesion type VI.

Bottom Line: The following results were obtained by analyzing the remaining 77 patients.Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001).MRI could improve selection criteria for invasive therapy in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Technische Universität München, Munich, Germany. lorenaesposito@web.de

ABSTRACT

Purpose: The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I-VIII). Within these lesion types, lesion types IV-V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones.

Methods: Eighty-three consecutive patients (45 male (54.2%); age 54-88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50-99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I-VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance.

Results: Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV-V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001).

Conclusions: MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.

Show MeSH
Related in: MedlinePlus