Evaluation of carotid plaque vulnerability in vivo: Correlation between dynamic contrast-enhanced MRI and MRI-modified AHA classification

Xiaoqian Ge; Zien Zhou; Huilin Zhao; Xiao Li; Beibei Sun; Shiteng Suo; Maree L Hackett; Jieqing Wan; Jianrong Xu; Xiaosheng Liu

doi:10.1002/jmri.25637

Evaluation of carotid plaque vulnerability in vivo: Correlation between dynamic contrast-enhanced MRI and MRI-modified AHA classification

J Magn Reson Imaging. 2017 Sep;46(3):870-876. doi: 10.1002/jmri.25637. Epub 2017 Jan 24.

Authors

Affiliations

¹ Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China.
² Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Sydney, Australia.
³ Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China.

PMID: 28120364
DOI: 10.1002/jmri.25637

Abstract

Purpose: To noninvasively monitor carotid plaque vulnerability by exploring the relationship between pharmacokinetic parameters (PPs) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and plaque types based on MRI-modified American Heart Association (AHA) classification, as well as to assess the ability of PPs in discrimination between stable and vulnerable plaques suspected on MRI.

Materials and methods: Of 70 consecutive patients with carotid plaques who volunteered for 3.0T MRI (3D time-of-flight [TOF], T₁ -weighted, T₂ -weighted, 3D magnetization-prepared rapid acquisition gradient-echo [MP-RAGE] and DCE-MRI), 66 participants were available for analysis. After plaque classification according to MRI-modified AHA Lesion-Type (LT), PPs (K^trans , k_ep , v_e , and v_p ) of DCE-MRI were measured. The Extended Tofts model was used for calculation of PPs. For participants with multiple carotid plaques, the plaque with the worst MRI-modified AHA LT was chosen for analysis. Correlations between PPs and plaque types and the ability of these parameters to distinguish stable and vulnerable plaques suspected on MRI were assessed.

Results: Significant positive correlation between K^trans and LT III to VI was found (ρ = 0.532, P < 0.001), as was the correlation between k_ep and LT III to VI (ρ = 0.409, P < 0.001). Stable and vulnerable plaques suspected on MRI could potentially be distinguished by K^trans (sensitivity 83%, specificity 100%) and k_ep (sensitivity 77%, specificity 91%).

Conclusion: K^trans and k_ep from DCE-MRI can provide quantitative information to monitor plaque vulnerability in vivo and differentiate vulnerable plaques suspected on MRI from stable ones. These two parameters could be adopted as imaging biomarkers for plaque characterization and risk stratification.

Level of evidence: 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:870-876.

Keywords: carotid artery; dynamic; inflammation; neovascularization; vulnerable plaque.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Carotid Arteries / diagnostic imaging*
Contrast Media*
Female
Humans
Image Enhancement / methods*
Male
Plaque, Atherosclerotic / diagnostic imaging*
Sensitivity and Specificity

Substances

Contrast Media