In-vivo carotid T2 mapping can accurately quantify plaque lipid content to discriminate between symptomatic and asymptomatic patients: histological validation, scan-rescan reproducibility and clinical study
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KeywordsCarotid Endarterectomy Lipid Core Plaque Component Plaque Vulnerability Masson Trichrome
In-vivo carotid CMR is able to identify features of plaque vulnerability such as lipid core size. However, the current standard (multicontrast CMR) requires contrast media, extensive post-processing and subjective interpretation. Recently we proposed to use quantitative T2 mapping to distinguish plaque lipid from surrounding fibrous tissue and measure lipid core size. This study aimed to (1) validate plaque lipid quantification by T2 mapping against histology and (2) investigate if it could discriminate between symptomatic and asymptomatic patients.
Plaques were collected at the time of carotid endarterectomy, processed and cut at 1 mm intervals using carotid bifurcation and T1w images as references to match T2 map locations. Plaque lipid area was manually segmented on sections stained with H&E and Masson Trichrome, with Oil-red-O used to confirm lipid distribution.
We have demonstrated that carotid T2 mapping can be used to quantify plaque lipid content with good accuracy and reproducibility, and to classify plaques as symptomatic or asymptomatic based on their lipid core size. This technique can potentially be used to identify patients at risk of plaque rupture; informing decisions of stents vs. surgery; stratify for more intensive lipid treatment; and monitor response to treatment in clinical trials.
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