Abstract
Stroke is the third leading cause of death in the United States. The degree of luminal narrowing evaluated by angiography is the standard for assessing the risk of stroke in patients with carotid atherosclerosis and for determining the need for surgical intervention. However, multiple studies have shown that clinical events arise not from the degree of stenosis but from the morphologic characteristics and plaque composition. This is borne out by the difference in absolute risk reduction between symptomatic and asymptomatic patients who receive surgical carotid endarterectomy (CEA). Future clinical practice may diagnose patients with high-risk atherosclerosis, based on plaque characteristics and morphology rather than the degree of stenosis alone. Carotid MRI is a noninvasive imaging method that can provide information on atherosclerotic plaque morphology, composition, and progression or regression. This chapter describes the current capabilities of MRI for visualizing carotid atherosclerosis, including MRI protocols to appropriately evaluate carotid plaque, the image features of carotid arteries, and the future direction of carotid MR imaging and how it can be better used for the management of patients with subclinical atherosclerosis, resulting in a higher quality of life.
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Rosamond W, Flegal K, Furie K et al. Heart disease and stroke statistics – 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008, 117(4):e25–146
Prevalence of stroke–United States, 2005. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 2007 May 18;56(19):469–74
Biller J, Feinberg WM, Castaldo JE et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation. 1998, 97(5):501–9
Virmani R, Ladich ER, Burke AP, Kolodgie FD. Histopathology of carotid atherosclerotic disease. Neurosurgery. 2006, 59:S219–27
Naghavi M. Preventive cardiology: the SHAPE of the future. A synopsis from the screening for heart attack prevention and education (SHAPE) task force report. Herz. 2007, 32:356–61
Wasserman BA, Wityk RJ, Trout HH 3rd et al. Low-grade carotid stenosis: looking beyond the lumen with MRI. Stroke. 2005, 36(11):2504–13
O’Leary DH, Polak JF, Kronmal RA et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999, 340(1):14–22
Yuan C, Mitsumori LM, Ferguson MS et al. In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. Circulation. 2001, 104:2051–6
Yuan C, Kerwin WS, Ferguson MS et al. Contrast-enhanced high resolution MRI for atherosclerotic carotid artery tissue characterization. J Magn Reson Imaging. 2002, 15:62–67
Hatsukami TS, Ross R, Polissar NL et al. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation. 2000, 102:959–64
Cai JM, Hatsukami TS, Ferguson MS et al. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation. 2002, 106:1368–73
Toussaint JF, LaMuraglia GM, Southern JF et al. Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo. Circulation. 1996, 94:932–8
Clarke SE, Hammond RR, Mitchell JR et al. Quantitative assessment of carotid plaque composition using multicontrast MRI and registered histology. Magn Reson Med. 2003, 50:1199–208
Finn JP, Edelman RR. Black-blood and segmented k-space magnetic resonance angiography. Magn Reson Imaging Clin N Am. 1993, 1:349–57
Edelman RR, Chien D, Kim D, et al. Fast selective black blood MR imaging. Radiology. 1991, 181:655–60
Yarnykh VL, Yuan C. T1-insensitive flow suppression using quadruple inversion-recovery. Magn Reson Med. 2002, 48:899–905
Yuan C, Beach KW, Smith LH, Jr, Hatsukami TS. Measurement of atherosclerotic carotid plaque size in vivo using high resolution magnetic resonance imaging. Circulation. 1998, 98:2666–71
Yarnykh VL, Yuan C. Multi-slice double inversion-recovery black-blood imaging with simultaneous slice-re-inversion. J Magn Reson Imaging. 2003, 17:478–83.
Yarnykh VL, Yuan C. Simultaneous outer volume and blood suppression by quadruple inversion-recovery. Magn Reson Med. 2006, 55(5):1083–92
Mitsumori LM, Yuan C, Ferguson MS, Hatsukami TS. In vivo identification of lipid cores in advanced carotid atherosclerotic plaques by high resolution MR imaging (abstr). Circulation. 2000, 102(Suppl):II252
Aoki S, Aoki K, Ohsawa S et al. Dynamic MR imaging of the carotid wall. J Magn Reson Imaging. 1999, 9:420–7
Coombs BD, Ursell PC, Reilly LM et al. Carotid bifurcation plaque structure: high resolution MRI with histologic correlation (abstr) In: Proceedings of the sixth meeting of the international society for magnetic resonance in medicine. Berkeley, Calif: International Society for Magnetic Resonance in Medicine, 1998; 591
Hayes CE, Mathis CM, Yuan C. Surface coil phased arrays for high-resolution imaging of the carotid arteries. J Magn Reson Imaging 1996, 6:109–12
Cai J, Hatsukami TS, Ferguson MS et al. In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology. Circulation. 2005, 112(22):3437–44
Merickel MB, Carman CS, Brookeman JR et al. Identification and 3-D quantification of atherosclerosis using magnetic resonance imaging. Comput Biol Med. 1988, 18:89–102
Yuan C, Petty C, O’Brien KD et al. In vitro and in situ magnetic resonance imaging signal features of atherosclerotic plaque-associated lipids. Arterioscler Thromb Vasc Biol. 1997, 17:1496–503
Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000, 20:1262–75
Spagnoli LG, Mauriello A, Sangiorgi G, Fratoni S, Bonanno E, Schwartz RS, Piepgras DG, Pistolese R, Ippoliti A, Holmes DR Jr. Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA. 2004, 292:1845–52
Mitsumori LM, Hatsukami TS, Ferguson MS et al. In vivo accuracy of multisequence MR imaging for identifying unstable fibrous caps in advanced human carotid plaques. J Magn Reson Imaging. 2003, 17:410–20
Trivedi RA, U-King-Im J, Graves MJ et al. Multi-sequence in vivo MRI can quantify fibrous cap and lipid core components in human carotid atherosclerotic plaques. Eur J Vasc Endovasc Surg. 2004, 28:207–13
Wasserman BA, Smith WI, Trout HH 3rd et al. Carotid artery atherosclerosis: in vivo morphologic characterization with gadolinium-enhanced double-oblique MR imaging initial results. Radiology. 2002, 223:566–73
Chu B, Yuan C, Takaya N et al. Images in cardiovascular medicine. Serial high-spatial-resolution, multisequence magnetic resonance imaging studies identify fibrous cap rupture and penetrating ulcer into carotid atherosclerotic plaque. Circulation. 2006, 113: e660–1
Yuan C, Zhang SX, Polissar NL et al. Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation. 2002, 105:181–5
Takaya N, Yuan C, Chu B et al. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI--initial results. Stroke. 2006, 37(3):818–23
Saam T, Hatsukami TS, Takaya N, Chu B, Underhill H, Kerwin WS, Cai J, Ferguson MS, Yuan C. The vulnerable, or high-risk, atherosclerotic plaque: noninvasive MR imaging for characterization and assessment. Radiology. 2007, 244:64–77
Davies MJ, Thomas AC. Plaque fissuring–the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J. 1985, 53:363–73
Kolodgie FD, Gold HK, Burke AP et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med. 2003, 349:2316–25
Mofidi R, Crotty TB, McCarthy P et al. Association between plaque instability, angiogenesis and symptomatic carotid occlusive disease. Br J Surg. 2001, 88:945–50
Carr S, Farb A, Pearce WH, Virmani R, Yao JS. Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. J Vasc Surg. 1996, 23:755–65
Chu B, Kampschulte A, Ferguson MS et al. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke. 2004, 35:1079–84
Cappendijk VC, Cleutjens KB, Kessels AG et al. Assessment of human atherosclerotic carotid plaque components with multisequence MR imaging: initial experience. Radiology. 2005, 234:487–92
Moody AR, Murphy RE, Morgan PS et al. Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation. 2003, 107:3047–52
Saam T, Cai J, Ma L et al. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology. 2006, 240:464–72
Altaf N, Daniels L, Morgan PS et al. Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events. J Vasc Surg. 2008, 47(2):337–42
Altaf N, MacSweeney ST, Gladman J et al. Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis. Stroke. 2007, 38:1633–5
Takaya N, Yuan C, Chu B et al. Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation. 2005, 111:2768–75
O’Leary DH, Polak JF, Kronmal RA et al. Distribution and correlates of sonographically detected carotid artery disease in the cardiovascular health study. The CHS Collaborative Research Group. Stroke. 1992, 23:1752–60
Saam T, Hatsukami TS, Underhill H et al. Prevalence of AHA type VI carotid lesions identified by MRI across different categories of stenosis measured by duplex ultrasound. Circulation. 2006, 114:II–776
Shimizu Y, Kitagawa K, Nagai Y et al. Carotid atherosclerosis as a risk factor for complex aortic lesions in patients with ischemic cerebrovascular disease. Circ J. 2003, 67:597–600
Inzitari D, Eliasziw M, Gates P et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial collaborators. N Engl J Med. 2000, 342:1693–700
Koktzoglou I, Chung YC, Carroll TJ et al. Three-dimensional black-blood MR imaging of carotid arteries with segmented steady-state free precession: initial experience. Radiology. 2007, 243(1):220–8
Koktzoglou I, Li D. Diffusion-prepared segmented steady-state free precession: Application to 3D black-blood cardiovascular magnetic resonance of the thoracic aorta and carotid artery walls. J Cardiovasc Magn Reson. 2007, 9(1):33–42
Wasserman BA, Sharrett AR, Lai S et al. Risk factor associations with the presence of a lipid core in carotid plaque of asymptomatic individuals using high-resolution MRI: the multi-ethnic study of atherosclerosis (MESA). Stroke. 2008, 39(2):329–35
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Yuan, C., Ota, H., Zhao, X., Hatsukami, T. (2011). The Role of MRI in Examining Subclinical Carotid Plaque. In: Naghavi, M. (eds) Asymptomatic Atherosclerosis. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-179-0_27
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DOI: https://doi.org/10.1007/978-1-60327-179-0_27
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