Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke.
BACKGROUND
High-resolution MRI has been shown to be capable of distinguishing intact, thick fibrous caps from thin and ruptured caps in human carotid atherosclerosis in vivo. The aim of this study was to determine whether MRI identification of fibrous cap thinning or rupture is associated with a history of recent transient ischemic attack (TIA) or stroke.


RESULTS
Fifty-three consecutive patients (mean age, 71 years; 49 male) scheduled for carotid endarterectomy were recruited after obtaining informed consent. Twenty-eight subjects had a recent history of TIA or stroke on the side appropriate to the index carotid lesion, and 25 were asymptomatic. Preoperative carotid MRI was performed in a 1.5-T GE Signa scanner that generated T(1)-, PD-, and T(2)-weighted and three-dimensional time-of-flight images. Using previously reported MRI criteria, the fibrous cap was categorized as intact-thick, intact-thin, or ruptured for each carotid plaque by blinded review. There was a strong and statistically significant trend showing a higher percentage of symptomatic patients for ruptured caps (70%) compared with thick caps (9%) (P=0.001 Mann-Whitney test for cap status versus symptoms). Compared with patients with thick fibrous caps, patients with ruptured caps were 23 times more likely to have had a recent TIA or stroke (95% CI=3, 210).


CONCLUSIONS
MRI identification of a ruptured fibrous cap is highly associated with a recent history of TIA or stroke. Ongoing prospective studies will determine the predictive value fibrous cap characteristics, as visualized by MRI, for risk of subsequent ischemic events.
Yuan
Chun
C
Department of Radiology, University of Washington, Seattle 98195, USA. cyuan@u.washington.edu
Zhang
Shao-xiong
SX
Polissar
Nayak L
NL
Echelard
Denise
D
Ortiz
Geraldo
G
Davis
Joseph W
JW
Ellington
Elizabeth
E
Ferguson
Marina S
MS
Hatsukami
Thomas S
TS
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020521:Stroke / Q000150:complications*; D013997:Time Factors