Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging.
BACKGROUND
Recent studies demonstrated that in vivo and ex vivo MRI can characterize the components of the carotid atherosclerotic plaque, such as fibrous tissue, lipid/necrotic core, calcium, hemorrhage, and thrombus. The purpose of this study was to determine whether in vivo high-resolution multicontrast MRI could accurately classify human carotid atherosclerotic plaque according to the American Heart Association classification.


RESULTS
Sixty consecutive patients (mean age 70 years; 54 males) scheduled for carotid endarterectomy were imaged with a 1.5-T scanner after informed consent was obtained. A standardized protocol was used to obtain 4 different contrast-weighted images (time of flight and T1-, PD-, and T2-weighted) of the carotid arteries. Best voxel size was 0.25x0.25x1 mm3. Carotid plaques were removed intact and processed for histological examination. Both MR images and histological sections were independently reviewed, categorized, and compared. Overall, the classification obtained by MRI and the American Heart Association classifications showed good agreement, with Cohen's kappa (95% CI) of 0.74 (0.67 to 0.82) and weighted kappa of 0.79. The sensitivity and specificity, respectively, of MRI classification were as follows: type I-II lesions, 67% and 100%; type III lesions, 81% and 98%; type IV-V lesions, 84% and 90%; type VI lesions, 82% and 91%; type VII lesions, 80% and 94%; and type VIII lesions, 56% and 100%.


CONCLUSIONS
In vivo high-resolution multicontrast MRI is capable of classifying intermediate to advanced atherosclerotic lesions in the human carotid artery and is also capable of distinguishing advanced lesions from early and intermediate atherosclerotic plaque.
Cai
Jian-Ming
JM
Department of Radiology, University of Washington, Seattle, Wash 98195-7115, USA.
Hatsukami
Thomas S
TS
Ferguson
Marina S
MS
Small
Randy
R
Polissar
Nayak L
NL
Yuan
Chun
C
D000368:Aged; D002340:Carotid Artery Diseases / Q000145:classification / Q000473:pathology*; D017536:Carotid Artery, Common / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male