In vivo detection of hemorrhage in human atherosclerotic plaques with magnetic resonance imaging.
OBJECTIVE
To investigate the performance of high-resolution T1-weighted (T1w) turbo field echo (TFE) magnetic resonance imaging (MRI) for the identification of the high-risk component intraplaque hemorrhage, which is described in the literature as a troublesome component to detect.


METHODS
An MRI scan was performed preoperatively on 11 patients who underwent carotid endarterectomy because of symptomatic carotid disease with a stenosis larger than 70%. A commonly used double inversion recovery (DIR) T1w turbo spin echo (TSE) served as the T1w control for the T1w TFE pulse sequence. The MR images were matched slice by slice with histology, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the MR images were calculated. Additionally, two readers, who were blinded for the histological results, independently assessed the MR slices concerning the presence of intraplaque hemorrhage.


RESULTS
More than 80% of the histological proven intraplaque hemorrhage could be detected using the TFE sequence with a high interobserver agreement (Kappa = 0.73). The TFE sequence proved to be superior to the TSE sequence concerning SNR and CNR, but also in the qualitative detection of intraplaque hemorrhage. The false positive TFE results contained fibrous tissue and were all located outside the main plaque area.


CONCLUSIONS
The present study shows that in vivo high-resolution T1w TFE MRI can identify the high-risk component intraplaque hemorrhage with a high detection rate in patients with symptomatic carotid disease. Larger clinical trials are warranted to investigate whether this technique can identify patients at risk for an ischemic attack.
Cappendijk
Vincent C
VC
Department of Radiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital of Maastricht, The Netherlands.
Cleutjens
Kitty B J M
KB
Heeneman
Sylvia
S
Schurink
Geert Willem H
GW
Welten
Rob J Th J
RJ
Kessels
Alfons G H
AG
van Suylen
Robert J
RJ
Daemen
Mat J A P
MJ
van Engelshoven
Jos M A
JM
Kooi
M Eline
ME
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery; D016894:Endarterectomy, Carotid; D005189:False Positive Reactions; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation