Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study.
OBJECTIVE
Histological studies suggest associations between hemorrhage and large lipid-rich/necrotic cores with thin or ruptured fibrous caps in advanced atherosclerosis. We investigated these associations in carotid arteries with mild to severe stenosis by in vivo 3T MRI.


RESULTS
Seventy-seven patients with >or=50% carotid stenosis in at least one side by duplex ultrasound underwent bilateral multi-contrast carotid MRI scans. Measurements for wall and lipid-rich/necrotic core sizes, presence of hemorrhage, and fibrous cap status (classified as intact thick, intact thin or ruptured) were recorded. Arteries with poor image quality, occlusion, or no detectable lipid-rich/necrotic core were excluded. For the 798 MRI slices included, multivariate ordinal regression analysis demonstrated larger %lipid-rich/necrotic core (odds ratio for 10% increase, 1.49; P=0.02) and presence of hemorrhage (odds ratio, 5.91; P<0.001) were independently associated with a worse (intact thin or ruptured) stage of fibrous cap status. For artery-based multivariate analysis, a larger maximum %lipid-rich/necrotic core and presence of hemorrhage independently associated with worse fibrous cap status (P<0.001, for both). No hemorrhage was detected in arteries with thick fibrous caps.


CONCLUSIONS
Hemorrhage and larger %lipid-rich/necrotic core were independently associated with a thin or ruptured fibrous cap status at an early to advanced stage of carotid atherosclerosis.
Ota
Hideki
H
Department of Radiology, University of Washington, Seattle, WA, USA.
Yu
Wei
W
Underhill
Hunter R
HR
Oikawa
Minako
M
Dong
Li
L
Zhao
Xihai
X
Polissar
Nayak L
NL
Neradilek
Blazej
B
Gao
Tianli
T
Zhang
Zhuo
Z
Yan
Zixu
Z
Guo
Miao
M
Zhang
Zhaoqi
Z
Hatsukami
Thomas S
TS
Yuan
Chun
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000473:pathology*; D016893:Carotid Stenosis / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012422:Rupture, Spontaneous