title: Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study.
abstract: 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.
authors.affiliation: Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ota
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.forename: Hunter R
authors.initials: HR
authors.lastname: Underhill
authors.forename: Minako
authors.initials: M
authors.lastname: Oikawa
authors.forename: Li
authors.initials: L
authors.lastname: Dong
authors.forename: Xihai
authors.initials: X
authors.lastname: Zhao
authors.forename: Nayak L
authors.initials: NL
authors.lastname: Polissar
authors.forename: Blazej
authors.initials: B
authors.lastname: Neradilek
authors.forename: Tianli
authors.initials: T
authors.lastname: Gao
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Zhang
authors.forename: Zixu
authors.initials: Z
authors.lastname: Yan
authors.forename: Miao
authors.initials: M
authors.lastname: Guo
authors.forename: Zhaoqi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Hatsukami
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
mesh_terms: 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