The added value of longitudinal black-blood cardiovascular magnetic resonance angiography in the cross sectional identification of carotid atherosclerotic ulceration.
BACKGROUND
Carotid atherosclerotic ulceration is a significant source of stroke. This study evaluates the efficacy of adding longitudinal black-blood (BB) cardiovascular magnetic resonance (CMR) angiography to cross-sectional CMR images in the identification of carotid atherosclerotic ulceration.


METHODS
Thirty-two subjects (30 males and two females with ages between 48 and 83 years) scheduled for carotid endarterectomy were imaged on a 1.5T GE Signa scanner using multisequence [3D time-of-flight, T1, proton density, T2, contrast enhanced T1], cross-sectional CMR images and longitudinal BB CMR angiography (0.625 x 0.625 mm/pixel). Two rounds of review (round 1: cross-sectional CMR images alone and round 2: cross-sectional CMR images plus longitudinal BB CMR angiography) were conducted for the presence and volume measurements of ulceration. Ulceration was defined as a distinct depression into the plaque containing blood flow signal on cross-sectional CMR and longitudinal BB CMR angiography.


RESULTS
Of the 32 plaques examined by histology, 17 contained 21 ulcers. Using the longitudinal BB CMR angiography sequence in addition to the cross-sectional CMR images in round 2, the sensitivity improved to 80% for ulcers of at least 6 mm3 in volume by histology and 52.4% for all ulcers, compared to 30% and 23.8% in round 1, respectively. There was a slight decline in specificity from 88.2% to 82.3%, though both the positive and negative predictive values increased modestly from 71.4% to 78.6% and from 48.4% to 58.3%, respectively.


CONCLUSIONS
The addition of longitudinal BB CMR angiography to multisequence cross-sectional CMR images increases accuracy in the identification of carotid atherosclerotic ulceration.
Yu
Wei
W
Department of Radiology, University of Washington, Seattle, WA, USA. yuwei02@gmail.com
Underhill
Hunter R
HR
Ferguson
Marina S
MS
Hippe
Daniel S
DS
Hatsukami
Thomas S
TS
Yuan
Chun
C
Chu
Baocheng
B
D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014456:Ulcer / Q000473:pathology* / Q000601:surgery
D003287:Contrast Media
Circulation. 2000 Aug 29;102(9):959-64
10961958
Stroke. 2002 Apr;33(4):977-81
11935047
Circulation. 2005 Jul 5;112(1):e3-4
15998688
Nature. 2008 Feb 21;451(7181):953-7
18288186
Stroke. 2006 Nov;37(11):2696-701
17008627
J Vasc Surg. 2002 Apr;35(4):741-7
11932673
Circulation. 2002 Jan 15;105(2):181-5
11790698
Circulation. 2001 Oct 23;104(17):2051-6
11673345
Magn Reson Med. 1998 Apr;39(4):635-41
9543426
AJNR Am J Neuroradiol. 2008 Oct;29(9):1736-42
18635618
Rev Recent Clin Trials. 2006 Sep;1(3):293-301
18473981
Stroke. 2005 Nov;36(11):2450-6
16224089
AJNR Am J Neuroradiol. 2010 Feb;31(2):311-6
19779001
J Magn Reson Imaging. 2009 Nov;30(5):1209-14
19780187
J Magn Reson Imaging. 2005 Jun;21(6):845-9
15906347
JAMA. 2004 Oct 20;292(15):1845-52
15494582
Magn Reson Med. 2007 Nov;58(5):973-81
17969103
Circulation. 1998 Dec 15;98(24):2666-71
9851951
Circulation. 2008 Jan 29;117(4):e25-146
18086926
Stroke. 2005 Feb;36(2):253-7
15653581
Circulation. 2006 Mar 28;113(12):e660-1
16567574
Stroke. 1994 Jun;25(6):1130-2
8202969
Circulation. 2006 May 16;113(19):2320-8
16651471
Stroke. 1994 Feb;25(2):304-8
8303736
Magn Reson Med. 2002 Nov;48(5):899-905
12418006
J Cardiovasc Magn Reson. 2007;9(1):63-70
17178682
J Magn Reson Imaging. 2006 May;23(5):691-8
16555259
Stroke. 2000 Mar;31(3):615-21
10700494
Radiology. 2002 May;223(2):566-73
11997569
Stroke. 2006 Mar;37(3):818-23
16469957
J Vasc Surg. 1998 May;27(5):872-8; discussion 878-9
9620139
Arterioscler Thromb Vasc Biol. 2005 Jan;25(1):234-9
15528475
J Magn Reson Imaging. 1996 Jan-Feb;6(1):109-12
8851414
AJNR Am J Neuroradiol. 2008 May;29(5):875-82
18272562
AJNR Am J Neuroradiol. 2007 Jun-Jul;28(6):1061-6
17569958
Radiology. 2007 Apr;243(1):220-8
17392255
Top Magn Reson Imaging. 2007 Oct;18(5):371-8
18025991
Radiology. 2006 Aug;240(2):464-72
16864672
J Magn Reson Imaging. 2003 Apr;17(4):478-83
12655588