Gadofosveset-enhanced magnetic resonance imaging of human carotid atherosclerotic plaques: a proof-of-concept study.
OBJECTIVE
To investigate the potential of gadofosveset-enhanced MR imaging for the characterization of human carotid atherosclerotic plaques.


METHODS
Sixteen (9 symptomatic, 7 asymptomatic) patients with 70% to 99% carotid stenosis (according to NASCET criteria) were included (13 men, 3 women, mean age 67.6 years). All patients underwent baseline precontrast MR imaging of the carotid plaque. Immediately after completion of the baseline examination, 0.03 mmol/kg gadofosveset was administered. At 24 hours postinjection, the acquisition was repeated. Twelve patients were scheduled for carotid endarterectomy. Carotid endarterectomy specimens were HE-, CD31-, CD68-, and albumin-stained to correlate signal enhancement with plaque composition, intraplaque microvessel density, and macrophage and albumin content. A random intercept model was used to compare signal enhancement between symptomatic and asymptomatic patients, adjusting for size of various plaque components. This study was approved by the institutional medical ethics committee. All participants gave written informed consent.


RESULTS
Signal enhancement (SE) of the plaque was significantly higher in symptomatic patients compared with asymptomatic patients (median log SE 0.182 vs. -0.109, respectively, P < 0.001). A positive association (as expressed by a regression coefficient beta = 0.0035) was found between signal enhancement on the log scale and intraplaque albumin content (P = 0.038). There was no association between signal enhancement and various other plaque components.


CONCLUSIONS
In this study, the potential of gadofosveset-enhanced human carotid plaque MR imaging for identification of high-risk plaques was demonstrated. Signal enhancement of the plaque after administration of gadofosveset was associated with differences in intraplaque albumin content. Although promising, we emphasize that these results are based on a small patient population. Larger prospective studies are warranted.
Lobbes
Marc B I
MB
Department of Radiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands. marclobbes@planet.nl
Heeneman
Sylvia
S
Passos
Valeria Lima
VL
Welten
Rob
R
Kwee
Robert M
RM
van der Geest
Rob J
RJ
Wiethoff
Andrea J
AJ
Caravan
Peter
P
Misselwitz
Bernd
B
Daemen
Mat J A P
MJ
van Engelshoven
Jos M A
JM
Leiner
Tim
T
Kooi
Marianne E
ME
D000368:Aged; D000418:Albumins / Q000032:analysis; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D016893:Carotid Stenosis / Q000175:diagnosis*; D003287:Contrast Media; D016894:Endarterectomy, Carotid; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009942:Organometallic Compounds
D000418:Albumins; D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium