Carotid plaques in transient ischemic attack and stroke patients: one-year follow-up study by magnetic resonance imaging.
OBJECTIVE
To investigate the natural course of carotid plaque progression in transient ischemic attack/stroke patients by using serial multisequence magnetic resonance imaging (MRI).


METHODS
Forty transient ischemic attack/stroke patients with ipsilateral <70% carotid stenosis underwent MRI of the plaque ipsilateral to the symptomatic side at baseline and after 1 year. The MRI protocol consisted of T1-weighted turbo field-echo, time-of-flight, T2-weighted turbo spin-echo (TSE), and pre- and postgadopentetate dimeglumine-enhanced T1-weighted TSE images. For each plaque, carotid lumen volume, wall volume, total vessel volume (=carotid lumen volume + wall volume), the presence of a lipid-rich necrotic core (LRNC), fibrous cap (FC) status, and the presence of intraplaque hemorrhage (IPH) were assessed at both time points.


RESULTS
Over a 1-year period, mean carotid lumen volume decreased with 4.8% ± 2.0% (±standard error) (P = 0.013). Mean wall volume increased with 11.2% ± 2.2% (P < 0.001). Total vessel volume did not significantly change (P = 0.147). At baseline, there were 18 plaques with a LRNC, which also had a LRNC at 1-year follow-up. No plaque without a LRNC at baseline developed a LRNC during the follow-up period. All plaques with a LRNC had a thin and/or ruptured FC at both time points. Twelve patients had IPH both at baseline and at follow-up. In one patient, IPH disappeared, whereas in another patient, new IPH appeared at follow-up. The presence of IPH and a LRNC with a thin and/or ruptured FC were not significantly associated with plaque progression (P > 0.05).


CONCLUSIONS
In symptomatic patients with an ipsilateral carotid plaque causing <70% stenosis, we found evidence for inward plaque remodeling over a 1-year period. Overall, the presence/absence of IPH, a LRNC, and FC status did not change over 1 year.
Kwee
Robert M
RM
Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.
van Oostenbrugge
Robert J
RJ
Mess
Werner H
WH
Prins
Martin H
MH
van der Geest
Rob J
RJ
ter Berg
Johannes W M
JW
Franke
Cees L
CL
Korten
Arthur G G C
AG
Meems
Bé J
BJ
van Engelshoven
Jos M A
JM
Wildberger
Joachim E
JE
Kooi
Marianne Eline
ME
D016893:Carotid Stenosis / Q000150:complications* / Q000473:pathology; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000473:pathology; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000473:pathology
D003287:Contrast Media; D019786:Gadolinium DTPA