title: Plaque hemorrhage is a marker of thromboembolic activity in patients with symptomatic carotid disease.
abstract: OBJECTIVE
  To assess whether carotid plaque hemorrhage depicted with magnetic resonance (MR) imaging was associated with thromboembolic activity as assessed with transcranial Doppler imaging.
  
  
  METHODS
  The local research ethics committee approved the study, and all patients gave informed written consent. Between April 2005 and December 2006, patients with high-grade symptomatic carotid stenosis were prospectively recruited. All underwent MR imaging of the carotid arteries for plaque hemorrhage and diffusion-weighted imaging of the brain. Transcranial Doppler imaging of the symptomatic carotid artery was performed over 1 hour to assess the presence of microembolic signal. To determine the relationship between the presence of plaque hemorrhage and diffusion-weighted imaging-positive signal and presence of microembolic signal, a logistic regression analysis was performed.
  
  
  RESULTS
  Fifty-one patients (23 women and 28 men; mean age ± standard deviation, 72 years ± 11) underwent complete MR imaging; 46 (86%) of these patients underwent complete transcranial Doppler imaging. In 32 (63%) patients, there was plaque hemorrhage in the index carotid artery. The presence of plaque hemorrhage increased the risk for ipsilateral abnormalities at diffusion-weighted imaging (odds ratio, 6.2 [95% confidence interval: 1.7, 21.8]; P < .05). Multiple diffusion-weighted imaging-depicted abnormalities of multiple ages were present exclusively in patients with plaque hemorrhage shown at MR imaging (12 of 32 [38%] patients with plaque hemorrhage versus none of 19 patients without plaque hemorrhage; P < .05). The presence of plaque hemorrhage also increased the presence of microembolic signal (odds ratio, 6.0 [95% confidence interval: 1.8, 19.9]; P = .003).
  
  
  CONCLUSIONS
  In patients with carotid plaque hemorrhage demonstrated at MR imaging, there was increased spontaneous microembolic activity at transcranial Doppler imaging and cerebral ischemic lesion patterns suggestive of recurrent embolic events; these findings suggest that plaque hemorrhage shown at MR imaging might be a marker of thromboembolic activity and further validate the usefulness of carotid imaging in identifying patients with active carotid arterial disease.
authors.affiliation: Department of Academic Radiology, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England. nishaltaf@gmail.com
authors.forename: Nishath
authors.initials: N
authors.lastname: Altaf
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Goode
authors.forename: Andrew
authors.initials: A
authors.lastname: Beech
authors.forename: John R F
authors.initials: JR
authors.lastname: Gladman
authors.forename: Paul S
authors.initials: PS
authors.lastname: Morgan
authors.forename: Shane T
authors.initials: ST
authors.lastname: MacSweeney
authors.forename: Dorothee P
authors.initials: DP
authors.lastname: Auer
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D013923:Thromboembolism / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial