title: High-resolution MRI of carotid plaque with a neurovascular coil and contrast-enhanced MR angiography: one-stop shopping for the comprehensive assessment of carotid atherosclerosis.
abstract: OBJECTIVE
  The objective of our study was to assess a protocol of study of carotid atherosclerosis coupling vascular wall imaging and luminal imaging in the same examination and to evaluate the accuracy of high-resolution MRI with a neurovascular coil in carotid plaque characterization.
  
  
  METHODS
  Thirty-two consecutive patients with 34 carotid artery stenoses were prospectively enrolled. MRI was performed on a 1.5-T unit. Plaque assessment was performed starting with a diffusion-weighted sequence and followed by a fat-suppressed T1-weighted sequence; after contrast-enhanced MR angiography (CE-MRA), all patients were evaluated with a T1-weighted 3D high-resolution sequence. Carotid plaques were classified as type A, having a large lipid-necrotic core; type B, being a complex fibrotic-calcified plaque with soft content (mixed plaque); or type C, being a fibrotic-calcified plaque (hard). Additional features indicative of vulnerable plaque such as intraplaque hemorrhage (IPH), ulceration, and severe stenosis were registered. MR findings were compared with surgical specimens.
  
  
  RESULTS
  MRI correctly identified 11 of 13 type A, eight of 11 type B, and eight of 10 type C plaques (sensitivity, 84.6%, 72.7%, and 80%, respectively). In the identification of lipid-necrotic core plaque, MRI showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.6%, 100%, 100%, and 91.3%, respectively (κ = 0.87). For reordering all plaques in two groups (i.e., soft vs nonsoft) in the identification of soft plaques, MRI had a sensitivity, specificity, PPV, and NPV of 83.3%, 80%, 90.9%, and 66.7%, respectively (κ = 0.59). IPH, ulcers, and severe stenosis were detected in eight of eight, 11 of 13, and 25 of 25 cases, respectively.
  
  
  CONCLUSIONS
  In patients with carotid atherosclerosis, ongoing CE-MRA with a neurovascular coil for the simultaneous detection of unstable plaques is feasible. Our MR protocol accurately identifies the major features of vulnerable plaque.
authors.affiliation: Dipartimento di Radiologia Clinica Diagnostica ed Interventistica, Azienda USL Ferrara, Italy. s.tartari@alice.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Tartari
authors.forename: Roberto
authors.initials: R
authors.lastname: Rizzati
authors.forename: Riccardo
authors.initials: R
authors.lastname: Righi
authors.forename: Anna
authors.initials: A
authors.lastname: Deledda
authors.forename: Katia
authors.initials: K
authors.lastname: Capello
authors.forename: Riccardo
authors.initials: R
authors.lastname: Soverini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Benea
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000601:surgery; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium