title: Carotid plaque high-resolution MRI at 3 T: evaluation of a new imaging score for symptomatic plaque assessment.
abstract: OBJECTIVE
  To assess the sensitivity and specificity of intra-plaque hemorrhage (IPH), large lipid-rich necrotic core (LR-NC) and ulceration or cap rupture (UCR) for symptomatic carotid plaque characterization and to evaluate a new imaging score [Hemorrhage, Ulceration or cap rupture, Lipid-rich necrotic Core (HULC) score based on the sum of presence/absence of IPH, UCR and LR-NC; range 0-3] for assessment of recently symptomatic carotid plaques.
  
  
  METHODS
  Twenty-seven recently symptomatic (<8 weeks) and 36 asymptomatic patients with a carotid plaque thicker than 2 mm were prospectively imaged on a 3-T magnetic resonance (MR) system using high-resolution, multi-contrast MR sequences. Prior to analysis, all images were reviewed to assess image quality of each sequence. Sensitivity and specificity of IPH, LR-NC, UCR and HULC scores were calculated.
  
  
  RESULTS
  Fifty-one patients were analyzed (26 symptomatic carotids and 67 asymptomatic carotids) after exclusion of studies with poor image quality. Sensitivity and specificity for symptomatic carotid plaque was, respectively, 46.1% and 97% for IPH, 84.6% and 73.1% for UCR and 80.7% and 76.1% for LR-NC. A HULC score of 2 or more showed a sensitivity of 73% and a specificity of 92.5%.
  
  
  CONCLUSIONS
  At 3 T, intra-plaque hemorrhage is the most specific criterion to characterize symptomatic carotid plaque. The HULC score offers the best compromise between sensitivity and specificity.
authors: Department of Radiology, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, Lyon, France. Laurence.gury@gmail.com
authors: Laurence
authors: L
authors: Gury-Paquet
authors: Antoine
authors: A
authors: Millon
authors: Fatima
authors: F
authors: Salami
authors: Alexandru
authors: A
authors: Cernicanu
authors: Jean-Yves
authors: JY
authors: Scoazec
authors: Philippe
authors: P
authors: Douek
authors: Loïc
authors: L
authors: Boussel
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000473:pathology; D015992:Body Mass Index; D016893:Carotid Stenosis / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000473:pathology*; D012680:Sensitivity and Specificity