title: Association of carotid atherosclerotic plaque features with acute ischemic stroke: a magnetic resonance imaging study.
abstract: OBJECTIVE
  It remains unclear whether direct vessel wall imaging can identify carotid high-risk lesions in symptomatic subjects and whether carotid plaque characteristics are more effective indicators for cerebral infarct severity than stenosis. This study sought to determine the associations of carotid plaque characteristics by MR imaging with stenosis and acute cerebral infarct (ACI) sizes on diffusion weighted imaging (DWI).
  
  
  METHODS
  One hundred and fourteen symptomatic patients underwent carotid and brain MRI. ACI volume was determined from symptomatic internal carotid artery territory on DWI images. Ipsilateral carotid plaque morphological and compositional characteristics, and stenosis were also determined. The relationships between carotid plaque characteristics, stenosis and ACIs size were then evaluated.
  
  
  RESULTS
  In carotid arteries with 30-49% stenosis, 86.7% and 26.7% were found to have lipid-rich necrotic core (LRNC) and intraplaque hemorrhage, respectively. Furthermore, 45.8% of carotid arteries with 0-29% stenosis developed LRNCs. Carotid morphological measurements, such as % wall volume, and the LRNC size were significantly associated with ipsilateral ACIs volume before and after adjustment for significant demographic factors (age and LDL) or stenosis in patients with carotid plaque (all p<0.05).
  
  
  CONCLUSIONS
  A substantial number of high-risk plaques characterized by vessel wall imaging exist in carotid arteries with lower grade stenosis. In addition, carotid plaque characteristics, particularly the % wall volume and LRNC size, are independently associated with cerebral infarction as measured by DWI lesions. Our findings indicate that characterizing atherosclerotic plaque by MR vessel wall imaging might be useful for stratification of plaque risk and infarction severity.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
authors.forename: Huilin
authors.initials: H
authors.lastname: Zhao
authors.forename: Xihai
authors.initials: X
authors.lastname: Zhao
authors.forename: Xiaosheng
authors.initials: X
authors.lastname: Liu
authors.forename: Ye
authors.initials: Y
authors.lastname: Cao
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.forename: Jie
authors.initials: J
authors.lastname: Sun
authors.forename: Feiyu
authors.initials: F
authors.lastname: Li
authors.forename: Jianrong
authors.initials: J
authors.lastname: Xu
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D015984:Causality; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*
keywords: Atherosclerosis; Carotid arteries; Magnetic resonance imaging; Plaque; Stenosis; Stroke