title: Comparison of symptomatic and asymptomatic atherosclerotic carotid plaques using parallel imaging and 3 T black-blood in vivo CMR.
abstract: BACKGROUND
  To determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients.
  
  
  METHODS
  In this prospective monocentric observational study 34 patients (24 males; 70 ±9.3 years) with symptomatic carotid disease defined as ischemic brain lesions in one internal carotid artery territory on diffusion weighted images underwent a carotid bb-CMR at 3 T with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques (PAT factor = 2) within 10 days after symptom onset. All patients underwent extensive clinical workup (lab, brain MR, duplex sonography, 24-hour ECG, transesophageal echocardiography) to exclude other causes of ischemic stroke. Prevalence of American Heart Association lesion type VI (AHA-LT6), status of the fibrous cap, presence of hemorrhage/thrombus and area measurements of calcification, necrotic core and hemorrhage were determined in both carotid arteries in consensus by two reviewers who were blinded to clinical information. McNemar and Wilcoxon's signed rank tests were use for statistical comparison. A p-value <0.05 was considered statistically significant.
  
  
  RESULTS
  Symptomatic plaques showed a higher prevalence of AHA-LT6 (67.7% vs. 11.8%; p < 0.001; odds ratio = 12.5), ruptured fibrous caps (44.1% vs. 2.9%; p < 0.001; odds ratio = 15.0), juxtaluminal thrombus (26.5 vs. 0%; p < 0.01; odds ratio = 7.3) and intraplaque hemorrhage (58.6% vs. 11.8%; p = 0.01; odds ratio = 3.8). Necrotic core and hemorrhage areas were greater in symptomatic plaques (14.1 mm2 vs. 5.5 mm2 and 13.6 mm2 vs. 5.3 mm2; p < 0.01, respectively).
  
  
  CONCLUSIONS
  3 T bb-CMR is able to differentiate between symptomatic and asymptomatic carotid plaques, demonstrating the potential of bb-CMR to differentiate between stable and vulnerable lesions and ultimately to identify patients with low versus high risk for cardiovascular complications. Best predictors of the symptomatic side were a ruptured fibrous cap, AHA-LT 6, juxtaluminal hemorrhage/thrombus, and intraplaque hemorrhage.
authors.forename: Jochen M
authors.initials: JM
authors.lastname: Grimm
authors.forename: Andreas
authors.initials: A
authors.lastname: Schindler
authors.forename: Tobias
authors.initials: T
authors.lastname: Freilinger
authors.forename: Clemens C
authors.initials: CC
authors.lastname: Cyran
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Martin
authors.initials: M
authors.lastname: Dichgans
authors.forename: Caroline
authors.initials: C
authors.lastname: Freilinger
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Tobias
authors.initials: T
authors.lastname: Saam
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D005858:Germany; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D020521:Stroke / Q000209:etiology