title: MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients.
abstract: OBJECTIVE
  The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I-VIII). Within these lesion types, lesion types IV-V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones.
  
  
  METHODS
  Eighty-three consecutive patients (45 male (54.2%); age 54-88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50-99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I-VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance.
  
  
  RESULTS
  Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV-V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001).
  
  
  CONCLUSIONS
  MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.
authors.affiliation: Department of Neurology, Technische Universität München, Munich, Germany. lorenaesposito@web.de
authors.forename: Lorena
authors.initials: L
authors.lastname: Esposito-Bauer
authors.forename: Tobias
authors.initials: T
authors.lastname: Saam
authors.forename: Iman
authors.initials: I
authors.lastname: Ghodrati
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Pelisek
authors.forename: Peter
authors.initials: P
authors.lastname: Heider
authors.forename: Matthias
authors.initials: M
authors.lastname: Bauer
authors.forename: Petra
authors.initials: P
authors.lastname: Wolf
authors.forename: Angelina
authors.initials: A
authors.lastname: Bockelbrink
authors.forename: Regina
authors.initials: R
authors.lastname: Feurer
authors.forename: Dominik
authors.initials: D
authors.lastname: Sepp
authors.forename: Claudia
authors.initials: C
authors.lastname: Winkler
authors.forename: Peter
authors.initials: P
authors.lastname: Zepper
authors.forename: Tobias
authors.initials: T
authors.lastname: Boeckh-Behrens
authors.forename: Matthias
authors.initials: M
authors.lastname: Riemenschneider
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hemmer
authors.forename: Holger
authors.initials: H
authors.lastname: Poppert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis*
references.citation: Arterioscler Thromb Vasc Biol. 2005 Oct;25(10):2054-61
references.pmid: 16037567
references.citation: Acad Radiol. 2006 Oct;13(10):1180-6
references.pmid: 16979066
references.citation: Stroke. 2010 Oct;41(10 Suppl):S12-6
references.pmid: 20876485
references.citation: AJNR Am J Neuroradiol. 2010 Sep;31(8):1395-402
references.pmid: 20651015
references.citation: J Vasc Surg. 2008 Feb;47(2):337-42
references.pmid: 18164171
references.citation: AJNR Am J Neuroradiol. 2010 Mar;31(3):487-93
references.pmid: 19833801
references.citation: Neurosurgery. 2011 Jan;68(1):62-7; discussion 67
references.pmid: 21099723
references.citation: JAMA. 1995 May 10;273(18):1421-8
references.pmid: 7723155
references.citation: Stroke. 2010 Jan;41(1):e11-7
references.pmid: 19926843
references.citation: J Angiogenes Res. 2009 Dec 27;1:10
references.pmid: 20072672
references.citation: Radiology. 2009 Aug;252(2):502-8
references.pmid: 19508983
references.citation: Br J Surg. 2001 Jul;88(7):945-50
references.pmid: 11442525
references.citation: BMC Med Imaging. 2010 Nov 30;10:27
references.pmid: 21118504
references.citation: Circulation. 1992 Dec;86(6 Suppl):III30-42
references.pmid: 1424049
references.citation: Ultraschall Med. 1986 Apr;7(2):70-5
references.pmid: 2940679
references.citation: AJR Am J Roentgenol. 2011 May;196(5):1164-71
references.pmid: 21512087
references.citation: Circulation. 2000 Aug 29;102(9):959-64
references.pmid: 10961958
references.citation: Am Heart J. 2008 Mar;155(3):584.e1-8
references.pmid: 18294500
references.citation: J Vasc Surg. 1997 Oct;26(4):585-94
references.pmid: 9357458
references.citation: Stroke. 2007 May;38(5):1470-5
references.pmid: 17363718
references.citation: Stroke. 2004 May;35(5):1079-84
references.pmid: 15060318
references.citation: Radiology. 2001 Nov;221(2):285-99
references.pmid: 11687667
references.citation: Imaging Med. 2010 Feb 1;2(1):63-75
references.pmid: 20953294
references.citation: J Clin Epidemiol. 1995 Dec;48(12):1503-10
references.pmid: 8543964
references.citation: Stroke. 2007 Jun;38(6):1812-9
references.pmid: 17463311
references.citation: Nan Fang Yi Ke Da Xue Xue Bao. 2011 Feb;31(2):299-303
references.pmid: 21354916
references.citation: Radiology. 2011 Feb;258(2):538-45
references.pmid: 21163919
references.citation: Circulation. 2010 Nov 16;122(20):2031-8
references.pmid: 21041694
references.citation: AJNR Am J Neuroradiol. 2011 Mar;32(3):454-9
references.pmid: 21233234
references.citation: Stroke. 2006 Mar;37(3):818-23
references.pmid: 16469957
references.citation: Arch Surg. 1982 Nov;117(11):1479-88
references.pmid: 6182861
references.citation: J Neurol. 2007 Dec;254(12):1714-22
references.pmid: 17994312
references.citation: Lancet. 2004 May 8;363(9420):1491-502
references.pmid: 15135594
references.citation: Circulation. 2001 Oct 23;104(17):2051-6
references.pmid: 11673345
references.citation: Stroke. 2007 May;38(5):1633-5
references.pmid: 17379827
references.citation: Arterioscler Thromb. 1994 May;14(5):840-56
references.pmid: 8172861
references.citation: Circulation. 2002 Sep 10;106(11):1368-73
references.pmid: 12221054
references.citation: Circulation. 1995 Sep 1;92(5):1355-74
references.pmid: 7648691
references.citation: J Vasc Surg. 1996 May;23(5):755-65; discussion 765-6
references.pmid: 8667496
references.citation: Int Angiol. 1998 Sep;17(3):194-200
references.pmid: 9821034
references.citation: Arch Neurol. 2010 Feb;67(2):180-6
references.pmid: 20008646
references.citation: Eur J Vasc Endovasc Surg. 2005 Sep;30(3):275-84
references.pmid: 16130207