title: Imaging of carotid artery vessel wall edema using T2-weighted cardiovascular magnetic resonance.
abstract: BACKGROUND
  Atherothrombosis remains a major health problem in the western world, and carotid atherosclerosis is an important contributor to embolic ischemic strokes. It remains a clinical challenge to identify rupture-prone atherosclerotic plaques before clinical events occur. Inflammation, endothelial injury and angiogenesis are features of vulnerable plaques and may all be associated with plaque edema. Therefore, vessel wall edema, which can be detected by 2D T2-weighted cardiovascular magnetic resonance (CMR), may be used as a dynamic marker of disease activity in the atherosclerotic plaque. However, 2D imaging is limited by low spatial resolution in the slice-select direction compared to 3D imaging techniques. We sought to investigate the ability of novel 3D techniques to detect edema induced in porcine carotid arteries by acute balloon injury compared to conventional 2D T2-weighted black-blood CMR.
  
  
  METHODS
  Edema was induced unilaterally by balloon overstretch injury in the carotid artery of nine pigs. Between one to seven hours (average four hours) post injury, CMR was performed using 2D T2-weighted short-tau inversion recovery (T2-STIR), 3D volumetric isotropic turbo spin echo acquisition (VISTA) and 3D T2 prepared gradient-echo (T2prep-GE). The CMR images were compared in terms of signal-to-noise ratio (SNR) and contrast-to-noise (CNR) ratio. Furthermore, the presence of vessel wall injury was validated macroscopically by means of Evans Blue dye that only enters the injured vessel wall.
  
  
  RESULTS
  All three imaging sequences classified the carotid arteries correctly compared to Evans Blue and all sequences demonstrated a significant increase in SNR of the injured compared to the non-injured carotid vessel wall (T2-STIR, p = 0.002; VISTA, p = 0.004; and T2prep-GE, p = 0.003). There was no significant difference between sequences regarding SNR and CNR.
  
  
  CONCLUSIONS
  The novel 3D imaging sequences VISTA and T2prep-GE perform comparably to conventional 2D T2-STIR in terms of detecting vessel wall edema. The improved spatial coverage of these 3D sequences may facilitate visualization of vessel wall edema to enable detection and monitoring of vulnerable carotid atherosclerotic plaques.
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark. LARS.OLGAARD.BLOCH@STUDMED.AU.DK.
authors.forename: Lars Ølgaard
authors.initials: LØ
authors.lastname: Bloch
authors.forename: Anne Yoon Krogh Grøndal
authors.initials: AY
authors.lastname: Hansen
authors.forename: Steen Fjord
authors.initials: SF
authors.lastname: Pedersen
authors.forename: Jesper Langhoff
authors.initials: JL
authors.lastname: Honge
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Kim
authors.forename: Esben Søvsø Szocska
authors.initials: ES
authors.lastname: Hansen
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects; D000818:Animals; D002339:Carotid Arteries / Q000473:pathology*; D020212:Carotid Artery Injuries / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D004195:Disease Models, Animal; D004487:Edema / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D005260:Female; D018810:Magnetic Resonance Angiography; D011237:Predictive Value of Tests; D059629:Signal-To-Noise Ratio; D013552:Swine; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology