Association of carotid intraplaque hemorrhage and territorial acute infarction in patients with acute neurological symptoms using carotid magnetization-prepared rapid acquisition with gradient-echo.
OBJECTIVE
The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms.


METHODS
83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction.


RESULTS
Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010).


CONCLUSIONS
Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.
Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Jung Soo
JS
Park
Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
Hyo Sung
HS
Kwak
Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Jong Myong
JM
Lee
Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Eun Jeong
EJ
Koh
Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Gyung Ho
GH
Chung
Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Seung Bae
SB
Hwang
Atherosclerosis; Carotid artery; MRI; Stroke