title: High-resolution magnetic resonance imaging of carotid atherosclerotic plaques - a correlation study with histopathology.
abstract: BACKGROUND
  This study aimed to utilize high-resolution magnetic resonance imaging (MRI) to investigate the characteristics of stable and vulnerable carotid arteriosclerotic plaques, with correlations to histopathological findings.
  
  
  METHODS
  High-resolution MRI was performed in 817 patients, using three-dimensional magnetic resonance angiography. Plaque composition was evaluated by measuring the areas occupied by calcification, a lipid-rich necrotic core, intra-plaque haemorrhage, and fibrous cap rupture. Plaque morphology was analysed by measuring vessel wall area, thickness, and luminal area at the bifurcation of the common carotid artery. Plaque tissues were sampled during carotid endarterectomy and examined using haematoxylin-eosin, Oil Red O, Masson trichrome staining, and immunohistochemical staining for CD68.
  
  
  RESULTS
  Patients were divided into stable plaque group (n = 462) and vulnerable plaque group (n = 355), based on intraoperative observations and postoperative histopathological findings. Compared to the stable plaque group, the vulnerable plaque group exhibited increased vessel wall areas and thickness, and decreased mean luminal areas (P < 0.001). The vulnerable plaque group also had a lower collagen content, a higher lipid content, and higher CD68 expression in plaque tissues on histological examinations (P < 0.01). Incidences of lipid-rich necrotic core (38.1 % vs. 34.3 %), intra-plaque haemorrhage (26.9 % vs. 22.8 %), plaque calcification (45.2 % vs. 40.9 %), and fibrous cap rupture (36.0 % vs 39.8 %) in the plaques were concordant with MRI observations and histopathological findings (p > 0.05).
  
  
  CONCLUSIONS
  Stable and vulnerable carotid plaques had different morphologies and compositions. High-resolution MRI can assess such differences qualitatively and quantitatively in vivo and provide guidance for risk stratification and management.
authors.affiliation: 1 Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China.|2 Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, PR China.
authors.forename: Zhangyong
authors.initials: Z
authors.lastname: Xia
authors.affiliation: 3 Department of Neurology, the Third People's Hospital of Liaocheng, Liaocheng, Shandong, PR China.
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.affiliation: 3 Department of Neurology, the Third People's Hospital of Liaocheng, Liaocheng, Shandong, PR China.
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Yuan
authors.affiliation: 4 Department of Neurosurgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, PR China.
authors.forename: Jiyue
authors.initials: J
authors.lastname: Wang
authors.affiliation: 4 Department of Neurosurgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, PR China.
authors.forename: Shigang
authors.initials: S
authors.lastname: Zhang
authors.affiliation: 4 Department of Neurosurgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, PR China.
authors.forename: Liyong
authors.initials: L
authors.lastname: Zhang
authors.affiliation: 2 Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, PR China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Qu
authors.affiliation: 5 Department of Magnetic Resonance, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.affiliation: 6 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China.
authors.forename: Liqun
authors.initials: L
authors.lastname: Jiao
authors.affiliation: 7 School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia.
authors.forename: Le-Xin
authors.initials: LX
authors.lastname: Wang
authors.affiliation: 1 Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, PR China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Du
mesh_terms: D000368:Aged; D001706:Biopsy; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D002681:China; D003094:Collagen / Q000032:analysis; D016894:Endarterectomy, Carotid; D005260:Female; D005355:Fibrosis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007150:Immunohistochemistry; D008055:Lipids / Q000032:analysis; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D008055:Lipids; D003094:Collagen
keywords: Stroke; carotid atherosclerotic plaque; high-resolution magnetic resonance imaging (MRI); histopathology; immunohistochemistry