Atherosclerotic Plaque Progression in Carotid Arteries: Monitoring with High-Spatial-Resolution MR Imaging-Multicenter Trial

Department of Radiology, University of California, San Francisco, San Francisco, Calif., USA.
Radiology (Impact Factor: 6.21). 07/2009; 252(3):789-96. DOI: 10.1148/radiol.2523081798
Source: PubMed

ABSTRACT To estimate the annualized rate of progression of vessel-wall volume in the carotid arteries in 160 patients by using magnetic resonance (MR) imaging and to establish the fraction of studies that have acceptable image quality. Materials and Methods: The study procedures and consent forms were reviewed and approved by each site's institutional review board. All U.S. study sites conducted all phases of this study in compliance with HIPAA requirements. Written consent was obtained from each participant. One hundred sixty patients with greater than 50% narrowing of the diameter of the carotid artery were recruited at six centers for prospective imaging of the carotid arteries at baseline and 1 year later by using high-spatial-resolution, 1.5-T MR imaging. Studies with unacceptable image quality were excluded. Quantitative changes in atheroma volume were measured on unenhanced T1-weighted images. A multiple linear regression analysis was used to correlate progression with several clinical factors, including statin therapy.
All 160 patients completed both baseline and follow-up studies. Of these studies, 67.5% were deemed to have image quality that was acceptable for quantitative analysis. The causes of rejection were motion (46%), deep location of the carotid artery (22%), low bifurcation of the carotid artery (13%), and "other" (19%). The mean annual change in vessel-wall volume was 2.31% +/- 10.88 (standard deviation) (P = .014). At 1-year follow-up, vessel-wall volumes in patients not receiving statin therapy had increased faster compared with those in patients receiving statin therapy: 7.87% +/- 13.58% vs 1.14% +/- 9.9%, respectively (P = .029).
Evaluation of results of a multicenter study indicates that quantitative evaluation of the progression of volume of extracranial carotid vessel walls is feasible with 1.5-T MR imaging despite limitations due to patient motion or habitus. In patients who had preexisting carotid disease, the rate of increase in vessel-wall volume was slower in patients receiving statin therapy.

  • Source
    • "diagnostic capability to detect IPH [85]. The current area of research is also focusing on prospective studies to measure plaque progression [83]; assessing predictive value of VP [86]; determining clinical factors associated with VP [87]; increasing the use of 3T magnetic field and measuring reader reproducibility. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Ischemic syndromes associated with carotid atherosclerotic disease are often related to plaque rupture. The benefit of endarterectomy for high-grade carotid stenosis in symptomatic patients has been established. However, in asymptomatic patients, the benefit of endarterectomy remains equivocal. Current research seeks to risk stratify asymptomatic patients by characterizing vulnerable, rupture-prone atherosclerotic plaques. Plaque composition, biology, and biomechanics are studied by noninvasive imaging techniques such as magnetic resonance imaging, computed tomography, ultrasound, and ultrasound elastography. These techniques are at a developmental stage and have yet to be used in clinical practice. This review will describe noninvasive techniques in ultrasound, magnetic resonance imaging, and computed tomography imaging modalities used to characterize atherosclerotic plaque, and will discuss their potential clinical applications, benefits, and drawbacks.
    Canadian Association of Radiologists Journal 12/2013; 65(3). DOI:10.1016/j.carj.2013.05.003 · 0.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Most of the carotid plaque MR studies have been performed using black-blood protocols at 1.5 T without parallel imaging techniques. The purpose of this study was to evaluate a multi-sequence, black-blood MR protocol using parallel imaging and a dedicated 4-channel surface coil for vessel wall imaging of the carotid arteries at 3 T. 14 healthy volunteers and 14 patients with intimal thickening as proven by duplex ultrasound had their carotid arteries imaged at 3 T using a multi-sequence protocol (time-of-flight MR angiography, pre-contrast T1w-, PDw- and T2w sequences in the volunteers, additional post-contrast T1w- and dynamic contrast enhanced sequences in patients). To assess intrascan reproducibility, 10 volunteers were scanned twice within 2 weeks. Intrascan reproducibility for quantitative measurements of lumen, wall and outer wall areas was excellent with intraclass correlation coefficients >0.98 and measurement errors of 1.5%, 4.5% and 1.9%, respectively. Patients had larger wall areas than volunteers in both common carotid and internal carotid arteries and smaller lumen areas in internal carotid arteries (p < 0.001). Positive correlations were found between wall area and cardiovascular risk factors such as age, hypertension, coronary heart disease and hypercholesterolemia (Spearman's r = 0.45-0.76, p < 0.05). No significant correlations were found between wall area and body mass index, gender, diabetes or a family history of cardiovascular disease. The findings of this study indicate that high resolution carotid black-blood 3 T MR with parallel imaging is a fast, reproducible and robust method to assess carotid atherosclerotic plaque in vivo and this method is ready to be used in clinical practice.
    Journal of Cardiovascular Magnetic Resonance 10/2009; 11(1):41. DOI:10.1186/1532-429X-11-41 · 5.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The early identification of the unstable carotid plaque together with the best medical treatment, are two missing parts of the stroke-prevention puzzle. This review summarizes the available evidence on the effects of statins on carotid plaque morphology. A systematic review of the PubMed, Scopus and Cochrane Library databases was performed. Studies evaluating the effect of statins on plaque imaging features other than intima media thickness as well as on the serum inflammatory profile were eligible for inclusion. Seventeen studies were eligible for inclusion. The majority of the studies used MRI and ultrasound imaging. Plaque composition (fibrous cap and lipid core size), and size (plaque area and volume) were mainly used to evaluate the changes in plaque morphology. All studies showed slower progression, remodelling or even regression of the plaque even after only 1 month of statin administration, although the type, dosage and duration of treatment varied significantly between them. Intensive statin treatment was suggested to have a more pronounced effect on plaque morphology, however, that was mainly associated with maintaining LDL-levels <100 mg/mL and not with the intensity of the dosage. Seven studies measured CRP, four of which found significantly decreased levels with statin use. This review suggests that statins may have a beneficial effect on plaque morphology and the inflammatory response. Further validation of whether this is an LDL-associated effect or a separate pleiotropic phenomenon of statins is needed. There are significant inherent limitations to the safe extraction of solid conclusions from the studies due to data heterogeneity and publication bias.
    Atherosclerosis 11/2010; 213(1):8-20. DOI:10.1016/j.atherosclerosis.2010.04.032 · 3.97 Impact Factor
Show more