TY - JOUR
T1 - Comparison of carotid plaque ulcer detection using contrast- enhanced and time-of-flight MRA techniques
AU - Etesami, M.
AU - Hoi, Y.
AU - Steinman, D. A.
AU - Gujar, S. K.
AU - Nidecker, A. E.
AU - Astor, B. C.
AU - Portanova, A.
AU - Qiao, Y.
AU - Abdalla, W. M.A.
AU - Wasserman, B. A.
PY - 2013/1
Y1 - 2013/1
N2 - BACKGROUND AND PURPOSE: Ulceration in carotid plaque is a risk indicator for ischemic stroke. Our aim was to compare plaque ulcer detection by standard TOF and CE-MRA techniques and to identify factors that influence its detection. MATERIALS AND METHODS: Carotid MR imaging scans were acquired on 2066 participants in the ARIC study. We studied the 600 thickest plaques. TOF-MRA, CE-MRA, and black-blood MR images were analyzed together to define ulcer presence (plaque surface niche ≥2mmin depth). Sixty ulcerated arteries were detected. These arteries were randomly assigned, along with 40 nonulcerated plaques from the remaining 540, for evaluation of ulcer presence by 2 neuroradiologists. Associations between ulcer detection and ulcer characteristics, including orientation, location, and size, were determined and explored by CFD modeling. RESULTS: One CE-MRA and 3 TOF-MRAs were noninterpretable and excluded. Of 71 ulcers in 56 arteries, readers detected an average of 39 (55%) on both TOF-MRA and CE-MRA, 26.5 (37.5%) only on CE-MRA, and 1 (1.5%) only on TOF-MRA, missing 4.5 (6%) ulcers by both methods. Ulcer detection by TOF-MRA was associated with its orientation (distally pointing versus perpendicular: OR = 5.57 [95% CI, 1.08 -28.65]; proximally pointing versus perpendicular: OR=0.21 [95% CI, 0.14-0.29]); location relative to point of maximum stenosis (distal versus isolevel: OR=5.17 [95% CI, 2.10 -12.70]); and neck-to-depth ratio (OR=1.96 [95% CI, 1.11-3.45]) after controlling for stenosis and ulcer volume. CONCLUSIONS: CE-MRA detects more ulcers than TOF-MRA in carotid plaques. Missed ulcers on TOF-MRA are influenced by ulcer orientation, location relative to point of maximum stenosis, and neck-to-depth ratio.
AB - BACKGROUND AND PURPOSE: Ulceration in carotid plaque is a risk indicator for ischemic stroke. Our aim was to compare plaque ulcer detection by standard TOF and CE-MRA techniques and to identify factors that influence its detection. MATERIALS AND METHODS: Carotid MR imaging scans were acquired on 2066 participants in the ARIC study. We studied the 600 thickest plaques. TOF-MRA, CE-MRA, and black-blood MR images were analyzed together to define ulcer presence (plaque surface niche ≥2mmin depth). Sixty ulcerated arteries were detected. These arteries were randomly assigned, along with 40 nonulcerated plaques from the remaining 540, for evaluation of ulcer presence by 2 neuroradiologists. Associations between ulcer detection and ulcer characteristics, including orientation, location, and size, were determined and explored by CFD modeling. RESULTS: One CE-MRA and 3 TOF-MRAs were noninterpretable and excluded. Of 71 ulcers in 56 arteries, readers detected an average of 39 (55%) on both TOF-MRA and CE-MRA, 26.5 (37.5%) only on CE-MRA, and 1 (1.5%) only on TOF-MRA, missing 4.5 (6%) ulcers by both methods. Ulcer detection by TOF-MRA was associated with its orientation (distally pointing versus perpendicular: OR = 5.57 [95% CI, 1.08 -28.65]; proximally pointing versus perpendicular: OR=0.21 [95% CI, 0.14-0.29]); location relative to point of maximum stenosis (distal versus isolevel: OR=5.17 [95% CI, 2.10 -12.70]); and neck-to-depth ratio (OR=1.96 [95% CI, 1.11-3.45]) after controlling for stenosis and ulcer volume. CONCLUSIONS: CE-MRA detects more ulcers than TOF-MRA in carotid plaques. Missed ulcers on TOF-MRA are influenced by ulcer orientation, location relative to point of maximum stenosis, and neck-to-depth ratio.
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U2 - 10.3174/ajnr.A3132
DO - 10.3174/ajnr.A3132
M3 - Article
C2 - 22627797
AN - SCOPUS:84873646174
SN - 0195-6108
VL - 34
SP - 177
EP - 184
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 1
ER -