Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques

Rie Motoyama, Kozue Saito, Shuichi Tonomura, Hatsue Ishibashi-Ueda, Hiroshi Yamagami, Hiroharu Kataoka, Yoshiaki Morita, Yuto Uchihara, Koji Iihara, Jun C. Takahashi, Kazuma Sugie, Kazunori Toyoda, Kazuyuki Nagatsuka

Research output: Contribution to journalArticle

Abstract

Background: We aimed to improve the assessment quality of plaque vulnerability with combined use of magnetic resonance imaging and contrast-enhanced ultrasound (CEUS). Methods and Results: We prospectively enrolled 71 patients with internal carotid artery stenosis who underwent carotid endarterectomy and performed preoperative CEUS and magnetic resonance plaque imaging. We distinguished high–signal-intensity plaques (HIPs) and non-HIPs based on magnetization-prepared rapid acquisition with gradient echo images. We graded them according to the CEUS contrast effect and compared the CEUS images with the carotid endarterectomy specimens. Among the 70 plaques, except 1 carotid endarterectomy tissue sample failure, 59 were classified as HIPs (43 symptomatic) and 11 were classified as non-HIPs (5 symptomatic). Although the magnetization-prepared rapid acquisition with gradient echo findings alone had no significant correlation with symptoms (P=0.07), concomitant use of magnetization-prepared rapid acquisition with gradient echo and CEUS findings did show a significant correlation (P<0.0001). CEUS showed that all 5 symptomatic non-HIPs had a high-contrast effect. These 5 plaques were histopathologically confirmed as vulnerable, with extensive neovascularization but only a small amount of intraplaque hemorrhage. Conclusions: Complementary use of magnetic resonance imaging and CEUS to detect intraplaque hemorrhage and neovascularization in plaques can be useful for evaluating plaque vulnerability, consistent with the destabilization process associated with neovessel formation and subsequent intraplaque hemorrhage.

Original languageEnglish
Article numbere011302
JournalJournal of the American Heart Association
Volume8
Issue number8
DOIs
Publication statusPublished - Apr 16 2019

Fingerprint

Carotid Endarterectomy
Magnetic Resonance Imaging
Hemorrhage
Carotid Stenosis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques. / Motoyama, Rie; Saito, Kozue; Tonomura, Shuichi; Ishibashi-Ueda, Hatsue; Yamagami, Hiroshi; Kataoka, Hiroharu; Morita, Yoshiaki; Uchihara, Yuto; Iihara, Koji; Takahashi, Jun C.; Sugie, Kazuma; Toyoda, Kazunori; Nagatsuka, Kazuyuki.

In: Journal of the American Heart Association, Vol. 8, No. 8, e011302, 16.04.2019.

Research output: Contribution to journalArticle

Motoyama, R, Saito, K, Tonomura, S, Ishibashi-Ueda, H, Yamagami, H, Kataoka, H, Morita, Y, Uchihara, Y, Iihara, K, Takahashi, JC, Sugie, K, Toyoda, K & Nagatsuka, K 2019, 'Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques', Journal of the American Heart Association, vol. 8, no. 8, e011302. https://doi.org/10.1161/JAHA.118.011302
Motoyama, Rie ; Saito, Kozue ; Tonomura, Shuichi ; Ishibashi-Ueda, Hatsue ; Yamagami, Hiroshi ; Kataoka, Hiroharu ; Morita, Yoshiaki ; Uchihara, Yuto ; Iihara, Koji ; Takahashi, Jun C. ; Sugie, Kazuma ; Toyoda, Kazunori ; Nagatsuka, Kazuyuki. / Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 8.
@article{c09622b539fe404180ecfd8bf183069a,
title = "Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques",
abstract = "Background: We aimed to improve the assessment quality of plaque vulnerability with combined use of magnetic resonance imaging and contrast-enhanced ultrasound (CEUS). Methods and Results: We prospectively enrolled 71 patients with internal carotid artery stenosis who underwent carotid endarterectomy and performed preoperative CEUS and magnetic resonance plaque imaging. We distinguished high–signal-intensity plaques (HIPs) and non-HIPs based on magnetization-prepared rapid acquisition with gradient echo images. We graded them according to the CEUS contrast effect and compared the CEUS images with the carotid endarterectomy specimens. Among the 70 plaques, except 1 carotid endarterectomy tissue sample failure, 59 were classified as HIPs (43 symptomatic) and 11 were classified as non-HIPs (5 symptomatic). Although the magnetization-prepared rapid acquisition with gradient echo findings alone had no significant correlation with symptoms (P=0.07), concomitant use of magnetization-prepared rapid acquisition with gradient echo and CEUS findings did show a significant correlation (P<0.0001). CEUS showed that all 5 symptomatic non-HIPs had a high-contrast effect. These 5 plaques were histopathologically confirmed as vulnerable, with extensive neovascularization but only a small amount of intraplaque hemorrhage. Conclusions: Complementary use of magnetic resonance imaging and CEUS to detect intraplaque hemorrhage and neovascularization in plaques can be useful for evaluating plaque vulnerability, consistent with the destabilization process associated with neovessel formation and subsequent intraplaque hemorrhage.",
author = "Rie Motoyama and Kozue Saito and Shuichi Tonomura and Hatsue Ishibashi-Ueda and Hiroshi Yamagami and Hiroharu Kataoka and Yoshiaki Morita and Yuto Uchihara and Koji Iihara and Takahashi, {Jun C.} and Kazuma Sugie and Kazunori Toyoda and Kazuyuki Nagatsuka",
year = "2019",
month = "4",
day = "16",
doi = "10.1161/JAHA.118.011302",
language = "English",
volume = "8",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques

AU - Motoyama, Rie

AU - Saito, Kozue

AU - Tonomura, Shuichi

AU - Ishibashi-Ueda, Hatsue

AU - Yamagami, Hiroshi

AU - Kataoka, Hiroharu

AU - Morita, Yoshiaki

AU - Uchihara, Yuto

AU - Iihara, Koji

AU - Takahashi, Jun C.

AU - Sugie, Kazuma

AU - Toyoda, Kazunori

AU - Nagatsuka, Kazuyuki

PY - 2019/4/16

Y1 - 2019/4/16

N2 - Background: We aimed to improve the assessment quality of plaque vulnerability with combined use of magnetic resonance imaging and contrast-enhanced ultrasound (CEUS). Methods and Results: We prospectively enrolled 71 patients with internal carotid artery stenosis who underwent carotid endarterectomy and performed preoperative CEUS and magnetic resonance plaque imaging. We distinguished high–signal-intensity plaques (HIPs) and non-HIPs based on magnetization-prepared rapid acquisition with gradient echo images. We graded them according to the CEUS contrast effect and compared the CEUS images with the carotid endarterectomy specimens. Among the 70 plaques, except 1 carotid endarterectomy tissue sample failure, 59 were classified as HIPs (43 symptomatic) and 11 were classified as non-HIPs (5 symptomatic). Although the magnetization-prepared rapid acquisition with gradient echo findings alone had no significant correlation with symptoms (P=0.07), concomitant use of magnetization-prepared rapid acquisition with gradient echo and CEUS findings did show a significant correlation (P<0.0001). CEUS showed that all 5 symptomatic non-HIPs had a high-contrast effect. These 5 plaques were histopathologically confirmed as vulnerable, with extensive neovascularization but only a small amount of intraplaque hemorrhage. Conclusions: Complementary use of magnetic resonance imaging and CEUS to detect intraplaque hemorrhage and neovascularization in plaques can be useful for evaluating plaque vulnerability, consistent with the destabilization process associated with neovessel formation and subsequent intraplaque hemorrhage.

AB - Background: We aimed to improve the assessment quality of plaque vulnerability with combined use of magnetic resonance imaging and contrast-enhanced ultrasound (CEUS). Methods and Results: We prospectively enrolled 71 patients with internal carotid artery stenosis who underwent carotid endarterectomy and performed preoperative CEUS and magnetic resonance plaque imaging. We distinguished high–signal-intensity plaques (HIPs) and non-HIPs based on magnetization-prepared rapid acquisition with gradient echo images. We graded them according to the CEUS contrast effect and compared the CEUS images with the carotid endarterectomy specimens. Among the 70 plaques, except 1 carotid endarterectomy tissue sample failure, 59 were classified as HIPs (43 symptomatic) and 11 were classified as non-HIPs (5 symptomatic). Although the magnetization-prepared rapid acquisition with gradient echo findings alone had no significant correlation with symptoms (P=0.07), concomitant use of magnetization-prepared rapid acquisition with gradient echo and CEUS findings did show a significant correlation (P<0.0001). CEUS showed that all 5 symptomatic non-HIPs had a high-contrast effect. These 5 plaques were histopathologically confirmed as vulnerable, with extensive neovascularization but only a small amount of intraplaque hemorrhage. Conclusions: Complementary use of magnetic resonance imaging and CEUS to detect intraplaque hemorrhage and neovascularization in plaques can be useful for evaluating plaque vulnerability, consistent with the destabilization process associated with neovessel formation and subsequent intraplaque hemorrhage.

UR - http://www.scopus.com/inward/record.url?scp=85064823539&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064823539&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.011302

DO - 10.1161/JAHA.118.011302

M3 - Article

C2 - 30977413

AN - SCOPUS:85064823539

VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 8

M1 - e011302

ER -