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(Circulation. 2001;104:2051.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

In Vivo Accuracy of Multispectral Magnetic Resonance Imaging for Identifying Lipid-Rich Necrotic Cores and Intraplaque Hemorrhage in Advanced Human Carotid Plaques

Chun Yuan, PhD; Lee M. Mitsumori, MD; Marina S. Ferguson, BS; Nayak L. Polissar, PhD; Denise Echelard, BS; Geraldo Ortiz, BS; Randy Small, BS; Joseph W. Davies, BS; William S. Kerwin, PhD; Thomas S. Hatsukami, MD

From the Departments of Radiology (C.Y., L.M.M., D.E., W.S.K., G.O.), Pathology (R.S.), and Surgery (J.W.D., T.S.H.), University of Washington; Marina Ferguson Inc (M.S.F.); The Mountain-Whisper-Light Statistical Consulting (N.L.P.); and Surgery and Perioperative Care, VA Puget Sound Health Care System (T.S.H.), Seattle, Wash.

Reprint requests to Chun Yuan, PhD, University of Washington, Department of Radiology, Box 357115, 1959 NE Pacific Avenue, Seattle, WA 98195. E-mail cyuan{at}u.washington.edu

Background— High-resolution MRI has been shown to be capable of identifying plaque constituents, such as the necrotic core and intraplaque hemorrhage, in human carotid atherosclerosis. The purpose of this study was to evaluate differential contrast-weighted images, specifically a multispectral MR technique, to improve the accuracy of identifying the lipid-rich necrotic core and acute intraplaque hemorrhage in vivo.

Methods and Results— Eighteen patients scheduled for carotid endarterectomy underwent a preoperative carotid MRI examination in a 1.5-T GE Signa scanner using a protocol that generated 4 contrast weightings (T1, T2, proton density, and 3D time of flight). MR images of the vessel wall were examined for the presence of a lipid-rich necrotic core and/or intraplaque hemorrhage. Ninety cross sections were compared with matched histological sections of the excised specimen in a double-blinded fashion. Overall accuracy (95% CI) of multispectral MRI was 87% (80% to 94%), sensitivity was 85% (78% to 92%), and specificity was 92% (86% to 98%). There was good agreement between MRI and histological findings, with a value of =0.69 (0.53 to 0.85).

Conclusions— Multispectral MRI can identify the lipid-rich necrotic core in human carotid atherosclerosis in vivo with high sensitivity and specificity. This MRI technique provides a noninvasive tool to study the pathogenesis and natural history of carotid atherosclerosis. Furthermore, it will permit a direct assessment of the effect of pharmacological therapy, such as aggressive lipid lowering, on plaque lipid composition.

Key Words: magnetic resonance imaging • lipids • atherosclerosis • carotid arteries

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				R. F. Redberg, R. A. Vogel, M. H. Criqui, D. M. Herrington, J. A. C. Lima, and M. J. Roman Task force #3--what is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1886 - 1898. [Full Text] [PDF]

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				G. J. Blake, R. J. Ostfeld, E. K. Yucel, N. Varo, U. Schonbeck, M. A. Blake, M. Gerhard, P. M. Ridker, P. Libby, and R. T. Lee Soluble CD40 Ligand Levels Indicate Lipid Accumulation in Carotid Atheroma: An In Vivo Study With High-Resolution MRI Arterioscler Thromb Vasc Biol, January 1, 2003; 23(1): e11 - 14. [Abstract] [Full Text] [PDF]

				G. J. Adams, D. M. Simoni, C. B. Bordelon Jr, G. W. Vick III, K. T. Kimball, W. Insull Jr, and J. D. Morrisett Bilateral Symmetry of Human Carotid Artery Atherosclerosis Stroke, November 1, 2002; 33(11): 2575 - 2580. [Abstract] [Full Text] [PDF]

				F. Bea, E. Blessing, B. Bennett, M. Levitz, E. P. Wallace, and M. E. Rosenfeld Simvastatin Promotes Atherosclerotic Plaque Stability in ApoE-Deficient Mice Independently of Lipid Lowering Arterioscler Thromb Vasc Biol, November 1, 2002; 22(11): 1832 - 1837. [Abstract] [Full Text] [PDF]

				Z. A. Fayad, V. Fuster, K. Nikolaou, and C. Becker Computed Tomography and Magnetic Resonance Imaging for Noninvasive Coronary Angiography and Plaque Imaging: Current and Potential Future Concepts Circulation, October 8, 2002; 106(15): 2026 - 2034. [Full Text] [PDF]

				H. Yabushita, B. E. Bouma, S. L. Houser, H. T. Aretz, I.-K. Jang, K. H. Schlendorf, C. R. Kauffman, M. Shishkov, D.-H. Kang, E. F. Halpern, et al. Characterization of Human Atherosclerosis by Optical Coherence Tomography Circulation, September 24, 2002; 106(13): 1640 - 1645. [Abstract] [Full Text] [PDF]

				J.-M. Cai, T. S. Hatsukami, M. S. Ferguson, R. Small, N. L. Polissar, and C. Yuan Classification of Human Carotid Atherosclerotic Lesions With In Vivo Multicontrast Magnetic Resonance Imaging Circulation, September 10, 2002; 106(11): 1368 - 1373. [Abstract] [Full Text] [PDF]

				R. P. Choudhury, V. Fuster, J. J. Badimon, E. A. Fisher, and Z. A. Fayad MRI and Characterization of Atherosclerotic Plaque: Emerging Applications and Molecular Imaging Arterioscler Thromb Vasc Biol, July 1, 2002; 22(7): 1065 - 1074. [Abstract] [Full Text] [PDF]