(Circulation. 2000;102:959.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Visualization of Fibrous Cap Thickness and Rupture in Human Atherosclerotic Carotid Plaque In Vivo With High-Resolution Magnetic Resonance Imaging
From the Surgical Service (T.S.H.), VA Puget Sound Health Care System, Seattle, Wash; The Mountain-Whisper-Light Statistical Consulting (N.L.P.), Seattle, Wash; and the Departments of Pathology (R.R.) and Radiology (C.Y.), University of Washington (Seattle).
Background—The results of studies of advanced lesions of atherosclerosis suggest that the thickness of the fibrous cap that overlies the necrotic core distinguishes the stable lesion from one that is at high risk for rupture and thromboembolic events. We have developed a high-resolution MRI technique that can identify the fine structure of the lesion, including the fibrous cap, in vivo. The aim of the present study was to determine the agreement between in vivo MRI and lesion architecture as seen on histology and gross tissue examination to identify fibrous cap thickness and rupture.
Methods and Results—Twenty-two subjects who were scheduled for
carotid endarterectomy underwent MRI with a
3-dimensional multiple overlapping thin slab angiography protocol. The
appearance of the fibrous cap was categorized as (1) an intact, thick,
(2) an intact, thin, or (3) a ruptured fibrous cap on MRI, gross, and
histological sections. Thirty-six sites were available
for comparison between MRI and histology. There was a high level of
agreement between MRI and histological findings: 89%
agreement, 
(95% CI)=0.83 (0.67 to 1.0), weighted =0.87.
Spearman’s correlation coefficient was 0.88 (significant to the 0.01
level).
Conclusions—These findings indicate that high-resolution MRI with a 3-dimensional multiple overlapping thin slab angiography protocol is capable of distinguishing intact, thick fibrous caps from intact thin and disrupted caps in atherosclerotic human carotid arteries in vivo. This noninvasive technique has the potential to permit studies that examine the relationship between fibrous cap changes and clinical outcome and to permit trials that evaluate therapy intended to "stabilize" the fibrous cap.
Key Words: atherosclerosis • magnetic resonance imaging • imaging
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|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
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|
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|
|
|
|
|
|
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|
|
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|
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|
|
|
|
|
|
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|
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|
|
|
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|
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|
|