Normalized intraplaque hemorrhage signal on MP-RAGE as a marker for acute ischemic neurological events

Abstract

Purpose

This study sought to validate whether the signal intensity ratio (SIR) of carotid intraplaque hemorrhage (IPH) was associated with acute ischemic neurologic events.

Methods

A retrospective review was completed of consecutive patients that underwent neck magnetic resonance angiography using magnetization prepared-rapid gradient echo (MP-RAGE) and T1-CUBE sequences between 2017 and 2020. Patients with magnetic resonance evidence of IPH were included. SIRs were measured by comparing the maximum IPH signal with the mean intramuscular signal from the adjacent sternocleidomastoid. Patients were stratified into ischemic or non-ischemic groups based on the presence of acute ipsilateral ischemic events (stroke, retinal artery occlusion). Logistic regression analysis was performed to determine if increasing IPH SIR was associated with an increased risk of ipsilateral ischemic events.

Results

Of 85 included patients (85 arteries), 66 were male (77.6%). Mean age was 71.0 (SD ± 11.1). There were 70 arteries with IPH that were ipsilateral to an ischemic event, and 15 that belonged to patients without an ischemic event. No association was found between increasing IPH SIR seen on MP-RAGE (odds ratio (OR): 0.82; 95% confidence interval (CI): 0.58–1.4; P = 0.43) or T1-CUBE sequences (OR: 0.85; 95% CI: 0.53–1.5; P = 0.56).

Conclusions

There was no association between the SIR of IPH and acute ischemia on either MP-RAGE or T1-CUBE sequences. Further investigation is required prior to widespread acceptance of SIR as a predictive imaging marker of symptomatic carotid plaque.

Keywords

Carotid plaque magnetic resonance angiography stroke intraplaque hemorrhage signal intensity

Get full access to this article

View all access options for this article.

References

Saba

Yuan

Hatsukami

, et al. Carotid artery wall imaging: perspective and guidelines from the ASNR Vessel Wall Imaging Study Group and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2018; 39: E9–E31.

Singh

Moody

Panzov

, et al. Carotid intraplaque hemorrhage in patients with embolic stroke of undetermined source. J Stroke Cerebrovasc Dis 2018; 27: 1956–1959.

Altaf

Daniels

Morgan

, et al. Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events. J Vasc Surg 2008; 47: 337–342.

Altaf

MacSweeney

Gladman

, et al. Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis. Stroke 2007; 38: 1633–1635.

Schindler

Schinner

Altaf

, et al. Prediction of stroke risk by detection of hemorrhage in carotid plaques: meta-analysis of individual patient data. JACC Cardiovasc Imaging 2020; 13: 395–406.

Sun

Underhill

Hippe

, et al. Sustained acceleration in carotid atherosclerotic plaque progression with intraplaque hemorrhage: a long-term time course study. JACC Cardiovasc Imaging 2012; 5: 798–804.

van den Bouwhuijsen

Bos

Ikram

, et al. Coexistence of calcification, intraplaque hemorrhage and lipid core within the asymptomatic atherosclerotic carotid plaque: the Rotterdam study. Cerebrovasc Dis 2015; 39: 319–324.

Milei

Parodi

Ferreira

, et al. Atherosclerotic plaque rupture and intraplaque hemorrhage do not correlate with symptoms in carotid artery stenosis. J Vasc Surg 2003; 38: 1241–1247.

Simpson

Akwei

Hosseini

, et al. MR Imaging–detected carotid plaque hemorrhage is stable for 2 years and a marker for stenosis progression. AJNR Am J Neuroradiol 2015; 36: 1171–1175.

10.

Yang

Liu

Han

, et al. Signal of carotid intraplaque hemorrhage on MR T1-weighted imaging: association with acute cerebral infarct. AJNR Am J Neuroradiol 2020; 41: 836–843.

11.

Wang

Sun

Zhao

, et al. Ipsilateral plaques display higher T1 signals than contralateral plaques in recently symptomatic patients with bilateral carotid intraplaque hemorrhage. Atherosclerosis 2017; 257: 78–85.

12.

North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett

HJM

Taylor

, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445–453.

13.

Brinjikji

DeMarco

Shih

, et al. Diagnostic accuracy of a clinical carotid plaque MR protocol using a neurovascular coil compared to a surface coil protocol. J Magn Reson Imaging 2018; 48: 1264–1272.

14.

Zhu

Ferguson

DeMarco

JK.

An optimized 3D inversion recovery prepared fast spoiled gradient recalled sequence for carotid plaque hemorrhage imaging at 3.0 T. Magn Reson Imaging 2008; 26: 1360–1366.

15.

Fryer

Myers

Appleberg

Carotid intraplaque hemorrhage: the significance of neovascularity. J Vasc Surg 1987; 6: 341–349.

16.

Virmani

Kolodgie

Burke

, et al. Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arterioscler Thromb Vasc Biol 2005; 25: 2054–2061.

17.

Daemen

Ferguson

Gijsen

, et al. Carotid plaque fissure: an underestimated source of intraplaque hemorrhage. Atherosclerosis 2016; 254: 102–108.

18.

Leung

Moody

AR.

MR imaging depicts oxidative stress induced by methemoglobin. Radiology 2010; 257: 470–476.

19.

Teng

Sadat

Brown

, et al. Plaque hemorrhage in carotid artery disease: pathogenesis, clinical and biomechanical considerations. J Biomech 2014; 47: 847–858.

20.

Takaya

Yuan

Chu

, et al. Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation 2005; 111: 2768–2775.

21.

Chu

Kampschulte

Ferguson

, et al. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke 2004; 35: 1079–1084.

22.

Singh

Moody

Gladstone

, et al. Moderate carotid artery stenosis: MR imaging-depicted intraplaque hemorrhage predicts risk of cerebrovascular ischemic events in asymptomatic men. Radiology 2009; 252: 502–508.

23.

McNally

McLaughlin

Hinckley

, et al. Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke 2015; 46: 84–90.