Plaque vulnerability in patients with high- and moderate-grade carotid stenosis - comparison of plaque features on MRI with histopathological findings.

Tapis, Pascal; El-Koussy, Marwan; Hewer, Ekkehard; Mono, Marie-Luise; Reinert, Michael (2020). Plaque vulnerability in patients with high- and moderate-grade carotid stenosis - comparison of plaque features on MRI with histopathological findings. Swiss medical weekly, 150(w20174), w20174. EMH Media 10.4414/smw.2020.20174

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  BACKGROUND: Plaque vulnerability plays an important role in determining the risk of subsequent cerebrovascular events in patients with carotid stenosis. Plaque morphology magnetic resonance imaging (MRI) can be used to assess plaque vulnerability. We therefore set out to examine the diagnostic accuracy of plaque morphology MRI compared with histopathological findings as gold standard in moderate- to high-grade carotid stenosis at our centre.

METHODS

A total of 36 patients with moderate- to high-grade carotid stenosis underwent plaque morphology MRI with a multisequence protocol (time of flight sequence, dark blood T1- [native and post-gadolinium] and T2-weighted sequence with fat suppression). The status of the fibrous cap, calcification, lipid-rich necrotic core (LRNC) and intraplaque haemorrhage (IPH) were assessed by means of qualitative MR analysis of plaque characteristics and compared with the histopathological findings. Detection statistics (sensitivity, specificity), chi-squared test, Cohen’s kappa (κ), percentage of agreement and phi coefficient (φ) were determined.

RESULTS

Carotid stenosis was symptomatic (transient ischaemic attack, amaurosis fugax or ischaemic stroke in the territory of the stenosed carotid artery) in 25 patients (69.5%). Twenty-eight patients (77.8%) had a high-grade and eight patients (12.2%) a moderate-grade stenosis. Significant congruence between MRI and histology was found for plaque calcification (89% histology, 75% MRI, κ = 0.364, p = 0.013), for LRNC (89% histology, 53% MRI, κ = 0.245, p = 0.025) and IPH (75% histology, 53% MRI, κ = 0.314, p = 0.035). In a subgroup of patients with symptomatic stenosis, the agreement for LRNC and IPH was slightly better (LRNC κ = 0.390, p = 0.014; IPH κ = 0.386, p = 0.045). Status of the fibrous cap, essentially ulceration, did not show any significant agreement (κ = 0.032, p = 0.842). There was significant correlation between LRNC on MRI and symptomatic carotid stenosis (φ = 0.339, p = 0.042).

CONCLUSION

Plaque morphology MRI is capable of identifying the main components of atherosclerotic plaques with moderate to good accuracy as compared with histopathological findings as gold standard. LRNC seems to be a useful marker of plaque vulnerability and warrants its use in clinical decision making. &nbsp.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

El-Koussy, Marwan; Hewer, Ekkehard; Mono, Marie-Luise and Reinert, Michael

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1424-3997

Publisher:

EMH Media

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

24 Feb 2020 15:27

Last Modified:

01 Mar 2020 02:50

Publisher DOI:

10.4414/smw.2020.20174

PubMed ID:

32065837

BORIS DOI:

10.7892/boris.140721

URI:

https://boris.unibe.ch/id/eprint/140721

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