Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Association of Carotid Intraplaque Hemorrhage and Territorial Acute Infarction in Patients with Acute Neurological Symptoms Using Carotid Magnetization-Prepared Rapid Acquisition with Gradient-Echo

  • Park, Jung Soo (Department of Neurosurgery, Chonbuk National University Medical School and Hospital) ;
  • Kwak, Hyo Sung (Department of Radiology, Chonbuk National University Medical School and Hospital) ;
  • Lee, Jong Myong (Department of Neurosurgery, Chonbuk National University Medical School and Hospital) ;
  • Koh, Eun Jeong (Department of Neurosurgery, Chonbuk National University Medical School and Hospital) ;
  • Chung, Gyung Ho (Department of Radiology, Chonbuk National University Medical School and Hospital) ;
  • Hwang, Seung Bae (Department of Radiology, Chonbuk National University Medical School and Hospital)
  • Received : 2014.07.14
  • Accepted : 2014.10.22
  • Published : 2015.02.28
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Abstract

Objective : The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods : 83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction. Results : Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010). Conclusion : Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.

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References

  1. Bitar R, Moody AR, Leung G, Symons S, Crisp S, Butany J, et al. : In vivo 3D high-spatial-resolution MR imaging of intraplaque hemorrhage. Radiology 249 : 259-267, 2008 https://doi.org/10.1148/radiol.2491071517
  2. de Sauvage Nolting PR, de Groot E, Zwinderman AH, Buirma RJ, Trip MD, Kastelein JJ : Regression of carotid and femoral artery intima-media thickness in familial hypercholesterolemia : treatment with simvastatin. Arch Intern Med 163 : 1837-1841, 2003 https://doi.org/10.1001/archinte.163.15.1837
  3. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. : Guidelines for the early management of patients with acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44 : 870-947, 2013 https://doi.org/10.1161/STR.0b013e318284056a
  4. Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, et al. : Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349 : 2316-2325, 2003 https://doi.org/10.1056/NEJMoa035655
  5. Lindsay AC, Biasiolli L, Lee JM, Kylintireas I, MacIntosh BJ, Watt H, et al. : Plaque features associated with increased cerebral infarction after minor stroke and TIA : a prospective, case-control, 3-T carotid artery MR imaging study. JACC Cardiovasc Imaging 5 : 388-396, 2012 https://doi.org/10.1016/j.jcmg.2011.10.007
  6. Lovett JK, Coull AJ, Rothwell PM : Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology 62 : 569-573, 2004 https://doi.org/10.1212/01.WNL.0000110311.09970.83
  7. McNally JS, Kim SE, Yoon HC, Findeiss LK, Roberts JA, Nightingale DR, et al. : Carotid magnetization-prepared rapid acquisition with gradient-echo signal is associated with acute territorial cerebral ischemic events detected by diffusion-weighted MRI. Circ Cardiovasc Imaging 5 : 376-382, 2012 https://doi.org/10.1161/CIRCIMAGING.111.967398
  8. Mercuri M, Bond MG, Sirtori CR, Veglia F, Crepaldi G, Feruglio FS, et al. : Pravastatin reduces carotid intima-media thickness progression in an asymptomatic hypercholesterolemic mediterranean population : the Carotid Atherosclerosis Italian Ultrasound Study. Am J Med 101 : 627-634, 1996 https://doi.org/10.1016/S0002-9343(96)00333-6
  9. Ota H, Yarnykh VL, Ferguson MS, Underhill HR, Demarco JK, Zhu DC, et al. : Carotid intraplaque hemorrhage imaging at 3.0-T MR imaging : comparison of the diagnostic performance of three T1-weighted sequences. Radiology 254 : 551-563, 2010 https://doi.org/10.1148/radiol.09090535
  10. Parmar JP, Rogers WJ, Mugler JP 3rd, Baskurt E, Altes TA, Nandalur KR, et al. : Magnetic resonance imaging of carotid atherosclerotic plaque in clinically suspected acute transient ischemic attack and acute ischemic stroke. Circulation 122 : 2031-2038, 2010 https://doi.org/10.1161/CIRCULATIONAHA.109.866053
  11. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med 339 : 1349-1357, 1998 https://doi.org/10.1056/NEJM199811053391902
  12. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease : the Scandinavian Simvastatin Survival Study (4S). Lancet 344 : 1383-1389, 1994
  13. Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. : Heart disease and stroke statistics--2007 update : a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 115 : e69-e171, 2007 https://doi.org/10.1161/CIRCULATIONAHA.106.179918
  14. Saam T, Cai J, Ma L, Cai YQ, Ferguson MS, Polissar NL, et al. : Compar-ison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology 240 : 464-472, 2006 https://doi.org/10.1148/radiol.2402050390
  15. Saam T, Hetterich H, Hoffmann V, Yuan C, Dichgans M, Poppert H, et al. : Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. J Am Coll Cardiol 62 : 1081-1091, 2013 https://doi.org/10.1016/j.jacc.2013.06.015
  16. Sitzer M, Muller W, Siebler M, Hort W, Kniemeyer HW, Jancke L, et al. : Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis. Stroke 26 : 1231-1233, 1995 https://doi.org/10.1161/01.STR.26.7.1231
  17. Smilde TJ, van Wissen S, Wollersheim H, Trip MD, Kastelein JJ, Stalenhoef AF : Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP) : a prospective, randomised, double-blind trial. Lancet 357 : 577-581, 2001 https://doi.org/10.1016/S0140-6736(00)04053-8
  18. Spagnoli LG, Mauriello A, Sangiorgi G, Fratoni S, Bonanno E, Schwartz RS, et al. : Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA 292 : 1845-1852, 2004 https://doi.org/10.1001/jama.292.15.1845
  19. Sun J, Balu N, Hippe DS, Xue Y, Dong L, Zhao X, et al. : Subclinical carotid atherosclerosis : short-term natural history of lipid-rich necrotic core--a multicenter study with MR imaging. Radiology 268 : 61-68, 2013 https://doi.org/10.1148/radiol.13121702
  20. Sun J, Underhill HR, Hippe DS, Xue Y, Yuan C, Hatsukami TS : Sustained acceleration in carotid atherosclerotic plaque progression with intraplaque hemorrhage : a long-term time course study. JACC Cardiovasc Imaging 5 : 798-804, 2012 https://doi.org/10.1016/j.jcmg.2012.03.014
  21. Takaya N, Yuan C, Chu B, Saam T, Polissar NL, Jarvik GP, et al. : Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques : a high-resolution magnetic resonance imaging study. Circulation 111 : 2768-2775, 2005 https://doi.org/10.1161/CIRCULATIONAHA.104.504167
  22. Takaya N, Yuan C, Chu B, Saam T, Underhill H, Cai J, et al. : Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events : a prospective assessment with MRI--initial results. Stroke 37 : 818-823, 2006 https://doi.org/10.1161/01.STR.0000204638.91099.91
  23. Turc G, Oppenheim C, Naggara O, Eker OF, Calvet D, Lacour JC, et al. : Relationships between recent intraplaque hemorrhage and stroke risk factors in patients with carotid stenosis : the HIRISC study. Arterioscler Thromb Vasc Biol 32 : 492-499, 2012 https://doi.org/10.1161/ATVBAHA.111.239335
  24. Yamada K, Song Y, Hippe DS, Sun J, Dong L, Xu D, et al. : Quantitative evaluation of high intensity signal on MIP images of carotid atherosclerotic plaques from routine TOF-MRA reveals elevated volumes of intraplaque hemorrhage and lipid rich necrotic core. J Cardiovasc Magn Reson 14 : 81, 2012 https://doi.org/10.1186/1532-429X-14-81
  25. Yim YJ, Choe YH, Ko Y, Kim ST, Kim KH, Jeon P, et al. : High signal intensity halo around the carotid artery on maximum intensity projection images of time-of-flight MR angiography : a new sign for intraplaque hemorrhage. J Magn Reson Imaging 27 : 1341-1346, 2008 https://doi.org/10.1002/jmri.21284
  26. Yoshimura S, Yamada K, Kawasaki M, Asano T, Kanematsu M, Takamatsu M, et al. : High-intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting. Stroke 42 : 3132-3137, 2011 https://doi.org/10.1161/STROKEAHA.111.615708
  27. Yuan C, Mitsumori LM, Ferguson MS, Polissar NL, Echelard D, Ortiz G, et al. : In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. Circulation 104 : 2051-2056, 2001 https://doi.org/10.1161/hc4201.097839
  28. Zhu DC, Ferguson MS, 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 26 : 1360-1366, 2008 https://doi.org/10.1016/j.mri.2008.05.002

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