Comparison of Symptomatic and Asymptomatic Atherosclerotic Carotid Plaque Features with in Vivo MR Imaging

Purpose: To retrospectively determine if in vivo magnetic resonance (MR) imaging can simultaneously depict differences between symptomatic and asymptomatic carotid atherosclerotic plaque.

Materials and Methods: Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Twenty-three patients (21 men, two women; mean age, 66.1 years ± 11.0 [standard deviation]) with unilateral symptomatic carotid disease underwent 1.5-T time-of-flight MR angiography and 1.5-T T1-, intermediate-, and T2-weighted MR imaging. Both carotid arteries were reviewed. One observer recorded quantitative and morphologic information, which included measurement of the area of the lumen, artery wall, and main plaque components; fibrous cap status (thick, thin, or ruptured); American Heart Association (AHA) lesion type (types I–VIII); and location (juxtaluminal vs intraplaque) and type of hemorrhage. Plaques associated with neurologic symptoms and asymptomatic plaques were compared with Wilcoxon signed rank and McNemar tests.

Results: Compared with asymptomatic plaques, symptomatic plaques had a higher incidence of fibrous cap rupture (P = .007), juxtaluminal hemorrhage or thrombus (P = .039), type I hemorrhage (P = .021), and complicated AHA type VI lesions (P = .004) and a lower incidence of uncomplicated AHA type IV and V lesions (P = .005). Symptomatic plaques also had larger hemorrhage (P = .003) and loose matrix (P = .014) areas and a smaller lumen area (P = .008). No significant differences between symptomatic and asymptomatic plaques were found for quantitative measurements of the lipid-rich necrotic core, calcification, and the vessel wall or for the occurrence of intraplaque hemorrhage or type II hemorrhage.

Conclusion: This study revealed significant differences between symptomatic and asymptomatic plaques in the same patient.

© RSNA, 2006


  • 1 Fuster V, Fayad ZA, Badimon JJ. Acute coronary syndromes: biology. Lancet 1999; 353(suppl 2): SII5–SII9. Crossref, MedlineGoogle Scholar
  • 2 Lekakis JP, Papamichael CM, Cimponeriu AT, et al. Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis. Am J Cardiol 2000;85:949–952. Crossref, MedlineGoogle Scholar
  • 3 Adams GJ, Simoni DM, Bordelon CB Jr, et al. Bilateral symmetry of human carotid artery atherosclerosis. Stroke 2002;33:2575–2580. Crossref, MedlineGoogle Scholar
  • 4 Golledge J, Greenhalgh RM, Davies AH. The symptomatic carotid plaque. Stroke 2000;31:774–781. Crossref, MedlineGoogle Scholar
  • 5 Fisher M, Paganini-Hill A, Martin A, et al. Carotid plaque pathology: thrombosis, ulceration, and stroke pathogenesis. Stroke 2005;36:253–257. Crossref, MedlineGoogle Scholar
  • 6 Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL, Yuan C. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation 2002;106:1368–1373. Crossref, MedlineGoogle Scholar
  • 7 Chu B, Kampschulte A, Ferguson MS, et al. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke 2004;35:1079–1084. Crossref, MedlineGoogle Scholar
  • 8 Hatsukami TS, Ross R, Polissar NL, Yuan C. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation 2000;102:959–964. Crossref, MedlineGoogle Scholar
  • 9 Kampschulte A, Ferguson MS, Kerwin WS, et al. Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging. Circulation 2004;110:3239–3244. Crossref, MedlineGoogle Scholar
  • 10 Saam T, Ferguson MS, Yarnykh VL, et al. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol 2005;25:234–239. Crossref, MedlineGoogle Scholar
  • 11 Serfaty JM, Chaabane L, Tabib A, Chevallier JM, Briguet A, Douek PC. Atherosclerotic plaques: classification and characterization with T2-weighted high-spatial-resolution MR imaging—an in vitro study. Radiology 2001;219:403–410. LinkGoogle Scholar
  • 12 Toussaint JF, LaMuraglia GM, Southern JF, Fuster V, Kantor HL. Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo. Circulation 1996;94:932–938. Crossref, MedlineGoogle Scholar
  • 13 Yuan C, Mitsumori LM, Ferguson MS, 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 2001;104:2051–2056. Crossref, MedlineGoogle Scholar
  • 14 Hayes CE, Mathis CM, Yuan C. Surface coil phased arrays for high-resolution imaging of the carotid arteries. J Magn Reson Imaging 1996;6:109–112. Crossref, MedlineGoogle Scholar
  • 15 Yuan C, Mitsumori LM, Beach KW, Maravilla KR. Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology 2001;221:285–299. LinkGoogle Scholar
  • 16 Kerwin WS, Han C, Chu B, et al. A quantitative vascular analysis system for evaluation of atherosclerotic lesions by MRI. In: Niessen WJ, Viergever MA, eds. Medical Image Computing and Computer-Assisted Intervention—MICCAI 2001. Lecture Notes in Computer Science. Vol 2208. Berlin, Germany: Springer, 2001; 786–794. Google Scholar
  • 17 Lehman EL. Nonparametrics: statistical methods based on ranks. New York, NY: Holden-Day, 1975; 268–269. Google Scholar
  • 18 Bassiouny HS, Sakaguchi Y, Mikucki SA, et al. Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. J Vasc Surg 1997;26:585–594. Crossref, MedlineGoogle Scholar
  • 19 Hatsukami TS, Ferguson MS, Beach KW, et al. Carotid plaque morphology and clinical events. Stroke 1997;28:95–100. Crossref, MedlineGoogle Scholar
  • 20 Burke AP, Kolodgie FD, Farb A, et al. Healed plaque ruptures and sudden coronary death: evidence that subclinical rupture has a role in plaque progression. Circulation 2001;103:934–940. Crossref, MedlineGoogle Scholar
  • 21 Davies MJ. Stability and instability: two faces of coronary atherosclerosis—the Paul Dudley White lecture 1995. Circulation 1996;94:2013–2020. Crossref, MedlineGoogle Scholar
  • 22 Fryer JA, Myers PC, Appleberg M. Carotid intraplaque hemorrhage: the significance of neovascularity. J Vasc Surg 1987;6:341–349. Crossref, MedlineGoogle Scholar
  • 23 Lusby RJ, Ferrell LD, Ehrenfeld WK, Stoney RJ, Wylie EJ. Carotid plaque hemorrhage: its role in production of cerebral ischemia. Arch Surg 1982;117:1479–1488. Crossref, MedlineGoogle Scholar
  • 24 Moody AR, Murphy RE, Morgan PS, et al. Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation 2003;107:3047–3052. Crossref, MedlineGoogle Scholar
  • 25 Sitzer M, Muller W, Siebler M, et al. Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis. Stroke 1995;26:1231–1233. Crossref, MedlineGoogle Scholar
  • 26 Kolodgie FD, Gold HK, Burke AP, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 2003;349:2316–2325. Crossref, MedlineGoogle Scholar
  • 27 Carr S, Farb A, Pearce WH, Virmani R, Yao JS. Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. J Vasc Surg 1996;23:755–765. Crossref, MedlineGoogle Scholar
  • 28 Takaya N, Yuan C, Chu B, et al. Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation 2005;111(21):2768–2775. Crossref, MedlineGoogle Scholar
  • 29 Davies MJ, Thomas AC. Plaque fissuring: the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J 1985;53:363–373. Crossref, MedlineGoogle Scholar
  • 30 Falk E. Coronary thrombosis: pathogenesis and clinical manifestations. Am J Cardiol 1991;68(7):28B–35B. Crossref, MedlineGoogle Scholar
  • 31 Fuster V, Stein B, Ambrose JA, Badimon L, Badimon JJ, Chesebro JH. Atherosclerotic plaque rupture and thrombosis: evolving concepts. Circulation 1990; 82(3 suppl):II47–II59. Google Scholar
  • 32 Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000;20:1262–1275. Crossref, MedlineGoogle Scholar
  • 33 Yuan C, Zhang SX, Polissar NL, et al. Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation 2002;105:181–185. Crossref, MedlineGoogle Scholar
  • 34 Yarnykh VL, Yuan C. Multislice double inversion-recovery black-blood imaging with simultaneous slice reinversion. J Magn Reson Imaging 2003;17:478–483. Crossref, MedlineGoogle Scholar
  • 35 Yarnykh VL, Yuan C. T1-insensitive flow suppression using quadruple inversion-recovery. Magn Reson Med 2002;48:899–905. Crossref, MedlineGoogle Scholar
  • 36 Saam T, Kerwin WS, Chu B, et al. Sample size calculation for clinical trials using magnetic resonance imaging for the quantitative assessment of carotid atherosclerosis. J Cardiovasc Magn Reson 2005;7(5):799–808. Crossref, MedlineGoogle Scholar

Article History

Published in print: Aug 2006