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RT Journal Article
SR Electronic
T1 Comparison of Carotid Plaque Ulcer Detection Using Contrast-Enhanced and Time-of-Flight MRA Techniques
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 177
OP 184
DO 10.3174/ajnr.A3132
VO 34
IS 1
A1 Etesami, M.
A1 Hoi, Y.
A1 Steinman, D.A.
A1 Gujar, S.K.
A1 Nidecker, A.E.
A1 Astor, B.C.
A1 Portanova, A.
A1 Qiao, Y.
A1 Abdalla, W.M.A.
A1 Wasserman, B.A.
YR 2013
UL http://www.ajnr.org/content/34/1/177.abstract
AB BACKGROUND AND PURPOSE: Ulceration in carotid plaque is a risk indicator for ischemic stroke. Our aim was to compare plaque ulcer detection by standard TOF and CE-MRA techniques and to identify factors that influence its detection. MATERIALS AND METHODS: Carotid MR imaging scans were acquired on 2066 participants in the ARIC study. We studied the 600 thickest plaques. TOF-MRA, CE-MRA, and black-blood MR images were analyzed together to define ulcer presence (plaque surface niche ≥2 mm in depth). Sixty ulcerated arteries were detected. These arteries were randomly assigned, along with 40 nonulcerated plaques from the remaining 540, for evaluation of ulcer presence by 2 neuroradiologists. Associations between ulcer detection and ulcer characteristics, including orientation, location, and size, were determined and explored by CFD modeling. RESULTS: One CE-MRA and 3 TOF-MRAs were noninterpretable and excluded. Of 71 ulcers in 56 arteries, readers detected an average of 39 (55%) on both TOF-MRA and CE-MRA, 26.5 (37.5%) only on CE-MRA, and 1 (1.5%) only on TOF-MRA, missing 4.5 (6%) ulcers by both methods. Ulcer detection by TOF-MRA was associated with its orientation (distally pointing versus perpendicular: OR = 5.57 [95% CI, 1.08–28.65]; proximally pointing versus perpendicular: OR = 0.21 [95% CI, 0.14–0.29]); location relative to point of maximum stenosis (distal versus isolevel: OR = 5.17 [95% CI, 2.10–12.70]); and neck-to-depth ratio (OR = 1.96 [95% CI, 1.11–3.45]) after controlling for stenosis and ulcer volume. CONCLUSIONS: CE-MRA detects more ulcers than TOF-MRA in carotid plaques. Missed ulcers on TOF-MRA are influenced by ulcer orientation, location relative to point of maximum stenosis, and neck-to-depth ratio. ARICAtherosclerosis Risk in CommunitiesCEcontrast-enhancedCFDcomputational fluid dynamicsCIconfidence intervalFDflow dividerIMTintima-media thicknessIQimage qualityMIPmaximum intensity projectionORodds ratioTOFtime-of-flight