PT  - JOURNAL ARTICLE
AU  - Crombag, G.A.J.C.
AU  - Aizaz, M.
AU  - Schreuder, F.H.B.M.
AU  - Benali, F.
AU  - van Dam-Nolen, D.H.K.
AU  - Liem, M.I.
AU  - Lucci, C.
AU  - van der Steen, A.F.
AU  - Daemen, M.J.A.P.
AU  - Mess, W.H.
AU  - van der Lugt, A.
AU  - Nederkoorn, P.J.
AU  - Hendrikse, J.
AU  - Hofman, P.A.M.
AU  - van Oostenbrugge, R.J.
AU  - Wildberger, J.E.
AU  - Kooi, M.E.
TI  - Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study
AID  - 10.3174/ajnr.A7384
DP  - 2022 Feb 01
TA  - American Journal of Neuroradiology
PG  - 265--271
VI  - 43
IP  - 2
4099  - http://www.ajnr.org/content/43/2/265.short
4100  - http://www.ajnr.org/content/43/2/265.full
SO  - Am. J. Neuroradiol.2022 Feb 01; 43
AB  - BACKGROUND AND PURPOSE: Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis.MATERIALS AND METHODS: Eighty-eight symptomatic patients with stroke (<70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap.RESULTS: We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P < .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P < .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022.CONCLUSIONS: We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.FCfibrous capIPHintraplaque hemorrhageQIR TSEquadruple inversion recovery turbo spin-echoTRFCthin/ruptured fibrous cap