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. 2009 Oct;29(10):1696-701.
doi: 10.1161/ATVBAHA.109.192179. Epub 2009 Jul 16.

Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study

Hideki Ota  1 , Wei Yu, Hunter R Underhill, Minako Oikawa, Li Dong, Xihai Zhao, Nayak L Polissar, Blazej Neradilek, Tianli Gao, Zhuo Zhang, Zixu Yan, Miao Guo, Zhaoqi Zhang, Thomas S Hatsukami, Chun Yuan
Affiliations

Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study

Hideki Ota et al. Arterioscler Thromb Vasc Biol. 2009 Oct.

Abstract

Objective: Histological studies suggest associations between hemorrhage and large lipid-rich/necrotic cores with thin or ruptured fibrous caps in advanced atherosclerosis. We investigated these associations in carotid arteries with mild to severe stenosis by in vivo 3T MRI.

Methods and results: Seventy-seven patients with >or=50% carotid stenosis in at least one side by duplex ultrasound underwent bilateral multi-contrast carotid MRI scans. Measurements for wall and lipid-rich/necrotic core sizes, presence of hemorrhage, and fibrous cap status (classified as intact thick, intact thin or ruptured) were recorded. Arteries with poor image quality, occlusion, or no detectable lipid-rich/necrotic core were excluded. For the 798 MRI slices included, multivariate ordinal regression analysis demonstrated larger %lipid-rich/necrotic core (odds ratio for 10% increase, 1.49; P=0.02) and presence of hemorrhage (odds ratio, 5.91; P<0.001) were independently associated with a worse (intact thin or ruptured) stage of fibrous cap status. For artery-based multivariate analysis, a larger maximum %lipid-rich/necrotic core and presence of hemorrhage independently associated with worse fibrous cap status (P<0.001, for both). No hemorrhage was detected in arteries with thick fibrous caps.

Conclusions: Hemorrhage and larger %lipid-rich/necrotic core were independently associated with a thin or ruptured fibrous cap status at an early to advanced stage of carotid atherosclerosis.

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Figures

Figure 1
Figure 1
Lipid-rich/necrotic core (arrows) with overlying intact thick fibrous cap. A smooth luminal surface and visible juxtaluminal band on TOF, CE-T1W, PDW, and T2W images indicate intact thick fibrous cap (arrow heads). * indicates lumen.
Figure 2
Figure 2
Lipid-rich/necrotic core (arrows) with overlying intact thin fibrous cap. Smooth surface with juxtaluminal band not apparent on TOF, CE-T1W, PDW, and T2W images indicates intact thin fibrous cap (arrow heads). * indicates lumen.
Figure 3
Figure 3
Hemorrhagic lipid-rich/necrotic core (arrows) with ruptured fibrous cap. Area with hypointensity on CE-T1W and hyperintensity on other images indicates a hemorrhagic lipid-rich/necrotic core. A surface irregularity of the lumen, a hyperintense juxtaluminal signal on TOF and invisible juxaluminal band on CE-T1W indicate ruptured fibrous cap (arrow heads). * indicates lumen.
See this image and copyright information in PMC

References

    1. Virmani R, Burke AP, Kolodgie FD, Farb A. Pathology of the thin-cap fibroatheroma: a type of vulnerable plaque. Journal of Interventional Cardiology. 2003;16:267–72. - PubMed
    1. Spagnoli LG, Mauriello A, Sangiorgi G, Fratoni S, Bonanno E, Schwartz RS, Piepgras DG, Pistolese R, Ippoliti A, Holmes DR., Jr Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA. 2004;292:1845–52. - PubMed
    1. Virmani R, Burke AP, Kolodgie FD, Farb A. Vulnerable plaque: the pathology of unstable coronary lesions. Journal of Interventional Cardiology. 2002;15:439–46. - PubMed
    1. Burke AP, Virmani R, Galis Z, Haudenschild CC, Muller JE. 34th Bethesda Conference: Task force #2--What is the pathologic basis for new atherosclerosis imaging techniques? J Am Coll Cardiol. 2003;41:1874–86. - PubMed
    1. 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;20:1262–75. - PubMed

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