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. 2017 Sep 11;16(1):111.
doi: 10.1186/s12933-017-0592-9.

Association between carotid plaque characteristics and acute cerebral infarction determined by MRI in patients with type 2 diabetes mellitus

Beibei Sun  1 , Xiao Li  1 , Xiaosheng Liu  2 , Xiaoqian Ge  1 , Qing Lu  1 , Xihai Zhao  3 , Jun Pu  4 , Jianrong Xu  1 , Huilin Zhao  5
Affiliations

Association between carotid plaque characteristics and acute cerebral infarction determined by MRI in patients with type 2 diabetes mellitus

Beibei Sun et al. Cardiovasc Diabetol. .

Abstract

Background: Type 2 diabetes mellitus (T2DM) might aggravate the carotid plaque vulnerability, and increase the risk for ischemic stroke. Few studies reported the acute stroke subtype with carotid plaque characteristics in T2DM patients. This study aimed to investigate the association between carotid plaque characteristics and acute cerebral infarct (ACI) lesion features determined by MRI in T2DM patients.

Methods: Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited. All patients were stratified into T2DM and non-T2DM groups and underwent both carotid and brain MRI scans. Ipsilateral carotid plaque morphological and compositional characteristics, intracranial and extracranial carotid artery stenosis were also determined. Stroke subtype based on the Trial of ORG 10172 in Acute Stroke Treatment classification and ACI lesion patterns were evaluated.

Results: Of the recruited 140 patients, 68 (48.6%) patients had T2DM (mean age 64.16 ± 11.38 years, 40 males). T2DM patients exhibited higher prevalence of carotid type IV-VI lesions, larger plaque burden as well as larger lipid-rich necrotic core (LRNC) compared with non-T2DM patients. Among the patients with carotid LRNC on symptomatic side, more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in T2DM group than those in non-T2DM group. Carotid plaque with LRNC% > 22.0% was identified as an independent risk factor for the presence of ACI lesions confined to the carotid territory in T2DM patients, regardless of other risk factors.

Conclusions: This study shows that more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in the T2DM patients with ipsilateral carotid LRNC plaque than those in non-T2DM patients. Quantification of the carotid plaque characteristics, particularly the LRNC% by MRI has the potential usefulness for stroke risk stratification.

Keywords: Acute stroke; Carotid plaque; Diabetes mellitus; Lipid-rich necrotic core; MR imaging.

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Figures

Fig. 1
Fig. 1
Independent predictors for the presence of carotid LRNC plaques on symptomatic side
Fig. 2
Fig. 2
Optimal threshold of carotid plaque features to predict the presence of ACI in ICA region in T2DM subjects (a) and non-T2DM subjects (b). T2DM type 2 diabetes mellitus, LRNC% % volume of LRNC, PWV Percent wall volume, Max WT maximum wall thickness
Fig. 3
Fig. 3
Representative MR images of a T2DM and a non-T2DM subject. a An atherosclerotic plaque with small LRNC (yellow outline) is detected in the right carotid artery of a non-T2DM patient: iso-intensity on T1WI and T2WI; no enhancement in T1WI+; hypo-intensity on MP-RAGE image. Cerebral DWI demonstrates a small perforating artery infarct (hyper-intensity) at right hemisphere. Brain MRA demonstrates right MCA M1 segment with mild stenosis (red arrow). b An atherosclerotic plaque with large LRNC (yellow outline) with mild to moderate stenosis is detected in the right carotid artery of a T2DM patient. LRNC appears as iso-intensity on T1WI; hypo-intensity on corresponding T2WI; no enhancement in T1WI+; hypo-intensity on MP-RAGE image. Cerebral DWI demonstrates large volume of ACI (hyperintensity) at right hemisphere. Brain MRA demonstrates right MCA M1 segment with moderate stenosis (red arrow). ACI acute cerebral infarct, LRNC lipid-rich necrotic core, WI weighted image, T1WI+ contrast enhanced T1-weighted image, MCA middle cerebral artery
See this image and copyright information in PMC

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