[논문]Association of Carotid Intraplaque Hemorrhage and Territorial Acute Infarction in Patients with Acute Neurological Symptoms Using Carotid Magnetization-Prepared Rapid Acquisition with Gradient-Echo

Park, Jung Soo; Kwak, Hyo Sung; Lee, Jong Myong; Koh, Eun Jeong; Chung, Gyung Ho; Hwang, Seung Bae

doi:10.3340/jkns.2015.57.2.94

Association of Carotid Intraplaque Hemorrhage and Territorial Acute Infarction in Patients with Acute Neurological Symptoms Using Carotid Magnetization-Prepared Rapid Acquisition with Gradient-Echo 원문보기

Journal of Korean Neurosurgical Society = 대한신경외과학회지, v.57 no.2, 2015년, pp.94 - 99

Park, Jung Soo (Department of Neurosurgery, Chonbuk National University Medical School and Hospital) , Kwak, Hyo Sung (Department of Radiology, Chonbuk National University Medical School and Hospital) , Lee, Jong Myong (Department of Neurosurgery, Chonbuk National University Medical School and Hospital) , Koh, Eun Jeong (Department of Neurosurgery, Chonbuk National University Medical School and Hospital) , Chung, Gyung Ho (Department of Radiology, Chonbuk National University Medical School and Hospital) , Hwang, Seung Bae (Department of Radiology, Chonbuk National University Medical School and Hospital)

Abstract ▼ AI-Helper

Objective : The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods : 83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction. Results : Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010). Conclusion : Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.

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문제 정의

The purpose of our study was to assess prevalence of IPH and associations between territorial acute infarction and IPH on MPRAGE in patients with acute neurologic symptoms.
Recently, some studies reported brain MR examination combined sequences of carotid plaque characterization such as MPRAGE, or conventional plaque MR and the relationship between vulnerable carotid plaque and territorial stroke event^5,7). This study was performed the relationship between territorial acute ischemic stroke and carotid IPH using acute stroke MR examination with MPRAGE sequence.

가설 설정

A 65-year-old woman with an acute infarction of the right basal ganglia. A : A positive signal on magnetization-prepared rapid acquisition with gradient-echo image is defined by the location in the plaque and at least 2 image slices with at least 2-fold higher signal intensity compared to adjacent muscle (arrow). B : Diffusion-weighted imaging (DWI) positive is defined as hyperintense signal on DWI trace with associated decreased signal on the apparent diffusion coefficient map, corresponding to an acute ischemic event at the time of the scan (arrow).
A : Magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) image shows the bilateral high signal intensity in the carotid atherosclerotic plaque (arrows). B : Diffusion-weighted image (DWI) shows the diffusion restriction in right periventricular white matter (arrow). MPRAGE-positive carotid artery coupled with territorial stroke events on DWI.
A : A positive signal on magnetization-prepared rapid acquisition with gradient-echo image is defined by the location in the plaque and at least 2 image slices with at least 2-fold higher signal intensity compared to adjacent muscle (arrow). B : Diffusion-weighted imaging (DWI) positive is defined as hyperintense signal on DWI trace with associated decreased signal on the apparent diffusion coefficient map, corresponding to an acute ischemic event at the time of the scan (arrow).

제안 방법

DWI was conducted with a spin-echo-type echo-planar imaging sequence, with 3 b-values of 0, 500, and 1000 sec/mm2 along all 3 orthogonal axes : repetition time (TR)/echo time (TE)=3000/80 ms; flap angle (FA)=90°; sensitivity encoding=3; field of view (FOV)=220×220 mm; matrix=128×128; section thickness/gap=5 mm/30%; scanning time=35–38 seconds.
This study used MRI at 3-T to immediately undertake combined carotid MPRAGE sequence and stroke MR protocol after admission at emergency room in patients with acute neurological symptoms. In this study, matched lesions between ipsilateral positive DWI and MPRAGE-positive IPH were significantly higher prevalence in high-grade stenosis.
Stroke MR imaging was performed immediately following CT scanning with the following techniques :1) diffusionweighted imaging (DWI); 2) 3D TOF MR angiography (MRA) of the intracranial arteries; 3) susceptibility-weighted imaging (SWI); 4) perfusion-weighted imaging (PWI); and contrast-enhanced MRA for evaluation of carotid artery. We also performed the MPRAGE sequence for this study. Total scan time was approximately 20–30 minutes.

대상 데이터

166 arteries of 83 patients (61 males, 22 females; age range 59–89, median age 69 years-old) are eligible for data analysis.
1. A 65-year-old woman with an acute infarction of the right basal ganglia. A : A positive signal on magnetization-prepared rapid acquisition with gradient-echo image is defined by the location in the plaque and at least 2 image slices with at least 2-fold higher signal intensity compared to adjacent muscle (arrow).
2. A 73-year-old man with an acute infarction of the right periventricular white matter. A : Magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) image shows the bilateral high signal intensity in the carotid atherosclerotic plaque (arrows).

데이터처리

Statistical analysis of carotid MPRAGE signal and brain DWI signal was performed using Fisher exact tests. Likelihood ratios from the 2×2 table were used to determine relative risk of a cerebrovascular ischemic event in MPRAGE-positive lesion with a 95% confidence interval.

성능/효과

010). Also, matched lesions between ipsilateral positive DWI and MPRAGE-positive IPH was significantly higher prevalence in high-grade stenosis (p=0.018).
4. In our study, the prevalence of IPH at baseline was 30.8% and MPRAGE-positive carotid in our patients with acute neurologic symptoms had a further 3.3-fold increased risk of acute stroke on DWI compared with MPRAGE-negative carotid. This result was relatively low prevalence compared with Western study^7,15).
This study used MRI at 3-T to immediately undertake combined carotid MPRAGE sequence and stroke MR protocol after admission at emergency room in patients with acute neurological symptoms. In this study, matched lesions between ipsilateral positive DWI and MPRAGE-positive IPH were significantly higher prevalence in high-grade stenosis. The relative risk of an acute territorial stroke event with an MPRAGE-positive carotid compared with an MPRAGE-negative carotid was 3.
Especially, MPRAGE-positive in patients with carotid atherosclerotic plaque was relatively higher risk of acute ischemic stroke. This study found that IPH in carotid atherosclerotic plaque was present in a high proportion of acute ischemic strokes. Therefore, routine use of the MPRAGE sequence in stroke MR examination may lead to a more accurate stroke risk estimate and more accurate determination of a carotid source of ischemic events.

참고문헌 (28)

1 Bitar R Moody AR Leung G Symons S Crisp S Butany J In vivo 3D high-spatial-resolution MR imaging of intraplaque hemorrhage Radiology 2008 249 259 267 18796681

상세보기
2 de Sauvage Nolting PR de Groot E Zwinderman AH Buirma RJ Trip MD Kastelein JJ Regression of carotid and femoral artery intima-media thickness in familial hypercholesterolemia : treatment with simvastatin Arch Intern Med 2003 163 1837 1841 12912721

상세보기
3 Jauch EC Saver JL Adams HP Jr Bruno A Connors JJ Demaerschalk BM Guidelines for the early management of patients with acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association/American Stroke Association Stroke 2013 44 870 947 23370205

상세보기
4 Kolodgie FD Gold HK Burke AP Fowler DR Kruth HS Weber DK Intraplaque hemorrhage and progression of coronary atheroma N Engl J Med 2003 349 2316 2325 14668457

상세보기
5 Lindsay AC Biasiolli L Lee JM Kylintireas I MacIntosh BJ Watt H Plaque features associated with increased cerebral infarction after minor stroke and TIA : a prospective, case-control, 3-T carotid artery MR imaging study JACC Cardiovasc Imaging 2012 5 388 396 22498328
6 Lovett JK Coull AJ Rothwell PM Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies Neurology 2004 62 569 573 14981172

상세보기
7 McNally JS Kim SE Yoon HC Findeiss LK Roberts JA Nightingale DR Carotid magnetization-prepared rapid acquisition with gradient-echo signal is associated with acute territorial cerebral ischemic events detected by diffusion-weighted MRI Circ Cardiovasc Imaging 2012 5 376 382 22495769

상세보기
8 Mercuri M Bond MG Sirtori CR Veglia F Crepaldi G Feruglio FS Pravastatin reduces carotid intima-media thickness progression in an asymptomatic hypercholesterolemic mediterranean population : the Carotid Atherosclerosis Italian Ultrasound Study Am J Med 1996 101 627 634 9003110

상세보기
9 Ota H Yarnykh VL Ferguson MS Underhill HR Demarco JK Zhu DC Carotid intraplaque hemorrhage imaging at 3.0-T MR imaging : comparison of the diagnostic performance of three T1-weighted sequences Radiology 2010 254 551 563 20093526

상세보기
10 Parmar JP Rogers WJ Mugler JP 3rd Baskurt E Altes TA Nandalur KR Magnetic resonance imaging of carotid atherosclerotic plaque in clinically suspected acute transient ischemic attack and acute ischemic stroke Circulation 2010 122 2031 2038 21041694

상세보기
11 The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels N Engl J Med 1998 339 1349 1357 9841303
12 Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease : the Scandinavian Simvastatin Survival Study (4S) Lancet 1994 344 1383 1389 7968073
13 Rosamond W Flegal K Friday G Furie K Go A Greenlund K Heart disease and stroke statistics--2007 update : a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation 2007 115 e69 e171 17194875
14 Saam T Cai J Ma L Cai YQ Ferguson MS Polissar NL Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging Radiology 2006 240 464 472 16864672

상세보기
15 Saam T Hetterich H Hoffmann V Yuan C Dichgans M Poppert H Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging J Am Coll Cardiol 2013 62 1081 1091 23850912

상세보기
16 Sitzer M Müller W Siebler M Hort W Kniemeyer HW Jäncke L Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis Stroke 1995 26 1231 1233 7604420

상세보기
17 Smilde TJ van Wissen S Wollersheim H Trip MD Kastelein JJ Stalenhoef AF Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP) : a prospective, randomised, double-blind trial Lancet 2001 357 577 581 11558482
18 Spagnoli LG Mauriello A Sangiorgi G Fratoni S Bonanno E Schwartz RS Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke JAMA 2004 292 1845 1852 15494582

상세보기
19 Sun J Balu N Hippe DS Xue Y Dong L Zhao X Subclinical carotid atherosclerosis : short-term natural history of lipid-rich necrotic core--a multicenter study with MR imaging Radiology 2013 268 61 68 23513240

상세보기
20 Sun J Underhill HR Hippe DS Xue Y Yuan C Hatsukami TS Sustained acceleration in carotid atherosclerotic plaque progression with intraplaque hemorrhage : a long-term time course study JACC Cardiovasc Imaging 2012 5 798 804 22897993
21 Takaya N Yuan C Chu B Saam T Polissar NL Jarvik GP Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques : a high-resolution magnetic resonance imaging study Circulation 2005 111 2768 2775 15911695

상세보기
22 Takaya N Yuan C Chu B Saam T Underhill H Cai J Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events : a prospective assessment with MRI--initial results Stroke 2006 37 818 823 16469957

상세보기
23 Turc G Oppenheim C Naggara O Eker OF Calvet D Lacour JC Relationships between recent intraplaque hemorrhage and stroke risk factors in patients with carotid stenosis : the HIRISC study Arterioscler Thromb Vasc Biol 2012 32 492 499 22075251

상세보기
24 Yamada K Song Y Hippe DS Sun J Dong L Xu D Quantitative evaluation of high intensity signal on MIP images of carotid atherosclerotic plaques from routine TOF-MRA reveals elevated volumes of intraplaque hemorrhage and lipid rich necrotic core J Cardiovasc Magn Reson 2012 14 81 23194180
25 Yim YJ Choe YH Ko Y Kim ST Kim KH Jeon P High signal intensity halo around the carotid artery on maximum intensity projection images of time-of-flight MR angiography : a new sign for intraplaque hemorrhage J Magn Reson Imaging 2008 27 1341 1346 18504753

상세보기
26 Yoshimura S Yamada K Kawasaki M Asano T Kanematsu M Takamatsu M High-intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting Stroke 2011 42 3132 3137 21868725

상세보기
27 Yuan C Mitsumori LM Ferguson MS Polissar NL Echelard D Ortiz G 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 11673345

상세보기
28 Zhu DC Ferguson MS DeMarco JK An optimized 3D inversion recovery prepared fast spoiled gradient recalled sequence for carotid plaque hemorrhage imaging at 3.0 T Magn Reson Imaging 2008 26 1360 1366 18583079

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