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가설 설정
- (a) Total IPH volume is significantly larger in the positive halo sign group than in the negative halo sign group on MIP images. (b) The maximal axial wall area of IPH is also significantly larger in the positive halo sign group than in the negative halo sign group on MIP images.
제안 방법
- 1). The results were determined by a consensus of two neuroradiologists that read the MIP of TOF MRA of the carotid artery while blinded to clinical information as well as research purpose. Reviewers described the IPH as positive or negative in the carotid plaque on MIP images.
- This study compared the diagnostic performances of high signal intensity halo from TOF MRA based on IPH volume on MPRAGE sequence for IPH detection.
대상 데이터
- Among the 125 consecutive patients that underwent carotid plaque MR imaging, 40 were excluded from analysis for: 1) no IPH on all T1 sequences (n = 30), 2) poor image quality (n = 5), 3) no carotid artery suppression on MPRAGE imaging (n = 3), and 4) total occlusion of ICA (n = 2). Consequentially, 78 carotid arteries of 65 patients with MPRAGE positive on carotid plaque MR imaging were recruited for this study. Demographic data of all enrolled patients are shown in Table 1.
데이터처리
- Continuous and categorical variables between the two groups were compared using the Mann-Whitney test and Fisher’s exact tests, respectively.
이론/모형
- We used semi-automated software for the quantitative analysis of IPH volume (Rapidia; Infinite, Seoul, Korea) on MPRAGE sequence. IPH segmentation was performed with a piecewise smooth regional level set method. A region of interest was then manually drawn around the outer boundary of the carotid artery.
- 1 (R Foundation for Statistical Computing, Vienna, Austria). In order to evaluate the cut-off value between the two groups, a receiver operating characteristic (ROC) curve analysis was performed to extract the optimal threshold using MedCalc software.
성능/효과
- Intraplaque hemorrhage (IPH) volume and maximal axial wall area of IPH as carotid stenosis categories. (a) Total volume of IPH of carotid arteries with 16-50% and 51-99% was significantly larger than that of carotid arteries with 0-15%. (b) Maximal axial wall area of IPH of carotid arteries with 16-50% and 51-99% was significantly larger than that of carotid arteries with 0-15%.
- (a) Total volume of IPH of carotid arteries with 16-50% and 51-99% was significantly larger than that of carotid arteries with 0-15%. (b) Maximal axial wall area of IPH of carotid arteries with 16-50% and 51-99% was significantly larger than that of carotid arteries with 0-15%.
- (8) reported the diagnostic performance of three T1-weighted MR sequences, 2D fast spin-echo, 3D TOF, and 3D MPRAGE, on carotid IPH imaging, using histologic analysis as the standard of reference. Among the three tested T1-weighted MR sequences, the MPRAGE sequence yielded the best agreement with histologic findings for detecting and quantifying IPH, when compared with fast spine echo and TOF sequencing. Therefore, the MPRAGE sequence was included in the routine MR protocol for the early detection of IPH, although this takes approximately three to four minutes (17-19).
- In conclusion, a high signal intensity halo of IPH on MIP of TOF MRA is associated with increased total volume and maximal axial wall area of IPH. Since samples without the halo sign on TOF sequence exhibited IPH that was apparent on the MPRAGE sequence, we suggest that future diagnostic procedures include MRPAGE to detect IPH rather than the presently-used TOF sequence.
- 7 times larger in those with the halo sign than in those without it. In our study, the sensitivity of high signal intensity on MIP images of TOF MRA for detecting IPH was 67.1%. This sensitivity was lower than that of previous studies that only used TOF MRA to evaluate IPH (6, 9), and higher than a previous comparison study between TOF MRA and carotid plaque MR imaging (1).
- MPRAGE sequence results exhibited the best agreement with histologic findings, and consistently yielded the highest κ value, which showed the highest sensitivity for detecting IPH, and it also presented both the highest correlation and smallest mean difference when compared to histologic findings.
- The total IPH volume and maximal axial wall area of IPH of the carotid arteries with 16-50% and 51-99% stenosis were significantly larger than those of the carotid arteries with 0-15% stenosis (Table 3) (Fig. 3). The total IPH volume and maximal axial wall area of the positive halo sign group with 16-50% and 51-99% carotid stenosis were significantly larger than those of the negative halo sign group (P < 0.
- The total IPH volume and maximal axial wall area of the positive halo sign group with 16-50% and 51-99% carotid stenosis were significantly larger than those of the negative halo sign group (P < 0.05).
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