Carotid Wall Imaging with Routine Brain MRI to Facilitate Early Detection of Carotid Plaque and Intraplaque Hemorrhage

permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Previous studies have reported stroke magnetic resonance imaging (MRI) assessments that included a carotid magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequence. The findings of these studies showed that a carotid MPRAGE-positive signal was associated with an increased risk of territorial cerebral ischemic events, as detected by brain diffusion weighted imaging (DWI). 1 This study evaluated the effectiveness of carotid MPRAGE added to standard brain MRI with contrast-enhanced MR angiography (CE-MRA) as an outpatient screening tool for detecting and evaluating carotid intraplaque hemorrhage (IPH) location. were enrolled for carotid wall imaging using the MPRAGE sequence and carotid contrast-enhanced MR angiography within the standard brain MRI protocol at 3.0-T (Achieva, Philips Healthcare, Best, The Netherlands). An experienced neuroradiolo-gist excluded images with the following traits: no carotid artery suppression, poor imaging quality, internal carotid artery (ICA) total occlusion, previous stent insertion or endarterectomy, or incomplete coverage of ICA bifurcation. Carotid plaques were defined as having wall thickness greater than 2 mm in at least 2 consecutive slices on MPRAGE imaging. Carotid plaques with a high signal intensity on MPRAGE (i.e., > 200% of the adjacent muscle in at least 2 consecutive slices) were defined as IPH. The locations of IPH were divided into common carotid artery, carotid bifurcation, and ICA. Among the 1,737 subjects underwent carotid wall MR imaging , 291 carotid plaques were detected in 226 subjects (13%) and enrolled in the study. Among these, 146 carotid plaques (50.2%) of 118 subjects (52.2%) demonstrated MR-positive IPH. Patient demographics between the two groups were similar. Among the subjects with carotid plaques, 65 (28.8%) showed bilateral lesions and 28 patients (12.4%) were recorded as showing bilateral MR-positive IPH. The findings of the carotid plaque in patients are shown in Table 1. The degree of carotid stenosis was significantly higher in the MR-positive IPH group (P= 0.001). The prevalence of moderate-to high-grade stenosis (> 50%) was significantly higher in the IPH-positive group. Among patients with carotid plaques, 101 (34.1%) showed normal angiographic findings on CE-MRA. Among these with normal angiographic findings, 43 (42.6%) carotid plaques with IPH were detected. The locations of IPH in the carotid artery are summarized in Table 2. Among subjects with IPH in the common carotid artery (CCA), 29 patients (90.6%) recorded normal angiographic findings on CE-MRA (Figure 1). Normal angiographic findings on CE-MRA …