Exploring the risk stratification of carotid plaque hemodynamic using four-dimensional blood flow technology

Figures

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  FIGURE 1. Periodic changes in wall shear stress on the carotid artery wall—schematic representation of 4D-flow characterization. (A) HRVW T1 image of the carotid artery, showing a ruptured fibrous cap on the plaque. (B) VEIN image on the 3D-Qflow sequence, displaying through-plane blood flow in the carotid artery (shown in red) in magnitude. (C) Sagittal reconstruction of the carotid artery from the HRVW 3D-T1 image (original image in axial view), showing the existence of IPH, calcification, and thin fibrous caps. Parameters such as the degree of lumen stenosis were measured at the axial image of the narrowest plane. (D) GT-Flow software integration of magnitude, AP, FH, and RL for the measurement of WSS, flow, velocity, and other hemodynamic parameters. (E) Pathlines of the carotid artery region of interest reconstructed from blood flow signals.

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  FIGURE 2. Enrollment of patients with carotid artery stenosis in this study.

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  FIGURE 3. Temporal variation in carotid artery wall shear stress (A,B). (A) Variation in the overall average value of the included carotid artery plaque measurements over time within a cardiac cycle. (B) Comparison of the total average values of 3D mean-WSS and Axi-WSS within a single cardiac cycle.

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  FIGURE 4. Plaque characterization with high-resolution MRI and 4D-flow hemodynamic analysis. (A) Coronal 3D T1 VISTA image showing a plaque at the origin of the left internal carotid artery (red arrow). (B) Axially reconstructed 3D-MERGE image of the same plaque. (C) Coronal view from GT-Flow software, showing the segmented lumen (dotted line) from 3D-Qflow data. The arrow indicates the plaque, visible as a filling defect. (D,E) Hemodynamic flow patterns represented by pathlines (D) and streamlines (E), reconstructed using GT-Flow. (F,G) Flow patterns streamlines, (F) and corresponding wall shear stress map WSS-Map, (G) reconstructed using the R language.

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  FIGURE 5. ROC curves illustrating the predictive efficacy of imaging high-risk features and hemodynamic parameters for new-onset stroke. The graph compares the diagnostic performance of four models: (1) WSS down max (blue), representing wall shear stress-derived high-risk features; (2) TFC (red), indicating hemodynamic parameters; (3) a combined model integrating WSS down max, TFC, and NWI (green); and (4) NWI alone (orange). Among individual markers, the combined model (WSS down max + TFC + NWI) exhibits the highest area under the curve (AUC), suggesting superior predictive efficacy for new-onset stroke. These findings highlight the enhanced prognostic value of multimodal integration of imaging and hemodynamic biomarkers over single-parameter assessments.