Key result
Irregular carotid plaque surface determined by MR vessel wall imaging independently predicted subsequent vascular events (adjusted HR 13.03; 95% CI 1.71-99.42; P=0.013).
Why the study?
The relationship between carotid plaque compositions and irregular plaque surface, along with its predictive value for vascular events, was unknown.
Does irregular carotid plaque surface predict subsequent vascular events in patients with cerebrovascular symptoms?
Cohort (n=140)
Does irregular carotid plaque surface predict subsequent vascular events in patients with cerebrovascular symptoms?
Hazard Ratio: 13.03 (95% CI 1.71–99.42)
p-value: p=0.013
Irregular carotid plaque surface determined by MR vessel wall imaging is an independent predictor for subsequent vascular events in patients with cerebrovascular symptoms.
Irregular carotid plaque surface on MR may identify higher VE risk; leaves open incremental value beyond composition in prospective validation.
BACKGROUND: The relationship between plaque compositions and irregular plaque surface and its predictive value for vascular events (VEs) are unknown. PURPOSE: To investigate the relationship between irregular carotid plaque surface and plaque compositional features and its predictive values for future VEs utilizing magnetic resonance (MR) vessel wall imaging. STUDY TYPE: Prospective study. POPULATION: In total, 140 patients with cerebrovascular symptoms were recruited. FIELD STRENGTH/SEQUENCE: -weighted, 3D time-of-flight, magnetization-prepared rapid acquisition gradient echo (MP-RAGE), and 3D motion sensitized driven equilibrium rapid gradient echo (MERGE). ASSESSMENT: The carotid artery stenosis and maximum wall thickness (Max WT) were measured. The presence/absence of irregular carotid plaque surface, calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture was determined. After baseline examination, all patients were followed-up for at least 1 year to record the VEs. STATISTICAL TESTS: Independent t-test, Mann-Whitney U-test, Chi-square, logistic regression, and Cox regression were used. RESULTS: In total, 82 (58.6%) had irregular plaque surfaces. The carotid Max WT, stenosis, and the presence of surface calcification, LRNC and IPH were significantly associated with irregular plaque surface (all P < 0.05). After adjusted for baseline confounding factors, these associations remained statistically significant (all P < 0.05). During the median follow-up time of 12.1 months, 37 (26.4%) patients had VEs. Univariable Cox regression analysis showed that the irregular carotid plaque surface was significantly associated with subsequent VEs (hazard ratio [HR], 11.02; 95% confidence interval [CI], 2.65-45.85; P = 0.001). After adjusted for baseline and follow-up confounding factors, this association remained statistically significant (HR, 13.03; 95% CI, 1.71-99.42, P = 0.013). After further adjusted for intracranial stenosis, this association also remained statistically significant (HR, 12.57; 95% CI, 1.63-96.83, P = 0.015). DATA CONCLUSION: The morphology of carotid atherosclerotic plaque surface determined by MR vessel wall imaging, particularly irregular plaque surface, is an independent predictor for subsequent vascular events. LEVEL OF EVIDENCE: 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;52:185-194.
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Li et al. (2020) conducted a cohort in Cerebrovascular symptoms (n=140). Irregular carotid plaque surface vs. Absence of irregular carotid plaque surface was evaluated on Subsequent vascular events (HR 13.03, 95% CI 1.71-99.42, p=0.013). Irregular carotid plaque surface determined by MR vessel wall imaging independently predicted subsequent vascular events (adjusted HR 13.03; 95% CI 1.71-99.42; P=0.013).
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