Comparison of Carotid Plaque Characteristics Between Men and Women Using Magnetic Resonance Vessel Wall Imaging: A Chinese Atherosclerosis Risk Evaluation Study

Background Carotid vulnerable plaque is a major cause of stroke and differs between men and women. Few studies have investigated the differences in carotid plaque features between sexes in a Chinese population. Purpose To compare carotid atherosclerotic plaque features between men and women in a Chinese population using magnetic resonance imaging. Study type Cross‐sectional. Subjects A total of 567 patients (mean age: 61.5 ± 10.1 years; 404 men) who had recent stroke or transient ischemia attack and atherosclerotic plaque in at least one carotid artery. Field strength A 3.0 T. Sequence T1‐ and T2‐weighted turbo spin echo, three‐dimensional time‐of‐flight (TOF) fast field echo and magnetization‐prepared rapid acquisition gradient echo sequences. Assessment Plaque characteristics including lumen area (LA), wall area (WA), total vessel area (TVA), mean wall thickness (MWT), and mean normalized wall index (NWI); presence of calcification, lipid‐rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR); and percent composition area (%area) were evaluated and compared between men and women. Statistical tests Independent‐sample t test, Mann–Whitney U test, chi‐square test, and multiple linear and logistic regressions. Results In symptomatic arteries, men had significantly greater LA (46.2 ± 15.6 mm 2 vs. 40.7 ± 12.9 mm 2 , P < 0.05), WA (33.9 ± 11.5 mm 2 vs. 26.3 ± 7.5 mm 2 , P < 0.05), and TVA (80.1 ± 20.4 mm 2 vs. 67.0 ± 18.0 mm 2 , P < 0.05); higher MWT (1.2 ± 0.4 mm vs. 1.0 ± 0.2 mm, P < 0.05); and higher prevalence of LRNC (72.3% vs. 46.0%, P < 0.05) and IPH (18.6% vs. 4.9%, P < 0.05) compared with women. In asymptomatic arteries, men had significantly greater LA (48.3 ± 16.9 mm 2 vs. 42.1 ± 12.6 mm 2 , P < 0.05), WA (32.9 ± 11.0 mm 2 vs. 25.8 ± 6.1 mm 2 , P < 0.05), and TVA (81.2 ± 22.1 mm 2 vs. 67.9 ± 16.5 mm 2 , P < 0.05); higher MWT (1.2 ± 0.3 mm vs. 1.0 ± 0.2 mm, P < 0.05); higher prevalence of LRNC (67.8% vs. 42.9%, P < 0.05), IPH (14.9% vs. 1.2%, P < 0.05), and FCR (6.4% vs. 1.2%, P < 0.05); and higher %LRNC area (24.8 ± 17.2% vs. 17.8 ± 14.1%, P < 0.05) compared with women. Data conclusion Men have similar plaque burden but more vulnerable atherosclerotic plaques compared with women in both symptomatic and asymptomatic carotid arteries in a Chinese population. Evidence Level 4 Technical Efficacy Stage 3