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A Noninvasive Imaging Approach to Assess Plaque Severity: The Carotid Atherosclerosis Score

A Noninvasive Imaging Approach to Assess Plaque Severity: The Carotid Atherosclerosis Score This Article Free to Access Figures Only Full Text Full Text (PDF) Supplemental Online Tables All Versions of this Article: ajnr.A2007v1 31/6/1068 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Underhill, H. R. Articles by Yuan, C. PubMed PubMed Citation Articles by Underhill, H. R. Articles by Yuan, C. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:1068-1075, June-July 2010 © 2010 American Society of Neuroradiology HEAD AND NECK A Noninvasive Imaging Approach to Assess Plaque Severity: The Carotid Atherosclerosis Score H.R. Underhill a , T.S. Hatsukami b , J. Cai c , W. Yu d , J.K. DeMarco e , N.L. Polissar f , H. Ota e , X. Zhao a , L. Dong a , M. Oikawa a and C. Yuan a a From the Departments of Radiology (H.R.U., X.Z., L.D., M.O., C.Y.) b Surgery (T.S.H.), University of Washington, Seattle, Washington c Department of Radiology (J.C.), People's Liberation Army General Hospital, Beijing, China d Department of Radiology (W.Y.), Anzhen Hospital, Capital Medical University, Beijing, China e Department of Radiology (J.K.D., H.O.), Michigan State University, East Lansing, Michigan f Mountain-Whisper-Light Statistical Consulting (N.L.P.), Seattle, Washington. Please address correspondence to Hunter R. Underhill, MD, Vascular Imaging Lab, University of Washington, 815 Mercer St, Box 358050, Seattle, WA 98109; e-mail: hunterru@u.washington.edu BACKGROUND AND PURPOSE: The presence of IPH and/or FCR in the carotid atherosclerotic plaque indicates a high-risk lesion. The aim of this multicenter cross-sectional study was to establish the characteristics of lesions that may precede IPH and/or FCR. We further sought to construct a CAS that stratifies carotid disease severity. MATERIALS AND METHODS: Three hundred forty-four individuals from 4 imaging centers with 16%–99% carotid stenosis by duplex sonography underwent carotid MR imaging. In approximately 60% of the study sample (training group), multivariate analysis was used to determine factors associated with IPH and FCR. Statistically significant parameters identified during multivariate analysis were used to construct CAS. CAS was then applied to the remaining arteries (40%, test group), and the accuracy of classification for determining the presence versus absence of IPH or, separately, FCR was determined by ROC analysis and calculation of the AUC. RESULTS: The maximum proportion of the arterial wall occupied by the LRNC was the strongest predictor of IPH ( P < .001) and FCR ( P < .001) during multivariate analysis of the training group. The subsequently derived CAS applied to the test group was an accurate classifier of IPH (AUC = 0.91) and FCR (AUC = 0.93). Compared with MRA stenosis, CAS was a stronger classifier of both IPH and FCR. CONCLUSIONS: LRNC quantification may be an effective complementary strategy to stenosis for classifying carotid atherosclerotic disease severity. CAS forms the foundation for a simple imaging-based risk-stratification system in the carotid artery to classify severity of atherosclerotic disease. Abbreviations: AH, Anzhen Hospital • AUC, area-under-the-curve • CAS, Carotid Atherosclerosis Score • CE, contrast-enhanced • CE-MRA, contrast-enhanced MR angiography • CE-T1WI, contrast-enhanced T1-weighted imaging • CI, confidence interval • FCR, fibrous cap rupture • FSE, fast spin-echo • FSPGR, fast SPGR • FSRS, Framingham Stroke Risk Score • IMT, intima-media thickness • Inf, infinite • IPH, intraplaque hemorrhage • JV, jugular vein • LRNC, lipid-rich necrotic core • Max, maximum • MDIR, multisection double inversion recovery • Min, minimum • MRA, MR angiography • MRI, MR imaging • MSU, Michigan State University • NWI, normalized wall index • OR, odds ratio • PD, proton density • PLA, People's Liberation Army General Hospital • QIR, quadruple inversion recovery • ROC, receiver operating characteristics • SPGR, spoiled gradient-recalled echo • T1WI, T1-weighted imaging • T2WI, T2-weighted imaging • TOF, time-of-flight • TVA, total vessel area • UW, University of Washington Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

A Noninvasive Imaging Approach to Assess Plaque Severity: The Carotid Atherosclerosis Score

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2007
Publisher site
See Article on Publisher Site

Abstract

This Article Free to Access Figures Only Full Text Full Text (PDF) Supplemental Online Tables All Versions of this Article: ajnr.A2007v1 31/6/1068 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Underhill, H. R. Articles by Yuan, C. PubMed PubMed Citation Articles by Underhill, H. R. Articles by Yuan, C. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:1068-1075, June-July 2010 © 2010 American Society of Neuroradiology HEAD AND NECK A Noninvasive Imaging Approach to Assess Plaque Severity: The Carotid Atherosclerosis Score H.R. Underhill a , T.S. Hatsukami b , J. Cai c , W. Yu d , J.K. DeMarco e , N.L. Polissar f , H. Ota e , X. Zhao a , L. Dong a , M. Oikawa a and C. Yuan a a From the Departments of Radiology (H.R.U., X.Z., L.D., M.O., C.Y.) b Surgery (T.S.H.), University of Washington, Seattle, Washington c Department of Radiology (J.C.), People's Liberation Army General Hospital, Beijing, China d Department of Radiology (W.Y.), Anzhen Hospital, Capital Medical University, Beijing, China e Department of Radiology (J.K.D., H.O.), Michigan State University, East Lansing, Michigan f Mountain-Whisper-Light Statistical Consulting (N.L.P.), Seattle, Washington. Please address correspondence to Hunter R. Underhill, MD, Vascular Imaging Lab, University of Washington, 815 Mercer St, Box 358050, Seattle, WA 98109; e-mail: hunterru@u.washington.edu BACKGROUND AND PURPOSE: The presence of IPH and/or FCR in the carotid atherosclerotic plaque indicates a high-risk lesion. The aim of this multicenter cross-sectional study was to establish the characteristics of lesions that may precede IPH and/or FCR. We further sought to construct a CAS that stratifies carotid disease severity. MATERIALS AND METHODS: Three hundred forty-four individuals from 4 imaging centers with 16%–99% carotid stenosis by duplex sonography underwent carotid MR imaging. In approximately 60% of the study sample (training group), multivariate analysis was used to determine factors associated with IPH and FCR. Statistically significant parameters identified during multivariate analysis were used to construct CAS. CAS was then applied to the remaining arteries (40%, test group), and the accuracy of classification for determining the presence versus absence of IPH or, separately, FCR was determined by ROC analysis and calculation of the AUC. RESULTS: The maximum proportion of the arterial wall occupied by the LRNC was the strongest predictor of IPH ( P < .001) and FCR ( P < .001) during multivariate analysis of the training group. The subsequently derived CAS applied to the test group was an accurate classifier of IPH (AUC = 0.91) and FCR (AUC = 0.93). Compared with MRA stenosis, CAS was a stronger classifier of both IPH and FCR. CONCLUSIONS: LRNC quantification may be an effective complementary strategy to stenosis for classifying carotid atherosclerotic disease severity. CAS forms the foundation for a simple imaging-based risk-stratification system in the carotid artery to classify severity of atherosclerotic disease. Abbreviations: AH, Anzhen Hospital • AUC, area-under-the-curve • CAS, Carotid Atherosclerosis Score • CE, contrast-enhanced • CE-MRA, contrast-enhanced MR angiography • CE-T1WI, contrast-enhanced T1-weighted imaging • CI, confidence interval • FCR, fibrous cap rupture • FSE, fast spin-echo • FSPGR, fast SPGR • FSRS, Framingham Stroke Risk Score • IMT, intima-media thickness • Inf, infinite • IPH, intraplaque hemorrhage • JV, jugular vein • LRNC, lipid-rich necrotic core • Max, maximum • MDIR, multisection double inversion recovery • Min, minimum • MRA, MR angiography • MRI, MR imaging • MSU, Michigan State University • NWI, normalized wall index • OR, odds ratio • PD, proton density • PLA, People's Liberation Army General Hospital • QIR, quadruple inversion recovery • ROC, receiver operating characteristics • SPGR, spoiled gradient-recalled echo • T1WI, T1-weighted imaging • T2WI, T2-weighted imaging • TOF, time-of-flight • TVA, total vessel area • UW, University of Washington Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Jun 1, 2010

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