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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29:1696.)
© 2009 American Heart Association, Inc.

Clinical and Population Studies

Hemorrhage and Large Lipid-Rich Necrotic Cores Are Independently Associated With Thin or Ruptured Fibrous Caps

An In vivo 3T MRI Study

Hideki Ota; Wei Yu; Hunter R. Underhill; Minako Oikawa; Li Dong; Xihai Zhao; Nayak L. Polissar; Blazej Neradilek; Tianli Gao; Zhuo Zhang; Zixu Yan; Miao Guo; Zhaoqi Zhang; Thomas S. Hatsukami; Chun Yuan

From the Departments of Radiology (H.O., H.R.U., M.O., L.D., X.Z., C.Y.) and Surgery (T.S.H.), University of Washington, Seattle; the Department of Radiology (H.O.), Michigan State University, East Lansing; the Departments of Radiology (W.Y., Z.Y., M.G., Zhaoqi Z.) and Neurology (T.G., Zhuo Z.), the Beijing Anzhen Hospital, Capital Medical University, Beijing China; and Mountain-Whisper-Light Statistical Consulting (N.L.P., B.N.), Seattle, Wash.

Correspondence to Chun Yuan, PhD, Vascular Imaging Laboratory, 815 Mercer St, Box 358050, Room 124, Seattle, WA 98109. E-mail cyuan{at}u.washington.edu

Objective— Histological studies suggest associations between hemorrhage and large lipid-rich/necrotic cores with thin or ruptured fibrous caps in advanced atherosclerosis. We investigated these associations in carotid arteries with mild to severe stenosis by in vivo 3T MRI.

Methods and Results— Seventy-seven patients with 50% carotid stenosis in at least one side by duplex ultrasound underwent bilateral multi-contrast carotid MRI scans. Measurements for wall and lipid-rich/necrotic core sizes, presence of hemorrhage, and fibrous cap status (classified as intact thick, intact thin or ruptured) were recorded. Arteries with poor image quality, occlusion, or no detectable lipid-rich/necrotic core were excluded. For the 798 MRI slices included, multivariate ordinal regression analysis demonstrated larger %lipid-rich/necrotic core (odds ratio for 10% increase, 1.49; P=0.02) and presence of hemorrhage (odds ratio, 5.91; P<0.001) were independently associated with a worse (intact thin or ruptured) stage of fibrous cap status. For artery-based multivariate analysis, a larger maximum %lipid-rich/necrotic core and presence of hemorrhage independently associated with worse fibrous cap status (P<0.001, for both). No hemorrhage was detected in arteries with thick fibrous caps.

Conclusion— Hemorrhage and larger %lipid-rich/necrotic core were independently associated with a thin or ruptured fibrous cap status at an early to advanced stage of carotid atherosclerosis.

We investigated associations of lipid-rich/necrotic core size and hemorrhage with fibrous cap status for carotid arteries with mild to severe stenosis by in vivo 3T MRI. For slice-based and artery-based multivariate analyses, larger %lipid-rich/necrotic core and presence of hemorrhage were independently associated with thin or ruptured fibrous caps.

Key Words: MRI • carotid artery • fibrous cap rupture • hemorrhage • lipid-rich necrotic core