Volume 53, Issue 2 pp. 613-625

Original Research

Associations Between Carotid Plaque Characteristics and Improvement of Cerebral Blood Perfusion in Patients With Moderate to Severe Carotid Stenosis Undergoing Carotid Endarterectomy

Ran Huo MD,

Ran Huo MD

orcid.org/0000-0003-3749-0253

Department of Radiology, Peking University Third Hospital, Beijing, China

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Huimin Xu MD,

Huimin Xu MD

Department of Radiology, Peking University Third Hospital, Beijing, China

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Dandan Yang MD,

Dandan Yang MD

Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

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Huiyu Qiao PhD,

Huiyu Qiao PhD

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

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Jin Li MD,

Jin Li MD

Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China

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Hualu Han BS,

Hualu Han BS

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

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Ying Liu MD,

Ying Liu MD

Department of Radiology, Peking University Third Hospital, Beijing, China

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Tao Wang MD,

Corresponding Author

Tao Wang MD

[email protected]

orcid.org/0000-0002-6454-0706

Department of Neurosurgery, Peking University Third Hospital, Beijing, China

Address reprint requests to: H.Y., Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China. E-mail: [email protected], or T.W., Department of Neurosurgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China. E-mail: [email protected]

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Huishu Yuan MD,

Corresponding Author

Huishu Yuan MD

[email protected]

orcid.org/0000-0002-5320-4360

Department of Radiology, Peking University Third Hospital, Beijing, China

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Xihai Zhao MD, PhD,

Xihai Zhao MD, PhD

orcid.org/0000-0001-8953-0566

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

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Ran Huo MD,

Ran Huo MD

orcid.org/0000-0003-3749-0253

Department of Radiology, Peking University Third Hospital, Beijing, China

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Huimin Xu MD,

Huimin Xu MD

Department of Radiology, Peking University Third Hospital, Beijing, China

Search for more papers by this author

Dandan Yang MD,

Dandan Yang MD

Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

Search for more papers by this author

Huiyu Qiao PhD,

Huiyu Qiao PhD

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

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Jin Li MD,

Jin Li MD

Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China

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Hualu Han BS,

Hualu Han BS

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

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Ying Liu MD,

Ying Liu MD

Department of Radiology, Peking University Third Hospital, Beijing, China

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Tao Wang MD,

Corresponding Author

Tao Wang MD

[email protected]

orcid.org/0000-0002-6454-0706

Department of Neurosurgery, Peking University Third Hospital, Beijing, China

Search for more papers by this author

Huishu Yuan MD,

Corresponding Author

Huishu Yuan MD

[email protected]

orcid.org/0000-0002-5320-4360

Department of Radiology, Peking University Third Hospital, Beijing, China

Search for more papers by this author

Xihai Zhao MD, PhD,

Xihai Zhao MD, PhD

orcid.org/0000-0001-8953-0566

Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

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First published: 10 October 2020

https://doi.org/10.1002/jmri.27365

Citations: 5

Dr. Huishu Yuan and Dr. Tao Wang are co-corresponding authors and have equally contributed to this study.

Contract grant sponsor: Beijing Natural Science Foundation; Contract grant number: 7192219; Contract grant sponsor: Peking University Third Hospital; Contract grant number: BYSY2015013; Contract grant sponsor: National Natural Science Foundation of China; Contract grant number: 81771825; Contract grant sponsor: Ministry of Science and Technology of China; Contract grant number: 2017YFC1307904.

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Abstract

Background

The relationship between plaque characteristics and their predictive value for perioperative cerebral blood flow (CBF) are unknown.

Purpose

To investigate the relationship between carotid plaque characteristics and perioperative CBF utilizing MRI.

Study Type

Prospective.

Population

In all, 131 patients with carotid moderate-to-severe stenosis referred for carotid endarterectomy (CEA).

Field Strength/Sequence

3T, black-blood T₁- and T₂-weighted, 3D time-of-flight, and simultaneous noncontrast angiography intraplaque hemorrhage.

Assessment

The relative CBF (rCBF = CBF_{index-hemisphere}/CBF_{contralateral-hemisphere}) and the CBF difference ratio (DR_CBF = [CBF_post-CEA – CBF_pre-CEA]/CBF_pre-CEA) in the middle cerebral artery territory were measured. The pre- and post-CEA CTP data were used as the assessment standard for CBF change. Carotid lipid-rich necrotic core (LRNC), intraplaque hemorrhage, calcification, fibrous cap rupture, maximum wall thickness, normalized wall index (NWI), and stenosis were determined.

Statistical Tests

Pearson or Spearman correlation, Mann–Whitney U-test, and linear regression.

Results

Patients with LRNC had higher rCBF_pre-CEA than those without (1.0 ± 0.1 vs. 0.9 ± 0.1, P < 0.05). NWI was weakly correlated with rCBF_pre-CEA (r = −0.213, P < 0.05) and DR_CBF (r = 0.185, P < 0.05) and marginally correlated with rCBF_post-CEA (r = 0.166, P = 0.057). LRNC was weakly correlated with rCBF_pre-CEA (r = 0.179, P < 0.05). NWI was associated with rCBF_pre-CEA (β = −0.035; 95% confidence interval [CI] [−0.064, −0.006]; P < 0.05), rCBF_post-CEA (β = 0.042; 95% CI [0.002, 0.081]; P < 0.05) and DR_CBF (β = 0.105; 95% CI [0.026, 0.185]; P < 0.05). After adjusting for confounding factors, associations of NWI with rCBF_post-CEA (β = 0.059; 95% CI [0.016, 0.103]; P < 0.05) and DR_CBF (β = 0.110; 95% CI [0.021, 0.199]; P < 0.05) remained statistically significant, while the association between NWI and rCBF_pre-CEA was no longer significant (β = −0.026; 95% CI [−0.058, 0.006]; P = 0.112).The associations of LRNC with rCBF_pre-CEA (β = 0.057; 95% CI [−0.0006, 0.114]; P = 0.052) and DR_CBF (β = −0.157; 95% CI [−0.314, 0.001]; P = 0.051) were close to statistical significance. After adjusting for confounding factors, these associations were statistically significant (of LRNC vs. rCBF_pre-CEA: β = 0.060; 95% CI [0.003, 0.118]; P < 0.05; LRNC vs. DR_CBF: β = −0.205; 95% CI [−0.375, −0.036]; P < 0.05).

Data Conclusion

Carotid plaque burden and components, particularly LRNC, might be effective indicators for CBF change following CEA.

Level of Evidence 1

Technical Efficacy Stage 5

Supporting Information

References

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Citing Literature

Volume53, Issue2

February 2021

Pages 613-625

Associations Between Carotid Plaque Characteristics and Improvement of Cerebral Blood Perfusion in Patients With Moderate to Severe Carotid Stenosis Undergoing Carotid Endarterectomy

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Supporting Information

References

Citing Literature

References

Information

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Associations Between Carotid Plaque Characteristics and Improvement of Cerebral Blood Perfusion in Patients With Moderate to Severe Carotid Stenosis Undergoing Carotid Endarterectomy

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Supporting Information

References

Citing Literature

References

Related

Information