Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medical Imaging
Published in: BMC Medical Imaging 1/2010

Open Access 01-12-2010 | Research article

MRI plaque imaging reveals high-risk carotid plaques especially in diabetic patients irrespective of the degree of stenosis

Authors: L Esposito, T Saam, P Heider, Angelina Bockelbrink, Jaroslav Pelisek, D Sepp, R Feurer, C Winkler, T Liebig, K Holzer, O Pauly, S Sadikovic, B Hemmer, H Poppert

Published in: BMC Medical Imaging | Issue 1/2010

Login to get access

Abstract

Background

Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics.

Methods

191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available.

Results

Eleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis.

Conclusion

DM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients.
See Commentary: http://​www.​biomedcentral.​com/​1741-7015/​8/​78/​abstract
Appendix
Available only for authorised users
Literature
1.
Crouse JR: Thematic review series: patient-oriented research. Imaging atherosclerosis: state of the art. J Lipid Res. 2006, 47 (8): 1677-1699. 10.1194/jlr.R600012-JLR200.CrossRefPubMed
2.
3.
Saam T, Hatsukami TS, Takaya N, Chu B, Underhill H, Kerwin WS, Cai J, Ferguson MS, Yuan C: The vulnerable, or high-risk, atherosclerotic plaque: noninvasive MR imaging for characterization and assessment. Radiology. 2007, 244 (1): 64-77. 10.1148/radiol.2441051769.CrossRefPubMed
4.
Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL, Yuan C: Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation. 2002, 106 (11): 1368-1373. 10.1161/01.CIR.0000028591.44554.F9.CrossRefPubMed
5.
Lusby RJ, Ferrell LD, Ehrenfeld WK, Stoney RJ, Wylie EJ: Carotid plaque hemorrhage. Its role in production of cerebral ischemia. Arch Surg. 1982, 117 (11): 1479-1488.CrossRefPubMed
6.
Virmani R, Kolodgie FD, Burke AP, Finn AV, Gold HK, Tulenko TN, Wrenn SP, Narula J: Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arterioscler Thromb Vasc Biol. 2005, 25 (10): 2054-2061. 10.1161/01.ATV.0000178991.71605.18.CrossRefPubMed
7.
Mofidi R, Crotty TB, McCarthy P, Sheehan SJ, Mehigan D, Keaveny TV: Association between plaque instability, angiogenesis and symptomatic carotid occlusive disease. Br J Surg. 2001, 88 (7): 945-950. 10.1046/j.0007-1323.2001.01823.x.CrossRefPubMed
8.
Falk E: Why do plaques rupture?. Circulation. 1992, 86 (6 Suppl): III30-42.PubMed
9.
Carr S, Farb A, Pearce WH, Virmani R, Yao JS: Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. J Vasc Surg. 1996, 23 (5): 755-765. 10.1016/S0741-5214(96)70237-9. discussion 765-756CrossRefPubMed
10.
Bassiouny HS, Sakaguchi Y, Mikucki SA, McKinsey JF, Piano G, Gewertz BL, Glagov S: Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. J Vasc Surg. 1997, 26 (4): 585-594. 10.1016/S0741-5214(97)70056-9.CrossRefPubMed
11.
Chu B, Kampschulte A, Ferguson MS, Kerwin WS, Yarnykh VL, O'Brien KD, Polissar NL, Hatsukami TS, Yuan C: Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke. 2004, 35 (5): 1079-1084. 10.1161/01.STR.0000125856.25309.86.CrossRefPubMed
12.
Yuan C, Zhang SX, Polissar NL, Echelard D, Ortiz G, Davis JW, Ellington E, Ferguson MS, Hatsukami TS: Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation. 2002, 105 (2): 181-185. 10.1161/hc0202.102121.CrossRefPubMed
13.
Hatsukami TS, Ross R, Polissar NL, Yuan C: Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation. 2000, 102 (9): 959-964.CrossRefPubMed
14.
Mitsumori LM, Hatsukami TS, Ferguson MS, Kerwin WS, Cai J, Yuan C: In vivo accuracy of multisequence MR imaging for identifying unstable fibrous caps in advanced human carotid plaques. J Magn Reson Imaging. 2003, 17 (4): 410-420. 10.1002/jmri.10264.CrossRefPubMed
15.
Yuan C, Mitsumori LM, Ferguson MS, Polissar NL, Echelard D, Ortiz G, Small R, Davies JW, Kerwin WS, Hatsukami TS: In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. Circulation. 2001, 104 (17): 2051-2056. 10.1161/hc4201.097839.CrossRefPubMed
16.
Esposito L, Sievers M, Sander D, Heider P, Wolf O, Greil O, Zimmer C, Poppert H: Detection of unstable carotid artery stenosis using MRI. J Neurol. 2007, 254 (12): 1714-1722. 10.1007/s00415-007-0634-4.CrossRefPubMed
17.
Henry RM, Kostense PJ, Dekker JM, Nijpels G, Heine RJ, Kamp O, Bouter LM, Stehouwer CD: Carotid Arterial Remodeling. A Maladaptive Phenomenon in Type 2 Diabetes but Not in Impaired Glucose Metabolism: The Hoorn Study. Stroke. 2004, 35 (3): 671-676. 10.1161/01.STR.0000115752.58601.0B.CrossRefPubMed
18.
Moreno PR, Fuster V: New aspects in the pathogenesis of diabetic atherothrombosis. J Am Coll Cardiol. 2004, 44 (12): 2293-2300. 10.1016/j.jacc.2004.07.060.CrossRefPubMed
19.
Idris I, Thomson GA, Sharma JC: Diabetes mellitus and stroke. Int J Clin Pract. 2006, 60 (1): 48-56. 10.1111/j.1368-5031.2006.00682.x.CrossRefPubMed
20.
Kang SS, Littooy FN, Gupta SR, Johnson GR, Fisher SG, Cote WL, Steffen GF, Mansour MA, Labropoulos N, Maggio JC: Higher prevalence of abdominal aortic aneurysms in patients with carotid stenosis but without diabetes. Surgery. 1999, 126 (4): 687-691. discussion 691-682CrossRefPubMed
21.
Rozenman Y, Sapoznikov D, Mosseri M, Gilon D, Lotan C, Nassar H, Weiss AT, Hasin Y, Gotsman MS: Long-term angiographic follow-up of coronary balloon angioplasty in patients with diabetes mellitus: a clue to the explanation of the results of the BARI study. Balloon Angioplasty Revascularization Investigation. J Am Coll Cardiol. 1997, 30 (6): 1420-1425. 10.1016/S0735-1097(97)00342-2.CrossRefPubMed
22.
Levine GN, Jacobs AK, Keeler GP, Whitlow PL, Berdan LG, Leya F, Topol EJ, Califf RM: Impact of diabetes mellitus on percutaneous revascularization (CAVEAT-I). CAVEAT-I Investigators. Coronary Angioplasty Versus Excisional Atherectomy Trial. Am J Cardiol. 1997, 79 (6): 748-755. 10.1016/S0002-9149(96)00862-4.CrossRefPubMed
23.
Luscher TF, Creager MA, Beckman JA, Cosentino F: Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part II. Circulation. 2003, 108 (13): 1655-1661. 10.1161/01.CIR.0000089189.70578.E2.CrossRefPubMed
24.
Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katanick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler RE: Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003, 229 (2): 340-346. 10.1148/radiol.2292030516.CrossRefPubMed
25.
SPACE Collaborative Group, Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Stingele R, Zeumer H, Hacke W: 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006, 368 (9543): 1239-1247. 10.1016/S0140-6736(06)69122-8.CrossRef
26.
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991, 325 (7): 445-453. 10.1056/NEJM199108153250701.
27.
Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998, 351 (9113): 1379-1387. 10.1016/S0140-6736(97)09292-1.
28.
Wolf O, Heider P, Heinz M, Poppert H, Schmidt-Thieme T, Sander D, Grafin von Einsiedel H, Brandl R: Frequency, clinical significance and course of cerebral ischemic events after carotid endarterectomy evaluated by serial diffusion weighted imaging. Eur J Vasc Endovasc Surg. 2004, 27 (2): 167-171. 10.1016/j.ejvs.2003.11.002.CrossRefPubMed
29.
Wolf O, Heider P, Heinz M, Poppert H, Sander D, Greil O, Weiss W, Hanke M, Eckstein HH: Microembolic signals detected by transcranial Doppler sonography during carotid endarterectomy and correlation with serial diffusion-weighted imaging. Stroke. 2004, 35 (11): e373-375. 10.1161/01.STR.0000143184.69343.ec.CrossRefPubMed
30.
Poppert H, Wilhelm T, Resch M, Theiss W, Brandl R, Winbeck K, Conrad B, Sander D: Differences in number and location of microembolic ischemic lesions after percutaneous transluminal angioplasty and operative thrombendarterectomy. Journal of Neurology. 2001, 248 (suppl 2): II/18-
31.
Stary HC, Chandler AB, Glagov S, Guyton JR, Insull W, Rosenfeld ME, Schaffer SA, Schwartz CJ, Wagner WD, Wissler RW: A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Arterioscler Thromb. 1994, 14 (5): 840-856.CrossRefPubMed
32.
Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W, Rosenfeld ME, Schwartz CJ, Wagner WD, Wissler RW: A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995, 92 (5): 1355-1374.CrossRefPubMed
33.
Moreno PR, Murcia AM, Palacios IF, Leon MN, Bernardi VH, Fuster V, Fallon JT: Coronary composition and macrophage infiltration in atherectomy specimens from patients with diabetes mellitus. Circulation. 2000, 102 (18): 2180-2184.CrossRefPubMed
34.
Di Mario U, Pugliese G: 15th Golgi lecture: from hyperglycaemia to the dysregulation of vascular remodelling in diabetes. Diabetologia. 2001, 44 (6): 674-692. 10.1007/s001250051676.CrossRefPubMed
35.
Wasserman BA, Sharrett AR, Lai S, Gomes AS, Cushman M, Folsom AR, Bild DE, Kronmal RA, Sinha S, Bluemke DA: Risk factor associations with the presence of a lipid core in carotid plaque of asymptomatic individuals using high-resolution MRI: the multi-ethnic study of atherosclerosis (MESA). Stroke. 2008, 39 (2): 329-335. 10.1161/STROKEAHA.107.498634.CrossRefPubMed
36.
Takaya N, Yuan C, Chu B, Saam T, Underhill H, Cai J, Tran N, Polissar NL, Isaac C, Ferguson MS, Garden GA, Cramer SC, Maravilla KR, Hashimoto B, Hatsukami TS: Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI--initial results. Stroke. 2006, 37 (3): 818-823. 10.1161/01.STR.0000204638.91099.91.CrossRefPubMed
37.
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995, 273 (18): 1421-1428. 10.1001/jama.273.18.1421.
38.
Mathur A, Roubin GS, Iyer SS, Piamsonboon C, Liu MW, Gomez CR, Yadav JS, Chastain HD, Fox LM, Dean LS, Vitek JJ: Predictors of stroke complicating carotid artery stenting. Circulation. 1998, 97 (13): 1239-1245.CrossRefPubMed
39.
Qureshi AI, Luft AR, Janardhan V, Suri MF, Sharma M, Lanzino G, Wakhloo AK, Guterman LR, Hopkins LN: Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting. Stroke. 2000, 31 (2): 376-382.CrossRefPubMed
Metadata
Title
MRI plaque imaging reveals high-risk carotid plaques especially in diabetic patients irrespective of the degree of stenosis
Authors
L Esposito
T Saam
P Heider
Angelina Bockelbrink
Jaroslav Pelisek
D Sepp
R Feurer
C Winkler
T Liebig
K Holzer
O Pauly
S Sadikovic
B Hemmer
H Poppert
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2010
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/1471-2342-10-27

Other articles of this Issue 1/2010

BMC Medical Imaging 1/2010 Go to the issue

Research article

Radiation Exposure from CT Examinations in Japan

Case report

Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of accompanying SPECT/CT - a case report

Research article

Texture analysis of MR images of patients with Mild Traumatic Brain Injury

Software

An open-source software tool for the generation of relaxation time maps in magnetic resonance imaging

Technical advance

Automatic colorimetric calibration of human wounds

Research article

Reliability of computed tomography measurements in assessment of thigh muscle cross-sectional area and attenuation