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Eisenmenger LB, Spahic A, McNally JS, Johnson KM, Song JW, Junn JC. MR Imaging for Intracranial Vessel Wall Imaging: Pearls and Pitfalls. Magn Reson Imaging Clin N Am 2023; 31:461-474. [PMID: 37414472 DOI: 10.1016/j.mric.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Conventional vascular imaging methods have primarily focused on evaluating the vascular lumen. However, these techniques are not intended to evaluate vessel wall abnormalities where many cerebrovascular pathologies reside. With increased interest for the visualization and study of the vessel wall, high-resolution vessel wall imaging (VWI) has gained traction.Over the past two decades, there has been a rapid increase in number of VWI publications with improvements in imaging techniques and expansion on clinical applications. With increasing utility and interest in VWI, application of proper protocols and understanding imaging characteristics of vasculopathies are important for the interpreting radiologists to understand.
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Affiliation(s)
- Laura B Eisenmenger
- University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA.
| | - Alma Spahic
- University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | | | - Kevin M Johnson
- University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Jae W Song
- University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jacqueline C Junn
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1234, New York City, NY 10029, USA
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Peret A, Romero-Sanchez G, Dabiri M, McNally JS, Johnson KM, Mossa-Basha M, Eisenmenger LB. MR Angiography of Extracranial Carotid Disease. Magn Reson Imaging Clin N Am 2023; 31:395-411. [PMID: 37414468 DOI: 10.1016/j.mric.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Magnetic resonance angiography sequences, such as time-of-flight and contrast-enhanced angiography, provide clear depiction of vessel lumen, traditionally used to evaluate carotid pathologic conditions such as stenosis, dissection, and occlusion; however, atherosclerotic plaques with a similar degree of stenosis may vary tremendously from a histopathological standpoint. MR vessel wall imaging is a promising noninvasive method to evaluate the content of the vessel wall at high spatial resolution. This is particularly interesting in the case of atherosclerosis as vessel wall imaging can identify higher risk, vulnerable plaques as well as has potential applications in the evaluation of other carotid pathologic conditions.
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Affiliation(s)
- Anthony Peret
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Ciudad de México, Mexico City, Mexico
| | - Mona Dabiri
- Radiology Department, Children's Medical Center, Tehran University of Medical Science, No 63, Gharib Avenue, Keshavarz Blv, Tehran 1419733151, Iran
| | - Joseph Scott McNally
- Department of Radiology, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA.
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de Havenon A, Orlando C, Delic A, McNally JS, Majersik JJ, Harman T, Alexander M, Reddy V, Lyden S, Anzai Y. Direct cost analysis of rapid MRI in the emergency department evaluation of patients suspected of having acute ischemic stroke*. Neuroradiol J 2023; 36:142-147. [PMID: 35701745 PMCID: PMC10034695 DOI: 10.1177/19714009221108681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Abbreviated "rapid MRI" protocols have become more common for the evaluation of acute ischemic stroke (AIS). Prior research has not evaluated the effect of rapid MRIs on cost or hospital length of stay in AIS patients. METHODS We retrospectively identified AIS patients who presented within 6 h of acute neurologic symptom onset to an emergency department (ED) and activated a "brain attack" code. We included sequential patients from January 2012 to September 2015, before rapid MRI was available, who had CT perfusion (CTP) and compared them to patients from October 2015 to May 2018 who had a rapid MRI. We used inverse-probability-weighting (IPW) to balance the cohorts. The primary outcomes were direct cost to our healthcare system and total hospital length of stay (LOS). RESULTS We included 408 brain attack activations (mean ± SD age 62.1 ± 17.6 years, 47.8% male): 257 in the CTP cohort and 151 in the MRI cohort. Discharge diagnosis was ischemic stroke in 193/408 (47.3%). After patient matching, we found significant reductions for the MRI cohort in total cost (-18.7%, 95% CI -35.0, -2.4, p = 0.02) and hospital LOS (-17.0%, 95% CI -31.2, -2.8, p = 0.02), with no difference in ED LOS (p = 0.74) as compared to the CTP cohort. CONCLUSION Although these results are preliminary and hypothesis-generating, we found that the use of a rapid MRI protocol in emergency department brain attacks was associated with a 18.7% reduction in total direct cost and 17% reduction in hospital length of stay.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Chris Orlando
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Alen Delic
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Tyler Harman
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Matthew Alexander
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Vivek Reddy
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stephanie Lyden
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Yoshimi Anzai
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
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Culleton S, Baradaran H, Kim SE, Stoddard G, Roberts J, Treiman G, Parker D, Duff K, McNally JS. MRI Detection of Carotid Intraplaque Hemorrhage and Postintervention Cognition. AJNR Am J Neuroradiol 2022; 43:1762-1769. [PMID: 36357151 DOI: 10.3174/ajnr.a7701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/01/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive improvement has been reported after carotid revascularization and attributed to treating stenosis and correcting hypoperfusion. This study investigated the effect of carotid intraplaque hemorrhage on postintervention cognition. MATERIALS AND METHODS In this institutional review board-approved single-center study, consecutive patients scheduled for carotid surgery were recruited for preoperative carotid MR imaging (MPRAGE) and pre- and postintervention cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status. Pre- and postintervention scores were compared using t tests and multivariable linear regression. RESULTS Twenty-three participants were included, with endarterectomy performed in 20 (87%) and angioplasty/stent placement, in 3 (13%). Overall, statistically significant improvements occurred in the pre- versus postintervention mean Total Scale score (92.1 [SD, 15.5] versus 96.1 [SD, 15.8], P = .04), immediate memory index (89.4 [SD, 18.2] versus 97.7 [SD, 14.9], P < .001), and verbal index (96.1 [SD, 14.1] versus 103.0 [SD, 12.0], P = .002). Intraplaque hemorrhage (+) participants (n = 11) had no significant improvement in any category, and the attention index significantly decreased (99.4 [SD, 18.0] versus 93.5 [SD, 19.4], P = .045). Intraplaque hemorrhage (-) participants (n = 12) significantly improved in the Total Scale score (86.4 [SD, 11.8] versus 95.5 [SD, 12.4], P = .004), immediate memory index (82.3 [SD, 14.6] versus 96.2 [SD, 14.1], P = .002), delayed memory index (94.3 [SD, 14.9] versus 102.4 [SD, 8.0], P = .03), and verbal index (94.3 [SD, 13.2] versus 101.5 [SD, 107.4], P = .009). Postintervention minus preintervention scores for intraplaque hemorrhage (+) versus (-) groups showed statistically significant differences in the Total Scale score (-0.4 [SD, 6.8] versus 8.0 [SD, 8.5], P = .02), attention index (-5.9 [SD, 8.5] versus 4.3 [SD, 11.9], P = .03), and immediate memory index (4.2 [SD, 6.7] versus 12.2 [SD, 10.2], P = .04). CONCLUSIONS Cognitive improvement was observed after carotid intervention, and this was attributable to intraplaque hemorrhage (-) plaque. MR imaging detection of intraplaque hemorrhage status may be an important determinant of cognitive change after intervention.
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Affiliation(s)
- S Culleton
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - H Baradaran
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - S-E Kim
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - G Stoddard
- Utah Center for Advanced Imaging Research, Division of Epidemiology (G.S.)
| | - J Roberts
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - G Treiman
- Department of Internal Medicine, Department of Surgery (G.T.)
| | - D Parker
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - K Duff
- Center for Alzheimer's Care, Imaging and Research (K.D.), University of Utah, Salt Lake City, Utah
| | - J S McNally
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
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Hoshina Y, Galli J, Wong KH, Kovacsovics T, Steinbach M, Salzman KL, McNally JS, Lancaster E, Paz Soldán MM, Clardy SL. GABA-A Receptor Encephalitis After Autologous Hematopoietic Stem Cell Transplant forMultiple Myeloma. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/6/e200024. [PMID: 36028311 PMCID: PMC9417160 DOI: 10.1212/nxi.0000000000200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022]
Abstract
Background and Objectives The relationship between autologous hematopoietic stem cell transplant (aHSCT) for multiple myeloma (MM) and anti-GABAA receptor (GABAAR) encephalitis is unknown. We aimed to describe the clinical features, diagnostic process, and outcome of 3 cases of anti-GABAAR encephalitis in patients with a history of prior aHSCT for MM. Methods A case series of 3 patients. Anti-GABAAR antibody was tested at the University of Pennsylvania Laboratory. Results The patients were all male, aged 52 (case 1), 61 (case 2), and 62 (case 3) years at encephalitis symptom onset. The duration between completion of aHSCT and the onset of encephalitis was 43, 18, and 9 months, respectively. All 3 patients presented with new seizures and altered cognitive function. Other symptoms included headache and visual obscurations in cases 1 and 2 and intractable vertigo and mania in case 3. Brain MRI demonstrated nonenhancing multifocal T2-weighted/fluid-attenuated inversion recovery cortical and subcortical hyperintensities in all 3 patients. Cases 2 and 3 underwent brain biopsy before initiating immunomodulatory therapy, which demonstrated nonspecific encephalitis with astrogliosis in the white matter; these 2 patients were started on immunotherapy for the treatment of anti-GABAAR encephalitis after 22 days and 3 months, respectively, from the first presentation. Case 1 was started on empiric immunotherapy within 8 days of presentation without requiring brain biopsy, given characteristic MRI imaging. CSF analysis demonstrated the presence of anti-GABAAR antibodies in all 3 cases. Cases 1 and 3 also tested positive for anti-GABAAR antibodies in the serum (serum test was not performed in case 2). Cases 1 and 2 recovered to work full-time within 1 year. Case 3 reported occasional myoclonic-like movement. Discussion We highlight the importance of considering anti-GABAAR encephalitis in patients with seizures, multifocal nonenhancing brain lesions, and a history of aHSCT for MM. Awareness in recovered post-aHSCT patients with MM may be crucial because prompt recognition can avoid brain biopsy and delays in treatment. The rapid initiation of immunotherapy while awaiting autoantibody results will likely improve functional outcomes.
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Affiliation(s)
- Yoji Hoshina
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Jonathan Galli
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Ka-Ho Wong
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Tibor Kovacsovics
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Mary Steinbach
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Karen L Salzman
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Joseph Scott McNally
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Eric Lancaster
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - M Mateo Paz Soldán
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia
| | - Stacey L Clardy
- From the Department of Neurology (Y.H., J.G., K.-H.W., M.M.P.S., S.L.C.), University of Utah Health; Department of Neurology (J.G., M.M.P.S., S.L.C.), Veterans Affairs Medical Center, UT; Division of Hematology and Hematologic Malignancies (T.K., M.S.), Huntsman Cancer Institute, University of Utah Health; Department of Radiology and Imaging Sciences (K.L.S., J.S.M.), University of Utah Health; and Department of Neurology (E.L.), University of Pennsylvania, Philadelphia.
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Culleton S, Wiggins R, McNally JS. Imaging spectrum of extracranial arterial vascular pathology: pearls for the radiologist. Clin Radiol 2021; 77:167-178. [PMID: 34799048 DOI: 10.1016/j.crad.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022]
Abstract
Non-invasive imaging plays an increasingly important role in assessing the extracranial vasculature. The applications of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) continue to expand with growing demand for stroke imaging and anatomical assessment preceding vascular intervention. Imaging of the neck is performed for a variety of clinical indications with different imaging protocols. Even on non-dedicated vascular imaging, such as soft-tissue studies, the neck vessels and the proximal aortic arch are readily evaluable, providing an opportunity to promptly identify critical vascular abnormalities with significant therapeutic implications. Vascular abnormalities can have non-specific clinical signs and symptoms resulting in delays in both diagnosis and treatment. Understanding the common locations and appearances of vascular pathologies will help the radiologist to develop a systematic search strategy for evaluating neck imaging. Not only is identifying the pathology of paramount importance but also understanding how imaging further prognosticates and determines treatment options. As imaging techniques advance, further vascular radiological features are recognised with therapeutic implications, particularly for stroke. Such features include plaque morphology and vulnerability with imaging helping to identify those at high risk of stroke and recurrent strokes. Using clinical cases from a quaternary care academic medical centre a spectrum of clinically relevant arterial pathologies and associated features that could add further benefit to the radiology report are illustrated. A suggested systematic approach to evaluating the vasculature on neck imaging is also presented.
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Affiliation(s)
- S Culleton
- Department of Radiology, University of Utah Health Sciences Centre, Salt Lake City, UT, USA.
| | - R Wiggins
- Department of Radiology, University of Utah Health Sciences Centre, Salt Lake City, UT, USA
| | - J S McNally
- Department of Radiology, University of Utah Health Sciences Centre, Salt Lake City, UT, USA
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Huang HY, Shah LM, McNally JS, Sant T, Hutchins TA, Goldstein ED, Peckham ME. COVID-19-Associated Myelitis Involving the Dorsal and Lateral White Matter Tracts: A Case Series and Review of the Literature. AJNR Am J Neuroradiol 2021; 42:1912-1917. [PMID: 34413066 DOI: 10.3174/ajnr.a7256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/30/2021] [Indexed: 11/07/2022]
Abstract
Coronavirus disease 2019 (COVID-19) myelitis is a rare condition, most commonly presenting with nonenhancing central expansile cord T2 signal changes. A single case report has also described longitudinal involvement of the dorsal columns. We present 5 cases of COVID-19-associated myelitis with tract-specific involvement of the dorsal and lateral columns and discuss potential pathophysiologic pathways for this unique pattern.
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Affiliation(s)
- H Y Huang
- From the Department of Neurology (H.Y.H., E.D.G.), University of Utah, Salt Lake City, Utah
| | - L M Shah
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
| | - J S McNally
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
| | - T Sant
- School of Medicine (T.S.), University of Utah, Salt Lake City, Utah
| | - T A Hutchins
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
| | - E D Goldstein
- From the Department of Neurology (H.Y.H., E.D.G.), University of Utah, Salt Lake City, Utah
| | - M E Peckham
- Departments of Radiology and Imaging Sciences (L.M.S., J.S.M., T.A.H., M.E.P.), University of Utah, Salt Lake City, Utah
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McNally JS, Sakata A, Alexander MD, Dewitt LD, Sonnen JA, Menacho ST, Stoddard GJ, Kim SE, de Havenon AH. Vessel Wall Enhancement on Black-Blood MRI Predicts Acute and Future Stroke in Cerebral Amyloid Angiopathy. AJNR Am J Neuroradiol 2021; 42:1038-1045. [PMID: 33737266 DOI: 10.3174/ajnr.a7047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral amyloid angiopathy (CAA) is a known risk factor for ischemic stroke though angiographic imaging is often negative. Our goal was to determine the relationship between vessel wall enhancement (VWE) in acute and future ischemic stroke in CAA patients. MATERIALS AND METHODS This was a retrospective study of patients with new-onset neurologic symptoms undergoing 3T vessel wall MR imaging from 2015 to 2019. Vessel wall enhancement was detected on pre- and postcontrast flow-suppressed 3D T1WI. Interrater agreement was evaluated in cerebral amyloid angiopathy-positive and age-matched negative participants using a prevalence- and bias-adjusted kappa analysis. In patients with cerebral amyloid angiopathy, multivariable Poisson and Cox regression were used to determine the association of vessel wall enhancement with acute and future ischemic stroke, respectively, using backward elimination of confounders to P < .20. RESULTS Fifty patients with cerebral amyloid angiopathy underwent vessel wall MR imaging, including 35/50 (70.0%) with ischemic stroke and 29/50 (58.0%) with vessel wall enhancement. Prevalence- and bias-corrected kappa was 0.82 (95% CI, 0.71-0.93). The final regression model for acute ischemic stroke included vessel wall enhancement (prevalence ratio = 1.5; 95% CI, 1.1-2.2; P = .022), age (prevalence ratio = 1.02; 95% CI, 1.0-1.05; P = .036), time between symptoms and MR imaging (prevalence ratio = 0.9; 95% CI, 0.8-0.9; P < .001), and smoking (prevalence ratio = 0.7; 95% CI, 0.5-1.0; P = .042) with c-statistic = 0.92 (95% CI, 0.84-0.99). Future ischemic stroke incidence with cerebral amyloid angiopathy was 49.7% (95% CI, 34.5%-67.2%) per year over a total time at risk of 37.5 person-years. Vessel wall enhancement-positive patients with cerebral amyloid angiopathy demonstrated significantly shorter stroke-free survival with 63.9% (95% CI, 43.2%-84.0%) versus 32.2% (95% CI, 14.4%-62.3%) ischemic strokes per year, chi-square = 4.9, P = .027. The final model for future ischemic stroke had a c-statistic of 0.70 and included initial ischemic stroke (hazard ratio = 3.4; 95% CI, 1.0-12.0; P = .053) and vessel wall enhancement (hazard ratio = 2.5; 95% CI, 0.9-7.0; P = .080). CONCLUSIONS Vessel wall enhancement is associated with both acute and future stroke in patients with cerebral amyloid angiopathy.
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Affiliation(s)
- J S McNally
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - A Sakata
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - M D Alexander
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - L D Dewitt
- Department of Pathology (J.A.S.), University of Utah, Salt Lake City, Utah
| | - J A Sonnen
- Department of Pathology (J.A.S.), University of Utah, Salt Lake City, Utah
| | - S T Menacho
- Department of Neurosurgery (S.T.M.), University of Utah, Salt Lake City, Utah
| | - G J Stoddard
- Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City, Utah
| | - S-E Kim
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - A H de Havenon
- Department of Neurology (L.D.D., A.H.d.H.), University of Utah, Salt Lake City, Utah
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Baradaran H, Eisenmenger LB, Hinckley PJ, de Havenon AH, Stoddard GJ, Treiman LS, Treiman GS, Parker DL, Scott McNally J. Optimal Carotid Plaque Features on Computed Tomography Angiography Associated With Ischemic Stroke. J Am Heart Assoc 2021; 10:e019462. [PMID: 33586471 PMCID: PMC8174260 DOI: 10.1161/jaha.120.019462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Stenosis has historically been the major factor used to determine carotid stroke sources. Recent evidence suggests that specific plaque features detected on imaging may be more highly associated with ischemic stroke than stenosis. We sought to determine computed tomography angiography (CTA) imaging features of carotid plaque that optimally discriminate ipsilateral stroke sources. Methods and Results In this institutional review board-approved retrospective cross-sectional study, 494 ipsilateral carotid CTA-brain magnetic resonance imaging pairs were available for analysis after excluding patients with alternative stroke sources. Carotid CTA and clinical markers were recorded, a multivariable Poisson regression model was fitted, and backward elimination was performed with a 2-sided threshold of P<0.10. Discriminatory value was determined using receiver operating characteristic analysis, area under the curve, and bootstrap validation. The final CTA carotid-source stroke prediction model included intraluminal thrombus (prevalence ratio, 2.8 [P<0.001]; 95% CI, 1.6-4.9), maximum soft plaque thickness (prevalence ratio, 1.2 [P<0.001]; 95% CI, 1.1-1.4), and the rim sign (prevalence ratio, 2.0 [P=0.007]; 95% CI, 1.2-3.3). The final discriminatory value (area under the curve=78.3%) was higher than intraluminal thrombus (56.4%, P<0.001), maximum soft plaque thickness (76.4%, P=0.007), or rim sign alone (69.9%, P=0.001). Furthermore, NASCET (North American Symptomatic Carotid Endarterectomy Trial) stenosis categories (cutoffs of 50% and 70%) had lower stroke discrimination (area under the curve=67.4%, P<0.001). Conclusions Optimal discrimination of ipsilateral carotid sources of stroke requires information on intraluminal thrombus, maximum soft plaque thickness, and the rim sign. These results argue against the sole use of carotid stenosis to determine stroke sources on CTA, and instead suggest these alternative markers may better diagnose vulnerable carotid plaque and guide treatment decisions.
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Affiliation(s)
- Hediyeh Baradaran
- Department of RadiologyUtah Center for Advanced Imaging ResearchSalt Lake CityUT
| | - Laura B. Eisenmenger
- Department of RadiologyUtah Center for Advanced Imaging ResearchSalt Lake CityUT
| | - Peter J. Hinckley
- Department of RadiologyUtah Center for Advanced Imaging ResearchSalt Lake CityUT
| | | | | | - Lauren S. Treiman
- Department of RadiologyUtah Center for Advanced Imaging ResearchSalt Lake CityUT
| | - Gerald S. Treiman
- Department of RadiologyUtah Center for Advanced Imaging ResearchSalt Lake CityUT
| | - Dennis L. Parker
- Department of RadiologyUtah Center for Advanced Imaging ResearchSalt Lake CityUT
| | - Joseph Scott McNally
- Department of RadiologyUtah Center for Advanced Imaging ResearchSalt Lake CityUT
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Alexander MD, de Havenon A, Mossa-Basha M, McNally JS. How Far Can We Take Vessel Wall MRI for Intracranial Atherosclerosis? The Tissue is Still the Issue. AJNR Am J Neuroradiol 2020; 41:E30-E31. [PMID: 32354713 DOI: 10.3174/ajnr.a6501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M D Alexander
- Departments of Radiology and Imaging Sciences and Neurosurgery
| | - A de Havenon
- Department of NeurologyUniversity of UtahSalt Lake City, Utah
| | - M Mossa-Basha
- Department of RadiologyUniversity of WashingtonSeattle, Washington
| | - J S McNally
- Departments of Radiology and Imaging SciencesUniversity of UtahSalt Lake City, Utah
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11
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de Havenon A, Muhina HJ, Parker DL, McNally JS, Alexander MD. Effect of Time Elapsed since Gadolinium Administration on Atherosclerotic Plaque Enhancement in Clinical Vessel Wall MR Imaging Studies. AJNR Am J Neuroradiol 2019; 40:1709-1711. [PMID: 31515211 DOI: 10.3174/ajnr.a6191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/17/2019] [Indexed: 11/07/2022]
Abstract
Vessel wall MR imaging is a useful tool for the evaluation of intracranial atherosclerotic disease. Enhancement can be particularly instructive. This study investigated the impact of the duration between contrast administration and image acquisition. The cohort with the longest duration had the greatest increase in signal intensity change. When using vessel wall MR imaging to assess intracranial atherosclerotic disease, protocols should be designed to maximize the duration between contrast administration and image acquisition to best demonstrate enhancement.
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Affiliation(s)
| | - H J Muhina
- the School of Medicine(H.J.M.), University of Utah, Salt Lake City, Utah
| | - D L Parker
- From the Departments of Radiology and Imaging Sciences (M.D.A., D.L.P., J.S.M.)
| | - J S McNally
- From the Departments of Radiology and Imaging Sciences (M.D.A., D.L.P., J.S.M.)
| | - M D Alexander
- From the Departments of Radiology and Imaging Sciences (M.D.A., D.L.P., J.S.M.) .,Neurosurgery (M.D.A.)
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12
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de Havenon A, Wong KH, Elkhetali A, McNally JS, Majersik JJ, Rost NS. Carotid Artery Stiffness Accurately Predicts White Matter Hyperintensity Volume 20 Years Later: A Secondary Analysis of the Atherosclerosis Risk in the Community Study. AJNR Am J Neuroradiol 2019; 40:1369-1373. [PMID: 31248859 DOI: 10.3174/ajnr.a6115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Arterial stiffness is a biomarker of cerebrovascular disease and dementia risk. Studies have shown an association between carotid artery stiffness and increased white matter hyperintensity volume and, as a result, reduced total brain volume on MR imaging, but none have had prolonged follow-up to fully evaluate the slow change seen in white matter hyperintensity volume and total brain volume with time. Our objective was to determine whether common carotid artery stiffness on sonography accurately predicts white matter hyperintensity volume and total brain volume on MR imaging more than 20 years later. MATERIALS AND METHODS We performed a secondary analysis of the Atherosclerosis Risk in the Community study to compare 5 measurements of carotid artery stiffness, including strain, distensibility, compliance, Stiffness index, and pressure-strain elastic modulus, with the white matter hyperintensity volume and total brain volume on a follow-up MR imaging using linear regression. RESULTS We included 1402 patients enrolled in the Atherosclerosis Risk in the Community study. There was a significant relationship between increasing carotid artery stiffness and both higher white matter hyperintensity volume and lower total brain volume on MR imaging, measured at a mean of 21.5 years later. In multivariable linear regression models, the carotid strain, distensibility, Stiffness index, and pressure-strain elastic modulus were associated with white matter hyperintensity volume. Only compliance was associated with total brain volume in the multivariate models. CONCLUSIONS Sonography measurements of carotid artery stiffness are predictive of white matter hyperintensity volume and total brain volume on MR imaging more than 20 years later. The association is more robust for white matter hyperintensity volume than total brain volume. These findings support the role of arterial stiffness as a method for identifying patients at risk of developing white matter hyperintensity volume and as a potential mechanism leading to small-artery disease of the brain.
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Affiliation(s)
- A de Havenon
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - K-H Wong
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - A Elkhetali
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - J S McNally
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - J J Majersik
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - N S Rost
- Harvard Medical School (N.S.R.). Boston, Massachusetts
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13
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Eisenmenger LB, Aldred BW, Kim SE, Stoddard GJ, de Havenon A, Treiman GS, Parker DL, McNally JS. Prediction of Carotid Intraplaque Hemorrhage Using Adventitial Calcification and Plaque Thickness on CTA. AJNR Am J Neuroradiol 2016; 37:1496-503. [PMID: 27102316 DOI: 10.3174/ajnr.a4765] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Carotid intraplaque hemorrhage is associated with stroke, plaque thickness, stenosis, ulceration, and adventitial inflammation. Conflicting data exist on whether calcification is a marker of plaque instability, and no data exist on adventitial calcification. Our goal was to determine whether adventitial calcification and soft plaque (a rim sign) help predict carotid intraplaque hemorrhage. MATERIALS AND METHODS This was a retrospective cohort study of 96 patients who underwent carotid MRA and CTA within 1 month, from 2009 to 2016. We excluded occlusions (n = 4) and near occlusions (n = 0), leaving 188 carotid arteries. Intraplaque hemorrhage was detected by using MPRAGE. Calcification, adventitial pattern, stenosis, maximum plaque thickness (total, soft, and hard), ulceration, and intraluminal thrombus on CTA were recorded. Atherosclerosis risk factors and medications were recorded. We used mixed-effects multivariable Poisson regression, accounting for 2 vessels per patient. For the final model, backward elimination was used with a threshold of P < .10. Receiver operating characteristic analysis determined intraplaque hemorrhage by using the area under the curve. RESULTS Our final model included the rim sign (prevalence ratio = 11.9, P < .001) and maximum soft-plaque thickness (prevalence ratio = 1.2, P = .06). This model had excellent intraplaque hemorrhage prediction (area under the curve = 0.94), outperforming the rim sign, maximum soft-plaque thickness, NASCET stenosis, and ulceration (area under the curve = 0.88, 0.86, 0.77, and 0.63, respectively; P < .001). Addition of the rim sign performed better than each marker alone, including maximum soft-plaque thickness (area under the curve = 0.94 versus 0.86, P < .001), NASCET stenosis (area under the curve = 0.90 versus 0.77, P < .001), and ulceration (area under the curve = 0.90 versus 0.63, P < .001). CONCLUSIONS The CTA rim sign of adventitial calcification with internal soft plaque is highly predictive of carotid intraplaque hemorrhage.
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Affiliation(s)
- L B Eisenmenger
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - B W Aldred
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - S-E Kim
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - G J Stoddard
- Department of Orthopedics (G.J.S.), Design and Biostatistics Center
| | | | - G S Treiman
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research Department of Surgery (G.S.T.), University of Utah, Salt Lake City, Utah Department of Surgery (G.S.T.), VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - D L Parker
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - J S McNally
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
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McNally JS, Burton TM, Aldred BW, Kim SE, McLaughlin MS, Eisenmenger LB, Stoddard GJ, Majersik JJ, Miller DV, Treiman GS, Parker DL. Vitamin D and Vulnerable Carotid Plaque. AJNR Am J Neuroradiol 2016; 37:2092-2099. [PMID: 27313129 DOI: 10.3174/ajnr.a4849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans. MATERIALS AND METHODS In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. To determine the association of low vitamin D levels with MR imaging detected intraplaque hemorrhage, we performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. MR imaging detected intraplaque hemorrhage volume was also correlated with vitamin D levels and maximum plaque thickness. Thirty-five patients underwent carotid endarterectomy, and histology-detected intraplaque hemorrhage was correlated with vitamin D levels and total plaque area. RESULTS Low vitamin D levels (<30 ng/mL, prevalence ratio = 2.05, P = .03) were a significant predictor of MR imaging detected intraplaque hemorrhage, along with plaque thickness (prevalence ratio = 1.40, P < .001). MR imaging detected intraplaque hemorrhage volume linearly correlated with plaque thickness (partial r = 0.45, P < .001) and low vitamin D levels (partial r = 0.26, P = .003). Additionally, histology-detected intraplaque hemorrhage area linearly correlated with plaque area (partial r = 0.46, P < .001) and low vitamin D levels (partial r = 0.22, P = .03). The association of intraplaque hemorrhage volume with low vitamin D levels was also higher with ischemic stroke. CONCLUSIONS Low vitamin D levels and plaque thickness predict carotid intraplaque hemorrhage and outperform lumen markers of vulnerable plaque. This research demonstrates a significant link between low vitamin D levels and carotid intraplaque hemorrhage.
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Affiliation(s)
- J S McNally
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - T M Burton
- Department of Neurology (T.M.B., J.J.M.)
| | - B W Aldred
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - S-E Kim
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - M S McLaughlin
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - L B Eisenmenger
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - G J Stoddard
- Department of Orthopedics, Study Design and Biostatistics Center (G.J.S)
| | | | | | - G S Treiman
- Department of Surgery at the University of Utah and VA Salt Lake City Health Care System, Salt Lake City, Utah (G.S.T.)
| | - D L Parker
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
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15
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McLaughlin MS, Hinckley PJ, Treiman SM, Kim SE, Stoddard GJ, Parker DL, Treiman GS, McNally JS. Optimal Prediction of Carotid Intraplaque Hemorrhage Using Clinical and Lumen Imaging Markers. AJNR Am J Neuroradiol 2015; 36:2360-6. [PMID: 26338923 DOI: 10.3174/ajnr.a4454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/03/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging detects intraplaque hemorrhage with high accuracy by using the magnetization-prepared rapid acquisition of gradient echo sequence. Still, MR imaging is not readily available for all patients, and many undergo CTA instead. Our goal was to determine essential clinical and lumen imaging predictors of intraplaque hemorrhage, as indicators of its presence and clues to its pathogenesis. MATERIALS AND METHODS In this retrospective cross-sectional study, patients undergoing stroke work-up with MR imaging/MRA underwent carotid intraplaque hemorrhage imaging. We analyzed 726 carotid plaques, excluding vessels with non-carotid stroke sources (n = 420), occlusions (n = 7), or near-occlusions (n = 3). Potential carotid imaging predictors of intraplaque hemorrhage included percentage diameter and millimeter stenosis, plaque thickness, ulceration, and intraluminal thrombus. Clinical predictors were recorded, and a multivariable logistic regression model was fitted. Backward elimination was used to determine essential intraplaque hemorrhage predictors with a thresholded 2-sided P < .10. Receiver operating characteristic analysis was also performed. RESULTS Predictors of carotid intraplaque hemorrhage included plaque thickness (OR = 2.20, P < .001), millimeter stenosis (OR = 0.46, P < .001), ulceration (OR = 4.25, P = .020), age (OR = 1.11, P = .001), and male sex (OR = 3.23, P = .077). The final model discriminatory value was excellent (area under the curve = 0.932). This was significantly higher than models using only plaque thickness (area under the curve = 0.881), millimeter stenosis (area under the curve = 0.830), or ulceration (area under the curve= 0.715, P < .001). CONCLUSIONS Optimal discrimination of carotid intraplaque hemorrhage requires information on plaque thickness, millimeter stenosis, ulceration, age, and male sex. These factors predict intraplaque hemorrhage with high discriminatory power and may provide clues to the pathogenesis of intraplaque hemorrhage. This model could be used to predict the presence of intraplaque hemorrhage when MR imaging is contraindicated.
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Affiliation(s)
- M S McLaughlin
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - P J Hinckley
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - S M Treiman
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - S-E Kim
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - G J Stoddard
- Department of Orthopedics (G.J.S.), Study Design and Biostatistics Center
| | - D L Parker
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - G S Treiman
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research Department of Surgery (G.S.T.), University of Utah, Salt Lake City, Utah Department of Surgery (G.S.T.), VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - J S McNally
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
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