1
|
Kassem M, de Kam SS, van Velzen TJ, van der Geest R, Wagner B, Sokolska M, Pizzini FB, Nederkoorn PJ, Rolf Jäger H, Brown MM, van Oostenbrugge RJ, Bonati LH, Eline Kooi M. Application of mask images of contrast-enhanced MR angiography to detect carotid intraplaque hemorrhage in patients with moderate to severe symptomatic and asymptomatic carotid stenosis. Eur J Radiol 2023; 168:111145. [PMID: 37837923 DOI: 10.1016/j.ejrad.2023.111145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/21/2022] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Carotid intraplaque hemorrhage (IPH) on MRI predicts stroke. Magnetization-prepared rapid acquisition gradient (MP-RAGE) is widely used to detect IPH. CE-MRA is used routinely to assess stenosis. Initial studies indicated that IPH can be identified on mask images of CE-MRA, while Time-of-Flight (TOF) images were reported to have high specificity but lower sensitivity. We investigated the diagnostic accuracy of detecting IPH on mask images of CE-MRA and TOF. METHODS Thirty-six patients with ≥ 50% stenosis enrolled in the ongoing 2nd European Carotid Surgery Trial underwent carotid MRI. A 5-point quality score was used. Inter-observer agreement between two independent readers was determined. The sensitivity and specificity of IPH detection on mask MRA and TOF were calculated with MP-RAGE as a reference standard. RESULTS Of the 36 patients included in the current analysis, 66/72 carotid arteries could be scored. The inter-observer agreements for identifying IPH on MP-RAGE, mask, and TOF were outstanding (κ: 0.93, 0.96, and 0.85). The image quality of mask (1.42 ± 0.66) and TOF (2.42 ± 0.66) was significantly lower than MP-RAGE (3.47 ± 0.61). When T1w images were used to delineate the outer carotid wall, very high specificities (>95%) of IPH detection on mask and TOF images were found, while the sensitivity was high for mask images (>81%) and poor for TOF (50-60%). Without these images, the specificity was still high (>97%), while the sensitivity reduced to 62-71%. CONCLUSION Despite the lower image quality, routinely acquired mask images from CE-MRA, but not TOF, can be used as an alternative to MP-RAGE images to visualize IPH.
Collapse
Affiliation(s)
- Mohamed Kassem
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Soraya S de Kam
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Twan J van Velzen
- Department of Neurology, Amsterdam UMC: De Boelelaan 1108, 1081 HV Amsterdam, the Netherlands
| | - Rob van der Geest
- Department of Radiology, Leiden University Medical Centre: Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Benjamin Wagner
- Department of Neurology, University Hospital Basel: Universitätsspital CH, Petersgraben 4, 4031 Basel, Switzerland
| | - Magdalena Sokolska
- Department of Imaging, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK; Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK
| | - Francesca B Pizzini
- Radiology, Department of Diagnostic and Public Health, University of Verona: Via S. Francesco, 22, 37129 Verona VR, Italy
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC: De Boelelaan 1108, 1081 HV Amsterdam, the Netherlands
| | - H Rolf Jäger
- Department of Imaging, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK
| | - Martin M Brown
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London: Queen Square, London WC1N 3BG, UK
| | - Robert J van Oostenbrugge
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Leo H Bonati
- Department of Neurology, University Hospital Basel: Universitätsspital CH, Petersgraben 4, 4031 Basel, Switzerland
| | - M Eline Kooi
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
| |
Collapse
|