Noninvasive imaging of carotid artery plaque with MRI can accurately predict future cardiovascular events like strokes and heart attacks in people without a history of cardiovascular disease, according to a new study published online in the journal Radiology.
Researchers have long known that some arterial plaque is more dangerous because of its vulnerability to rupture. MRI can discern features of vulnerable plaque, such as a lipid core with a thin fibrous cap. This ability makes MRI a potentially valuable tool for identifying patients at risk for subsequent cardiovascular events.
This shows transverse gadolinium-enhanced T1-weighted MR images obtained superior to the carotid artery bifurcation in a 72-year-old man. L = ICA lumen. (a) Low-signal-intensity calcium (arrow) and lipid core (arrowheads) can be seen. (b) Note contouring of the ICA. The outer adventitial wall (red), lipid core (blue), calcification (green), and vessel lumen (purple) are visible.
Credit: Radiological Society of North America
To study the predictive value of MRI plaque imaging, researchers performed carotid artery ultrasound and MRI on 946 asymptomatic patients from the Multi-Ethnic Study of Atherosclerosis (MESA). The carotid arteries are the large vessels located on each side of the neck that carry oxygenated blood to the front part of the brain. They are highly accessible for imaging, and their condition tends to mirror that of the coronary arteries that supply the heart with oxygenated blood.
The researchers used ultrasound to assess carotid wall thickness and MRI to define carotid plaque composition and the remodeling index, a measure of changes in vessel size. Imaging results were compared with cardiovascular events, including heart attacks, stroke and death, for an average of 5.5 years after examination.
"We studied asymptomatic individuals with a low risk of cardiovascular events at baseline and used noninvasive imaging to predict the risk of an event downstream," said David A. Bluemke, M.D, Ph.D., from the National Institutes of Health Clinical Center in Bethesda, Md. "This is the first population-based prospective study to determine if vulnerable plaque features by MRI add to the risk of a cardiovascular event beyond the traditional risk factors."
Cardiovascular events occurred in 59 of the patients. Abnormal thickening of the carotid artery wall and the presence of a lipid core and calcium in the internal carotid artery on MRI were significant predictors of subsequent events. A lipid core was present in almost half of the patients who had an event, compared with only 17.8 percent of those who did not have an event.
"The primary factors that predicted future risk were measures of vessel wall thickness in combination with the presence or absence of a lipid core," Dr. Bluemke said. "The presence of a lipid core was 50 percent more common in people who had subsequent events."
Use of MRI improved the reclassification of baseline cardiovascular risk in the study group. When both the carotid remodeling index and lipid core were used for risk stratification, approximately 16 percent more patients with events and 7 percent without events were correctly reclassified compared with the use of traditional risk factors.
"The results bolster the use of MRI as a surrogate marker of efficacy in therapeutic studies and point to a role in determining which patients might need more aggressive treatments," Dr. Bluemke said. "As risk factor prediction gets better, we'll be able to screen more intelligently and use more intensive treatments in those individuals who face a higher risk of cardiovascular events."
Dr. Bluemke noted that sequences for plaque composition could be readily added to existing carotid MRI angiography protocols for clinical purposes.
"Carotid MRI has significant advantages," he said. "The results are more reproducible than those of ultrasound."
Availability and cost effectiveness could limit the use of MRI, Dr. Bluemke cautioned. However, ultrasound and computed tomography (CT) are viable alternatives for screening, he said, especially with improvements in CT dose reduction.
"Carotid Artery Plaque Morphology and Composition in Relation to Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis (MESA)." Collaborating with Dr. Bluemke were Anna E. H. Zavodni, M.D., Bruce A. Wasserman, M.D., Robyn L. McClelland, Ph.D., Antoinette S. Gomes, M.D., Aaron R. Folsom, M.D., M.P.H., Joseph F. Polak, M.D., M.P.H., and João A. C. Lima, M.D.
Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc.
RSNA is an association of more than 53,000 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill.
For patient-friendly information on MRI, visit RadiologyInfo.org.
Linda Brooks | EurekAlert!
Self-learning software for better medical diagnoses
02.02.2016 | Fraunhofer MEVIS - Institut für Bildgestützte Medizin
New pen-sized microscope could ID cancer cells in doctor's offices and operating rooms
26.01.2016 | University of Washington
Automobiles increase the mobility of their users. However, their maneuverability is pushed to the limit by cramped inner city conditions. Those who need to...
Advance in biomedical imaging: The University of Würzburg's Biocenter has enhanced fluorescence microscopy to label and visualise up to nine different cell structures simultaneously.
Fluorescence microscopy allows researchers to visualise biomolecules in cells. They label the molecules using fluorescent probes, excite them with light and...
NASA's follow-on to the successful ICESat mission will employ a never-before-flown technique for determining the topography of ice sheets and the thickness of sea ice, but that won't be the only first for this mission.
Slated for launch in 2018, NASA's Ice, Cloud and land Elevation Satellite-2 (ICESat-2) also will carry a 3-D printed part made of polyetherketoneketone (PEKK),...
In the last decades, sea level has been rising continuously – about 3.3 mm per year. For reef islands such as the Maldives or the Marshall Islands a sinister picture is being painted evoking the demise of the island states and their cultures. Are the effects of sea-level rise already noticeable on reef islands? Scientists from the ZMT have now answered this question for the Takuu Atoll, a group of Pacific islands, located northeast of Papua New Guinea.
In the last decades, sea level has been rising continuously – about 3.3 mm per year. For reef islands such as the Maldives or the Marshall Islands a sinister...
The ‘Internet of Things’ is growing rapidly. Mobile phones, washing machines and the milk bottle in the fridge: the idea is that minicomputers connected to these will be able to process information, receive and send data. This requires electrical power. Transistors that are capable of switching information with a single electron use far less power than field effect transistors that are commonly used in computers. However, these innovative electronic switches do not yet work at room temperature. Scientists working on the new EU research project ‘Ions4Set’ intend to change this. The program will be launched on February 1. It is coordinated by the Helmholtz-Zentrum Dresden-Rossendorf (HZDR).
“Billions of tiny computers will in future communicate with each other via the Internet or locally. Yet power consumption currently remains a great obstacle”,...
02.02.2016 | Event News
26.01.2016 | Event News
26.01.2016 | Event News
05.02.2016 | Life Sciences
05.02.2016 | Materials Sciences
05.02.2016 | Physics and Astronomy