User Ratings

Easy to Follow Achieved Expected Results Overall Rating Add your comments

High‐Resolution Multi‐Contrast MRI of the Carotid Artery Wall for Evaluation of Atherosclerotic Plaques

Vasily L. Yarnykh¹, Chun Yuan¹

¹University of Washington, Seattle, Washington

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A1.4

DOI:

10.1002/0471142719.mia0104s11

Online Posting Date:

February, 2004

GO TO THE FULL TEXT:

PDF or HTML at Wiley Online Library

Are you the author of this protocol? Login or register and return to this page.

Abstract

Carotid atherosclerosis is an important medical condition associated with a high potential risk of stroke. In addition to the degree of artery stenosis, the size and tissue composition of the atherosclerotic plaque are thought to be important factors for disease management and prognosis. This unit presents a protocol for high-resolution multi-contrast MRI of the carotid artery wall. The protocol employs a combination of bright-blood magnetic resonance angiography and black-blood imaging with different contrast weightings (T1, T2, and proton-density contrasts) in order to provide comprehensive characterization of the atherosclerotic lesion. The images obtained with the protocol presented here can be used to identify basic tissue components of the atherosclerotic plaque (fibrous matrix, lipid core, calcificates, and hemorrhage) and to conduct morphological measurements of plaque size and distribution.

GO TO THE FULL PROTOCOL:

PDF or HTML at Wiley Online Library

Basic Protocol
Commentary
Literature Cited
Figures
Tables

GO TO THE FULL PROTOCOL:

PDF or HTML at Wiley Online Library

Figures

Figure A1.4.1

Photo of the bilateral phased-array carotid coil with head holder (Pathway Medical).

View Image
Figure A1.4.2

Setting scan geometry. (A) Position of slices for sequence 3 (oblique sagittal black-blood MRA) using transverse 2-D TOF MRA (sequence 2) as a localizer. 2-D TOF MRA image is also used to determine coordinates of the FOV (field of view) center (asterisk) for all subsequent transverse sequences. (B) Finding an inferior-superior coordinate of the bifurcation (arrow) on the oblique black-blood image obtained in sequence 3.

View Image
Figure A1.4.3

Oblique sagittal 2-D black-blood MRA images (sequence 3) processed by multi-planar reformation (MPR; A) and minimal-intensity projection (MinIP; B). Images were obtained at the left side from a patient with moderate atherosclerotic disease. Transverse images of this patient are shown in Figure A1.4.4. Abbreviations correspond to common (CCA), internal (ICA), end external (ECA) carotid arteries, jugular vein (JV), and plaque (P). Reformatted view (A) shows a fragment of plaque (P), whereas minimal-intensity projection (B) confirms that the lumen is almost unobstructed.

View Image
Figure A1.4.4

Transverse multi-contrast images (A) obtained from a patient with moderate atherosclerotic disease of the left carotid artery. Circular arrows indicate minor wrap-around artifacts. Magnified views of the carotid arteries (B) show atherosclerotic plaque overlaying the left internal carotid artery (solid arrows). This lesion contains a large fragment of loose fibrous matrix corresponding to a hyperintense area on the T₂-weighted image. In the right carotid bifurcation (open arrows), black-blood images display normal wall and a minor residual blood signal in the carotid bulb. This incompletely suppressed signal originates from recirculating blood and has minimal intensity on the T₁-weighted DIR image. Note the absence of flow enhancement in the right carotid bulb on the 3-D TOF image, which shows a tissue-like signal (open arrow). Without black-blood images, 3-D TOF MRA may result in misinterpretation of this region as plaque.

View Image

Literature Cited

Literature Cited
	Cai, J.M., Hatsukami, T.S., Ferguson, M.S., Small, R., Polissar, N.L., and Yuan, C. 2002. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation 106:1368-1373.
	Edelman, R.R., Chien, D., and Kim, D. 1991. Fast selective black blood MR imaging. Radiology 181:655-660.
	Hatsukami, T.S., Ross, R., Polissar, N.L., and Yuan, C. 2000. Identification of fibrous cap thickness and cap rupture in human atherosclerotic carotid plaque in vivo with high resolution magnetic resonance imaging. Circulation 102:959-964.
	Hayes, C.E., Mathis, C.M., and Yuan, C. 1996. Surface coil phased arrays for high-resolution imaging of the carotid arteries. J. Magn. Reson. Imaging 6:109-112.
	Kang, X.J., Polissar, N.L., Han, C., Lin, E., and Yuan, C. 2000. Analysis of the measurement precision of arterial lumen and wall areas using high resolution magnetic resonance imaging. Magn. Reson. Med. 44:968-972.
	Parker, D.L., Goodrich, K.C., Masiker, M., Tsuruda, J.S., and Katzman, G.L. 2002. Improved efficiency in double-inversion fast spin-echo imaging. Magn. Reson. Med. 47:1017-1021.
	Shellock, F.G. 2001. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Song, H.K., Wright, A.C., Wolf, R.L., and Wehrli, F.W. 2002. Multislice double inversion pulse sequence for efficient black-blood MRI. Magn. Reson. Med. 47:616-620.
	Steinman, D.A. and Rutt, B.K. 1998. On the nature and reduction of plaque-mimicking flow artifacts in black blood MRI of the carotid bifurcation. Magn. Reson. Med. 39:635-641.
	Toussaint, J.F., LaMuraglia, G.M., Southern, J.F., Fuster, V., and Kantor, H.L. 1996. Magnetic resonance images lipid, fibrous, calcified, hemorhagic, and thrombotic components of human atherosclerosis in vivo. Circulation 94:932-938.
	Yarnykh, V.L. and Yuan, C. 2003. Multislice double inversion-recovery black-blood imaging with simultaneous slice reinversion. J. Magn. Reson. Imaging 17:478-483.
	Yuan, C., Beach, K.W., Smith, L.H., and Hatsukami, T.S. 1998. Measurement of atherosclerotic carotid plaque size in vivo using high resolution magnetic resonance imaging. Circulation 98:2666-2671.
	Yuan, C., Mitsumori, L.M., Beach, K.W., and Maravilla, K.R. 2001a. Carotid atherosclerotic plaque: Noninvasive MR characterization and identification of vulnerable lesions. Radiology 221:285-299.
	Yuan, C., Mitsumori, L.M., Ferguson, M.S., Polissar, N.L., Echelard, D., Ortiz, G., Small, R., Davies, J.W., Kerwin, W.S., and Hatsukami, T.S. 2001b. In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. Circulation 104:2051-2056.
Key References
	Shellock, F.G. 2001. Magnetic Resonance Procedures: Health Effects and Safety. CRC Press, Boca Raton, Fla.
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.
	Yarnykh and Yuan, 2003. See above.
Describes technical principles and demonstrates advantages of a multislice DIR method, which is preferable for performing sequences 3, 5, and 6 in the Basic Protocol. The method produces excellent results and it is easy for implementation.
	Yuan et al., 2001a. See above.
Comprehensive review of clinical and technical aspects of carotid plaque MRI.
Internet Resources
	http://vil.rad.washington.edu
Web site of the Vascular Imaging Lab (University of Washington) contains example images and useful references on MRI of the carotid atherosclerotic plaque.
	http://www.mrisafety.com
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.