RT Journal Article SR Electronic T1 Predictors of Surface Disruption with MR Imaging in Asymptomatic Carotid Artery Stenosis JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 487 OP 493 DO 10.3174/ajnr.A1842 VO 31 IS 3 A1 H.R. Underhill A1 C. Yuan A1 V.L. Yarnykh A1 B. Chu A1 M. Oikawa A1 L. Dong A1 N.L. Polissar A1 G.A. Garden A1 S.C. Cramer A1 T.S. Hatsukami YR 2010 UL http://www.ajnr.org/content/31/3/487.abstract AB BACKGROUND AND PURPOSE: Surface disruption, either ulceration or fibrous cap rupture, has been identified as a key feature of the unstable atherosclerotic plaque. In this prospective observational study, we sought to determine the characteristics of the carotid lesion that predict the development of new surface disruption. MATERIALS AND METHODS: One hundred eight asymptomatic individuals with 50%–79% carotid stenosis underwent carotid MR imaging at baseline and at 3 years. Multicontrast imaging criteria were used to determine the presence or absence of calcification, LRNC, intraplaque hemorrhage, and surface disruption. Volume measurements of plaque morphology and the LRNC and calcification, when present, were collected. RESULTS: At baseline, 21.3% (23/108) of participants were identified with a surface disruption. After 3 years, 9 (10.6%) of the remaining 85 individuals without disruption at baseline developed a new surface disruption during follow-up. Among all baseline variables associated with new surface disruption during regression analysis, the proportion of wall volume occupied by the LRNC (percentage LRNC volume; OR per 5% increase, 2.6; 95% CI, 1.5–4.6) was the strongest classifier (AUC = 0.95) during ROC analysis. New surface disruption was associated with a significant increase in percentage LRNC volume (1.7 ± 2.0% per year, P = .035). CONCLUSIONS: This prospective investigation of asymptomatic individuals with 50%–79% stenosis provides compelling evidence that LRNC size may govern the risk of future surface disruption. Identification of carotid plaques in danger of developing new surface disruption may prove clinically valuable for preventing the transition from stable to unstable atherosclerotic disease. AUCarea-under-the-curveCIconfidence intervalImQimage qualityIPHintraplaque hemorrhageJVjugular veinLRNClipid-rich necrotic coreORodds ratioPDproton densityROCreceiver operating characteristicsT1WT1-weightedT2WT2-weightedTOFtime-of-flight