PT  - JOURNAL ARTICLE
AU  - H.R. Underhill
AU  - C. Yuan
AU  - V.L. Yarnykh
AU  - B. Chu
AU  - M. Oikawa
AU  - L. Dong
AU  - N.L. Polissar
AU  - G.A. Garden
AU  - S.C. Cramer
AU  - T.S. Hatsukami
TI  - Predictors of Surface Disruption with MR Imaging in Asymptomatic Carotid Artery Stenosis
AID  - 10.3174/ajnr.A1842
DP  - 2010 Mar 01
TA  - American Journal of Neuroradiology
PG  - 487--493
VI  - 31
IP  - 3
4099  - http://www.ajnr.org/content/31/3/487.short
4100  - http://www.ajnr.org/content/31/3/487.full
SO  - Am. J. Neuroradiol.2010 Mar 01; 31
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