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Characterization of carotid artery plaques with USPIO-enhanced MRI: assessment of inflammation and vascularity as in vivo imaging biomarkers for plaque vulnerability

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Abstract

To evaluate ultra small superparamagnetic iron oxide particles (USPIO) enhanced magnetic resonance (MR) imaging for characterization of atherosclerotic carotid plaques by assessing vascularity and plaque inflammation, besides contrast-enhanced MR angiography (CE-MRA) of the carotid artery stenosis. Twelve patients with severe carotid artery stenosis, scheduled for endarterectomy, underwent MRI of the carotid artery bifurcation using SHU 555 C at a dose of 40 μmol Fe/kg BW. The MR imaging protocol comprised pre- and post-contrast T2*-w, a first-pass CE-MRA and dynamic T1-w sequences. For quantitative data analysis, the signal intensities (SI) were measured and SNR-data (SNR = SIblood/plaque/bone marrow/standard deviationnoise) as well as ΔSI-data (SNRpost–SNRpre) were calculated. In addition, two radiologists rated the diagnostic performance of first-pass MRA according to a four level decision scale. Staining of anti-dextran (SHU 555 C) and anti-CD68 (macrophages) was performed for immunohistological confirmation. Plaque sections with a T2*-w signal decline (intracellular USPIO accumulation in macrophages) showed significantly changes (mean −14%, 95% CI, −5 to −20%; P < 0.01) and corresponding plaque regions had significantly higher (15.15 ± 1.76 vs. 5.22 ± 1.50; P < 0.01) T1-w enhancement data (global estimation of vascularity). The first-pass MRA of the supra-aortal vessels provided images of diagnostic quality. Representative immunohistology sections revealed colocalization of dextran- and CD68-immunoreactive cells. USPIO-enhanced MRI is feasible for in vivo assessment of vascularity and macrophage content in atherosclerotic carotid plaques, determining an association of these potential imaging biomarkers of plaque vulnerability. Diagnostic MRA of the supra-aortal vessels can be imaged additionally with a single administration of SHU 555 C.

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Acknowledgments

The authors would like to thank Renate Hegenloh, MS, for histologic processing. This work was supported by an unrestricted grant from Bayer Schering Pharma AG, Berlin, Germany.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany

    Stephan Metz, Marcus Settles & Ernst J. Rummeny

  2. Department of Nuclear Medicine, Technical University, Munich, Germany

    Ambros J. Beer & René M. Botnar

  3. Department of Vascular Surgery, Technical University, Munich, Germany

    Jaroslav Pelisek & Peter Heider

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  1. Stephan Metz
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  2. Ambros J. Beer
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Correspondence to Stephan Metz.

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Metz, S., Beer, A.J., Settles, M. et al. Characterization of carotid artery plaques with USPIO-enhanced MRI: assessment of inflammation and vascularity as in vivo imaging biomarkers for plaque vulnerability. Int J Cardiovasc Imaging 27, 901–912 (2011). https://doi.org/10.1007/s10554-010-9736-7

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  • DOI: https://doi.org/10.1007/s10554-010-9736-7

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