Introduction
Methods
Study population
Imaging acquisition
CMR imaging parameters | |||||
---|---|---|---|---|---|
Extracranial carotid artery | Intracranial artery | ||||
T1W | T2W | TOF | MP-RAGE | TOF-CMRA | |
Sequence | TSE | TSE | FFE | FFE | FFE |
Black blood | QIR | MDIR | – | – | – |
TR, ms | 800 | 4800 | 20 | 8.8 | 25 |
TE, ms | 10 | 50 | 4.9 | 5.3 | 3.5 |
Flip angle, deg | 90° | 90° | 20° | 15° | 20° |
FOV, mm | 140 × 140 | 140 × 140 | 140 × 140 | 140 × 140 | 240 × 240 |
In-plane resolution, mm2 | 0.5 × 0.5 | 0.5 × 0.5 | 0.5 × 0.5 | 0.5 × 0.5 | 0.7 × 0.7 |
Slice thickness, mm | 2 | 2 | 1 | 1 | 1.4 |
Follow-up and clinical outcome
Image analysis
Reproducibility
Statistical analysis
Results
Mean ± SD, or n (%) | |||
---|---|---|---|
Patients with vascular events (n = 41) | Patients without vascular events (n = 109) | P value | |
Baseline clinical characteristics | |||
Age, years | 64.9 ± 10.4 | 60.6 ± 12.2 | 0.047 |
Sex, male | 28 (68.3) | 81 (74.3) | 0.461 |
BMI, kg/m2 | 25.6 ± 3.3 | 25.5 ± 3.4 | 0.868 |
History of smoking | 24 (58.5) | 67 (61.5) | 0.743 |
History of hypertension | 28 (68.3) | 79 (72.5) | 0.614 |
History of diabetes | 7 (17.1) | 35 (32.1) | 0.068 |
History of hyperlipidemia | 16 (39.0) | 59 (54.1) | 0.099 |
History of coronary heart disease | 5 (12.2) | 12 (11.0) | 0.839 |
History of stroke | 20 (48.8) | 38 (34.9) | 0.119 |
Systolic blood pressure, mm Hg | 147.6 ± 23.2 | 144.7 ± 24.0 | 0.223 |
Diastolic blood pressure, mm Hg | 88.6 ± 13.5 | 86.6 ± 16.2 | 0.236 |
HDL, mmol/L | 1.1 ± 0.3 | 1.2 ± 0.6 | 0.374 |
LDL, mmol/L | 2.5 ± 1.4 | 2.9 ± 1.4 | 0.096 |
Total cholesterol, mmol/L | 4.2 ± 1.3 | 4.4 ± 1.2 | 0.398 |
Triglycerides, mmol/L | 1.7 ± 1.4 | 1.7 ± 1.0 | 0.646 |
NIHSS score | 5.6 ± 4.3 | 3.3 ± 3.0 | 0.003 |
Drug treatment during follow-up | |||
Antihypertension | 17 (41.5) | 49 (45.0) | 1.000 |
Lipid-lowering | 33 (80.5) | 86 (78.9) | 0.203 |
Anticoagulation | 22 (53.7) | 63 (57.8) | 0.064 |
Antiplatelet | 21 (51.2) | 39 (35.8) | 0.368 |
Baseline characteristics of cerebrovascular atherosclerosis on CMR imaging
Mean ± SD, or n (%) | P value | ||
---|---|---|---|
Patients with vascular events (n = 41) | Patients without vascular events (n = 109) | ||
Extracranial carotid artery | |||
Maximum wall thickness, mm | 3.3 ± 1.7 | 3.0 ± 1.4 | 0.316 |
Presence of stenosis | |||
Intracranial stenosis | 33 (80.5) | 63 (57.8) | 0.010 |
Extracranial carotid stenosis | 17 (41.5) | 40 (36.7) | 0.592 |
Presence of extracranial carotid plaque components | |||
Calcification | 22 (53.7) | 44 (40.4) | 0.144 |
Lipid-rich necrotic core | 34 (82.9) | 65 (59.6) | 0.007 |
Intraplaque hemorrhage | 9 (22.0) | 17 (15.6) | 0.359 |
Association between co-existing plaques and subsequent vascular events
Vascular events | ||||||
---|---|---|---|---|---|---|
Univariate Regression | Multivariate Regression* | |||||
HR | 95% CI | P value | HR | 95% CI | P value | |
Extracranial carotid artery | ||||||
Maximum wall thickness, mm | 1.06 | 0.88–1.28 | 0.542 | 0.91 | 0.67–1.23 | 0.526 |
Presence of calcification | 1.40 | 0.76–2.60 | 0.280 | 1.04 | 0.32–3.33 | 0.954 |
Presence of LRNC | 3.65 | 1.60–8.35 | 0.002 | 4.26 | 0.96–18.80 | 0.056 |
Presence of IPH | 1.25 | 0.60–2.64 | 0.552 | 0.57 | 0.09–3.60 | 0.552 |
Presence of stenosis | 1.16 | 0.62–2.16 | 0.647 | – | – | – |
Intracranial artery | ||||||
Presence of stenosis | 2.73 | 1.25–5.97 | 0.012 | 5.95 | 0.97–36.38 | 0.054 |
Co-existing plaques | ||||||
Intracranial stenosis and extracranial carotid plaque | 3.57 | 1.63–7.82 | 0.001 | 5.12 | 1.36–19.24 | 0.016 |
Intracranial stenosis and extracranial carotid calcification | 1.74 | 0.94–3.24 | 0.078 | 2.95 | 0.76–11.42 | 0.117 |
Intracranial stenosis and extracranial carotid LRNC | 4.47 | 2.15–9.27 | < 0.001 | 8.12 | 2.41–27.31 | 0.001 |
Intracranial stenosis and extracranial carotid IPH | 1.67 | 0.77–3.63 | 0.194 | 1.44 | 0.17–12.39 | 0.738 |