Carotid artery perivascular adipose tissue on magnetic resonance imaging: a potential indicator for carotid vulnerable atherosclerotic plaque

Shuwan Yu; Ran Huo; Huiyu Qiao; Zihan Ning; Huimin Xu; Dandan Yang; Rui Shen; Ning Xu; Hualu Han; Shuo Chen; Ying Liu; Xihai Zhao

doi:10.21037/qims-23-280

Carotid artery perivascular adipose tissue on magnetic resonance imaging: a potential indicator for carotid vulnerable atherosclerotic plaque

Quant Imaging Med Surg. 2023 Dec 1;13(12):7695-7705. doi: 10.21037/qims-23-280. Epub 2023 Sep 26.

Authors

Shuwan Yu¹, Ran Huo², Huiyu Qiao^{1

3}, Zihan Ning¹, Huimin Xu², Dandan Yang⁴, Rui Shen¹, Ning Xu¹, Hualu Han¹, Shuo Chen^{1

3}, Ying Liu^#², Xihai Zhao^#¹

Affiliations

¹ Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
² Department of Radiology, Peking University Third Hospital, Beijing, China.
³ Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.
⁴ Department of Radiology, Beijing Geriatric Hospital, Beijing, China.

^# Contributed equally.

Abstract

Background: Magnetic resonance imaging (MRI) has the potential in assessing the inflammation of perivascular adipose tissue (PVAT) due to its excellent soft tissue contrast. However, evidence is lacking for the association between carotid PVAT measured by MRI and carotid vulnerable atherosclerotic plaques. This study aimed to investigate the association between signal intensity of PVAT and vulnerable plaques in carotid arteries using multi-contrast magnetic resonance (MR) vessel wall imaging.

Methods: In this cross-sectional study, a total of 104 patients (mean age, 64.9±7.0 years; 86 men) with unilateral moderate-to-severe atherosclerotic stenosis referred to carotid endarterectomy (CEA) were recruited from April 2018 to December 2020 at Department of Neurosurgery of Peking University Third Hospital. All patients underwent multi-contrast MR vessel wall imaging including time-of-flight (ToF) MR angiography, black-blood T1-weighted (T1w) and T2-weighted (T2w) and simultaneous non-contrast angiography and intraplaque hemorrhage (IPH) imaging sequences. Patients with contraindications to endarterectomy or MRI examinations were excluded. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of PVAT were measured on ToF images and vulnerable plaque characteristics including IPH, large lipid-rich necrotic core (LRNC), and fibrous cap rupture (FCR) were identified. The SNR and CNR of PVAT were compared between slices with and without vulnerable plaque features using Mann-Whitney U test and their associations were analyzed using the generalized linear mixed model (GLMM).

Results: Carotid artery slices with IPH (30.93±14.56 vs. 27.34±10.02; P<0.001), FCR (30.35±13.82 vs. 27.53±10.37; P=0.006), and vulnerable plaque (29.15±12.52 vs. 27.32±10.05; P=0.016) had significantly higher value of SNR of PVAT compared to those without. After adjusting for clinical confounders, the SNR of PVAT was significantly associated with presence of IPH [odds ratio (OR) =0.627, 95% confidence interval (CI): 0.465-0.847, P_uncorr=0.002, P_FDR=0.016] and vulnerable plaque (OR =0.762, 95% CI: 0.629-0.924, P_uncorr=0.006, P_FDR=0.020). However, no significant association was found between the CNR of PVAT and presence of vulnerable plaque features (all P>0.05).

Conclusions: The SNR of carotid artery PVAT measured by ToF MR angiography is independently associated with vulnerable atherosclerotic plaque features, suggesting that the signal intensity of PVAT might be an effective indicator for vulnerable plaque.

Keywords: Perivascular adipose tissue (PVAT); carotid artery; magnetic resonance imaging (MRI); signal intensity; vulnerable plaque.