Associations between carotid atherosclerotic plaque characteristics determined by magnetic resonance imaging and improvement of cognition in patients undergoing carotid endarterectomy

Ran Huo; Ying Liu; Huimin Xu; Jin Li; Ruijing Xin; Zhangli Xing; Shasha Deng; Tao Wang; Huishu Yuan; Xihai Zhao

doi:10.21037/qims-21-981

Associations between carotid atherosclerotic plaque characteristics determined by magnetic resonance imaging and improvement of cognition in patients undergoing carotid endarterectomy

Quant Imaging Med Surg. 2022 May;12(5):2891-2903. doi: 10.21037/qims-21-981.

Authors

Ran Huo^#¹, Ying Liu^#¹, Huimin Xu¹, Jin Li², Ruijing Xin³, Zhangli Xing⁴, Shasha Deng⁵, Tao Wang^#⁶, Huishu Yuan^#¹, Xihai Zhao⁷

Affiliations

¹ Department of Radiology, Peking University Third Hospital, Beijing, China.
² Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
³ Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
⁴ Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
⁵ School of Medical Imaging, Changsha Medical University, Changsha, China.
⁶ Department of Neurosurgery, Peking University Third Hospital, Beijing, China.
⁷ Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.

^# Contributed equally.

Abstract

Background: To determine the predictive value of carotid plaque characteristics for the improvement of cognition in patients with moderate-to-severe carotid stenosis after carotid endarterectomy (CEA), using vessel wall magnetic resonance imaging (MRI).

Methods: This was a prospective cohort study. Patients with unilateral, moderate-to-severe carotid stenosis referred to the Peking University Third Hospital for CEA were prospectively recruited and underwent carotid vessel wall MRI within 1 week before CEA. We performed Montreal Cognitive Assessment (MoCA) within 1 week before and 3-4 days after CEA. The morphological and compositional characteristics of carotid plaques on MRI were evaluated. Improvement of cognition was defined as >10% increase of the total MoCA score after CEA compared with baseline. Carotid plaque characteristics were compared between patients with and without cognitive improvement.

Results: In total, 105 patients (91 males; mean age, 65.5±8.4 years) were included. The volume {48.0 [interquartile range (IQR), 21.0 to 91.6] vs. 16.3 (IQR, 8.1 to 53.1) mm³; P=0.005} and cumulative slice [4.0 (IQR, 3.0 to 7.0) vs. 3.0 (IQR, 2.0 to 5.0); P=0.019] of carotid calcification, and maximum percentage of calcification area [13.1% (IQR, 6.0% to 19.8%) vs. 6.2% (IQR, 3.7% to 10.8%); P=0.004] were significantly smaller in participants with cognitive improvement compared to those without. Univariate logistic regression analysis showed that volume [odds ratio (OR) =0.994; 95% confidence interval (CI): 0.989 to 1.000; P=0.043] and cumulative slice (OR =0.823; 95% CI: 0.698 to 0.970; P=0.020) of carotid calcification, and maximum percentage of calcification area (OR =0.949; 95% CI: 0.909 to 0.991; P=0.018) were significantly correlated with cognitive improvement. After adjusting for confounding factors, these associations remained statistically or marginally significant (volume: OR =0.994; 95% CI: 0.988 to 1.000; P=0.057; maximum percentage of calcification area: OR =0.937; 95% CI: 0.890 to 0.987; P=0.014; and cumulative slice: OR =0.791; 95% CI: 0.646 to 0.967; P=0.022). No significant associations were found between other plaque characteristics and cognitive improvement (all P>0.05).

Conclusions: More than half of the participants with unilateral, moderate-to-severe carotid atherosclerotic stenosis had cognitive improvement. The size of calcification might be an effective indicator of cognitive improvement after CEA.

Keywords: Carotid artery; atherosclerosis; carotid endarterectomy (CEA); cognitive function; vessel wall magnetic resonance imaging (vessel wall MRI).