Application of mask images of contrast-enhanced MR angiography to detect carotid intraplaque hemorrhage in patients with moderate to severe symptomatic and asymptomatic carotid stenosis

Mohamed Kassem; Soraya S de Kam; Twan J van Velzen; Rob van der Geest; Benjamin Wagner; Magdalena Sokolska; Francesca B Pizzini; Paul J Nederkoorn; H Rolf Jäger; Martin M Brown; Robert J van Oostenbrugge; Leo H Bonati; M Eline Kooi

doi:10.1016/j.ejrad.2023.111145

Application of mask images of contrast-enhanced MR angiography to detect carotid intraplaque hemorrhage in patients with moderate to severe symptomatic and asymptomatic carotid stenosis

Eur J Radiol. 2023 Nov:168:111145. doi: 10.1016/j.ejrad.2023.111145. Epub 2023 Oct 6.

Affiliations

¹ Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
² Department of Neurology, Amsterdam UMC: De Boelelaan 1108, 1081 HV Amsterdam, the Netherlands.
³ Department of Radiology, Leiden University Medical Centre: Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
⁴ Department of Neurology, University Hospital Basel: Universitätsspital CH, Petersgraben 4, 4031 Basel, Switzerland.
⁵ Department of Imaging, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK; Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK.
⁶ Radiology, Department of Diagnostic and Public Health, University of Verona: Via S. Francesco, 22, 37129 Verona VR, Italy.
⁷ Department of Imaging, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK.
⁸ Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London: Queen Square, London WC1N 3BG, UK.
⁹ Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
¹⁰ Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands. Electronic address: eline.kooi@mumc.nl.

PMID: 37837923
DOI: 10.1016/j.ejrad.2023.111145

Abstract

Purpose: Carotid intraplaque hemorrhage (IPH) on MRI predicts stroke. Magnetization-prepared rapid acquisition gradient (MP-RAGE) is widely used to detect IPH. CE-MRA is used routinely to assess stenosis. Initial studies indicated that IPH can be identified on mask images of CE-MRA, while Time-of-Flight (TOF) images were reported to have high specificity but lower sensitivity. We investigated the diagnostic accuracy of detecting IPH on mask images of CE-MRA and TOF.

Methods: Thirty-six patients with ≥ 50% stenosis enrolled in the ongoing 2nd European Carotid Surgery Trial underwent carotid MRI. A 5-point quality score was used. Inter-observer agreement between two independent readers was determined. The sensitivity and specificity of IPH detection on mask MRA and TOF were calculated with MP-RAGE as a reference standard.

Results: Of the 36 patients included in the current analysis, 66/72 carotid arteries could be scored. The inter-observer agreements for identifying IPH on MP-RAGE, mask, and TOF were outstanding (κ: 0.93, 0.96, and 0.85). The image quality of mask (1.42 ± 0.66) and TOF (2.42 ± 0.66) was significantly lower than MP-RAGE (3.47 ± 0.61). When T1w images were used to delineate the outer carotid wall, very high specificities (>95%) of IPH detection on mask and TOF images were found, while the sensitivity was high for mask images (>81%) and poor for TOF (50-60%). Without these images, the specificity was still high (>97%), while the sensitivity reduced to 62-71%.

Conclusion: Despite the lower image quality, routinely acquired mask images from CE-MRA, but not TOF, can be used as an alternative to MP-RAGE images to visualize IPH.

Keywords: CE-MRA; Carotid; Intraplaque hemorrhage; MP-RAGE; Mask; Stroke.

MeSH terms

Carotid Arteries / diagnostic imaging
Carotid Stenosis* / complications
Carotid Stenosis* / diagnostic imaging
Constriction, Pathologic
Hemorrhage / diagnostic imaging
Humans
Magnetic Resonance Angiography / methods
Magnetic Resonance Imaging / methods