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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 646-651. doi: 10.19723/j.issn.1671-167X.2023.04.013

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Correlations between plaque characteristics and cerebral blood flow in patients with moderate to severe carotid stenosis using magnetic resonance vessel wall imaging

Ying LIU1,Ran HUO1,Hui-min XU1,Zheng WANG1,Tao WANG2,Hui-shu YUAN1,*()   

  1. 1. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-10-09 Online:2023-08-18 Published:2023-08-03
  • Contact: Hui-shu YUAN E-mail:huishuy@bjmu.edu.cn
  • Supported by:
    Beijing Natural Science Foundation(7192219)

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Abstract:

Objective: To investigate the correlations between carotid plaque characteristics and cerebral blood flow (CBF) in patients with unilateral moderate to severe carotid stenosis using high-resolution magnetic resonance imaging (HR-MRI) and 3D pseudo-continuous arterial spin labeling (3D pcASL). Methods: A total of 43 patients with unilateral moderate to severe carotid stenosis were recruited. The degree of carotid stenosis, maximum wall thickness (Max WT) and normalized wall index (NWI) were measured using HR-MRI. The plaque characteristics were analyzed. Presence or absence of plaque components including intraplaque hemorrhage (IPH), lipid-rich necrotic nucleus (LRNC), calcification and ulcer were identified, and the grades of calcification and LRNC were recorded. CBF values within the region of interest representing the bilateral middle cerebral artery distribution were acquired using 3D pcASL. Paired sample t test was used to compare the differences of CBF values between the index side and the contralateral side. Spearman correlation analysis was conducted to evaluate the correlations of CBF values with the degree of carotid stenosis, Max WT and NWI. The differences of CBF values between the patients with or without IPH and ulcer were compared using Mann-Whitney U test. Different levels of calcification and LRNC were compared by Kruskal-Wallis test, respectively. Results: The ave-rage degree of carotid stenosis at the index side was 77.30%±11.79%. The mean CBF value of the index side was (46.77±11.65) mL/(100 g·min), and that of the contralateral side was (49.92±9.95) mL/(100 g·min), and the difference was statistically significant (t=-2.474, P=0.017). The mean Max WT and NWI of the carotid plaques at the index side was (6.40±1.87) mm and 62.91%±8.87%, respectively. There were no significant correlations of CBF values with the degrees of stenosis, Max WT and NMI (P>0.05). Plaque composition analysis showed that the CBF values of the index side were different when there was calcification or not and the degrees of calcification were different (P=0.030), but there were no differences between the CBF values on the index sides with or without IPH, ulcer and LRNC. Conclusion: In patients with unilateral moderate to severe carotid stenosis, calcification might affect CBF perfusion. When there is no calcification, the plaque components need attention.

Key words: Atherosclerotic plaque, Carotid stenosis, Vascular calcification, Magnetic resonance imaging, Cerebral blood flow

CLC Number: 

  • R543.4

Table 1

Proportion of carotid plaque components"

Plaque characteristics Score 0 Score 1 Score 2
Intraplaque hemorrhage 21 (48.84) 22 (51.16)
Lipid-rich necrotic nucleus 5 (11.63) 11 (25.58) 27 (62.79)
Calcification 8 (18.60) 25 (58.14) 10 (23.26)
Ulcer 12 (27.91) 31 (72.09)

Table 2

Correlation between carotid artery morphology and cerebral blood flow of the index side"

Variable Correlation coefficient P value
Degree of carotid stenosis -0.106 0.499
Max WT 0.158 0.311
NWI -0.017 0.913

Table 3

Cerebral blood flow on the index side in different carotid plaque component scores"

Plaque characteristics Score 0 Score 1 Score 2 P value
Intraplaque hemorrhage 47.04±10.80 46.52±12.66 0.662
Lipid-rich necrotic nucleus 53.57±14.61 45.79±10.01 45.92±11.75 0.528
Calcification 39.27±11.89 46.64±10.42 53.11±11.81 0.030
Ulcer 46.10±12.67 48.52±8.72 0.565

Figure 1

Calcified plaque at the beginning of right internal carotid artery and ipsilateral cerebral blood flow perfusion A, 3D T1WI CPR showed calcified plaque was at the beginning of right internal carotid artery with severe stenosis; B, TOF, SNAP, T1WI and T2WI sequences showed calcified plaque (white arrow) on the wall of internal carotid artery, and low signals were found on all sequences; C, cerebral blood flow(CBF) map showed that there was no significant change of CBF perfusion on the middle cerebral artery distribution of the index side. CPR, curved plannar reformation; MR, magnetic resonance; ASL, arterial spin labeling; TOF, time of flight; SNAP, simultaneous non-contrast angiography intraplaque hemorrhage."

Figure 2

Plaque without calcification at the beginning of right internal carotid artery and ipsilateral cerebral blood flow perfusion A, 3D T1WI CPR showed plaque without calcified at the beginning of right internal carotid artery with severe stenosis; B, TOF, SNAP, T1WI and T2WI sequences showed plaque without calcified (white asterisk showed lumen); C, CBF map showed that CBF perfusion of the right middle cerebral artery distribution was significantly decreased. Abbreviations as in Figure 1."

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