Dynamic MR imaging of the carotid wall

The purpose of this study was to clarify temporal changes of carotid wall enhancement using dynamic magnetic resonance (MR) and to correlate its findings with pathological conditions. Cervical carotid arteries of 84 consecutive patients were studied with a 1.5 T MR imager using phased array coils. Axial spoiled gradient‐echo (SPGR) images (30–58 second scan time) with fat saturation were repeated 4–8 times after the injection of contrast material. We evaluated the presence and thickness of hypointense inner rims and hyperintense outer rims of the carotid wall, temporal changes of outer rim enhancement, and their changes in relation to pathological conditions. Hypointense inner rims and enhanced outer rims were clearly visualized in 87% (73/84) of our subjects. Enhancement of the outer rim was minimal in early phases and gradually increased. Patient age had a significant correlation with outer rim thickness. In the portions with large atheromatous plaques, inner rims were disrupted or thickened. A marked thickening of the outer rim was observed in one patient with arteritis. The outer rims adjacent to malignant tumors were often obscured. Our study suggests that dynamic MR images of the cervical carotid artery can uniquely demonstrate angiogenesis of the wall itself. The outer rim of the artery shows relatively rapid enhancement, and its thickness correlates with age.J. Magn. Reson. Imaging 1999; 9:420–427. © 1999 Wiley‐Liss, Inc.

[1]  J. Pruvo,et al.  Helical CT for the diagnosis of extracranial internal carotid artery dissection. , 1996, Stroke.

[2]  N. Hayashi,et al.  Enhancement of the intracranial arterial wall at MR imaging: relationship to cerebral atherosclerosis. , 1995, Radiology.

[3]  J. Brunberg,et al.  3D gadolinium-enhanced MR angiography of the carotid arteries. , 1996, Magnetic resonance imaging.

[4]  L. Jelinski,et al.  Stroboscopic NMR microscopy of the carotid artery , 1989, Nature.

[5]  T K Foo,et al.  Contrast-enhanced abdominal MR angiography: optimization of imaging delay time by automating the detection of contrast material arrival in the aorta. , 1997, Radiology.

[6]  P. Molina,et al.  Motion artifact simulating aortic dissection on CT. , 1991, AJR. American journal of roentgenology.

[7]  Allan J. Fox,et al.  Significance of Plaque Ulceration in Symptomatic Patients With High‐Grade Carotid Stenosis , 1994, Stroke.

[8]  L. Valton,et al.  Asymptomatic cerebral embolic signals in patients with carotid stenosis. Correlation with appearance of plaque ulceration on angiography. , 1995, Stroke.

[9]  R A Kronmal,et al.  Sonographic evaluation of carotid artery atherosclerosis in the elderly: relationship of disease severity to stroke and transient ischemic attack. , 1993, Radiology.

[10]  A. Becker,et al.  Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. , 1994, Circulation.

[11]  R A Kronmal,et al.  Thickening of the carotid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group. , 1996, Stroke.

[12]  S. Sharma,et al.  Morphologic mural changes in the aorta revealed by CT in patients with nonspecific aortoarteritis (Takayasu's arteritis). , 1996, AJR. American journal of roentgenology.

[13]  A. Blumenfeld,et al.  The importance of carotid artery plaque disruption and hemorrhage. , 1987, Archives of neurology.

[14]  J Domjan,et al.  Ultrasonic carotid artery plaque structure and the risk of cerebral infarction on computed tomography. , 1994, Journal of vascular surgery.

[15]  V. Hachinski,et al.  Angiographic Detection of Carotid Plaque Ulceration: Comparison With Surgical Observations in a Multicenter Study , 1994, Stroke.

[16]  S Glagov,et al.  Nature of Species Differences in the Medial Distribution of Aortic Vasa Vasorum in Mammals , 1967, Circulation research.

[17]  L. Jäncke,et al.  Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis. , 1995, Stroke.

[18]  G C McKinnon,et al.  Breath-hold, contrast-enhanced, three-dimensional MR angiography. , 1996, Radiology.

[19]  R. Virmani,et al.  Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. , 1996, Journal of vascular surgery.

[20]  E M Haacke,et al.  Carotid plaque formation and its evaluation with angiography, ultrasound, and MR angiography , 1994, Journal of magnetic resonance imaging : JMRI.

[21]  D. Yousem,et al.  Carotid artery invasion by head and neck masses: prediction with MR imaging. , 1995, Radiology.

[22]  V. Fuster,et al.  Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo. , 1996, Circulation.

[23]  E. Connolly,et al.  Immunohistochemical detection of intracranial vasa vasorum: a human autopsy study. , 1996, Neurosurgery.

[24]  J. V. van Engelshoven,et al.  Peripheral vascular tree stenoses: detection with subtracted and nonsubtracted MR angiography. , 1998, Radiology.

[25]  T K Foo,et al.  Techniques for high‐resolution MR imaging of atherosclerotic plaque , 1994, Journal of magnetic resonance imaging : JMRI.

[26]  M S van Leeuwen,et al.  CT angiography: application to the evaluation of carotid artery stenosis. , 1993, Radiology.

[27]  W Ceusters,et al.  Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial , 1996, The Lancet.

[28]  Lippincott Williams Wilkins,et al.  Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. , 1991, Stroke.

[29]  J K Kim,et al.  Test bolus examination in the carotid artery at dynamic gadolinium-enhanced MR angiography. , 1998, Radiology.

[30]  P. Touboul,et al.  Ultrasonographic assessment of carotid wall characteristics and cognitive functions in a community sample of 59- to 71-year-olds. The EVA Study Group. , 1996, Stroke.

[31]  A. Fox,et al.  Carotid artery stenosis: external validity of the North American Symptomatic Carotid Endarterectomy Trial measurement method. , 1997, Radiology.

[32]  C. Yutani,et al.  Mechanisms of cerebral artery thrombosis: a histopathological analysis on eight necropsy cases. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[33]  A. Barger,et al.  Rupture of coronary vasa vasorum as a trigger of acute myocardial infarction. , 1990, The American journal of cardiology.

[34]  S. Higano,et al.  Evaluation of Large Intracranial Aneurysm with Three‐Dimensional MRI , 1995, Journal of computer assisted tomography.

[35]  R M Henkelman,et al.  High‐resolution MR imaging of human arteries , 1995, Journal of magnetic resonance imaging : JMRI.

[36]  P Douek,et al.  Contrast-enhanced magnetic resonance tomoangiography: a new imaging technique for studying thoracic great vessels. , 1993, Magnetic resonance imaging.

[37]  E. Bluth.  Evaluation and characterization of carotid plaque. , 1997, Seminars in ultrasound, CT, and MR.

[38]  R Kikinis,et al.  Common carotid artery bifurcation: evaluation with spiral CT. Work in progress. , 1992, Radiology.

[39]  M. Prince.  Gadolinium-enhanced MR aortography. , 1990, Radiology.

[40]  M. Prince,et al.  Arterial-phase three-dimensional contrast-enhanced MR angiography of the carotid arteries. , 1996, AJR. American journal of roentgenology.

[41]  J. Im,et al.  Takayasu arteritis: evaluation of mural changes in the aorta and pulmonary artery with CT angiography. , 1995, Radiology.

[42]  Computed tomographic study of cervical carotid calcification. , 1989, Stroke.

[43]  L. Chambless,et al.  Association of transient ischemic attack/stroke symptoms assessed by standardized questionnaire and algorithm with cerebrovascular risk factors and carotid artery wall thickness. The ARIC Study, 1987-1989. , 1996, American journal of epidemiology.

[44]  D. Nichols,et al.  Intracranial cerebrovascular vasa vasorum associated with atherosclerosis and large thick-walled aneurysms. , 1991, Surgical Neurology.

[45]  E. Haacke,et al.  Contrast‐enhanced magnetic resonance angiography of carotid arterial wall in pigs , 1997, Journal of magnetic resonance imaging : JMRI.

[46]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.

[47]  P. Savage,et al.  Duration of diabetes and carotid wall thickness. The Insulin Resistance Atherosclerosis Study (IRAS). , 1997, Stroke.

[48]  T L Chenevert,et al.  The effects of time varying intravascular signal intensity and k‐space acquisition order on three‐dimensional MR angiography image quality , 1996, Journal of magnetic resonance imaging : JMRI.

[49]  C Yuan,et al.  Phased‐Array Magnetic Resonance Imaging of the Carotid Artery Bifurcation: Preliminary Results in Healthy Volunteers and a Patient with Aherosclerotic Disease , 1995, Journal of magnetic resonance imaging : JMRI.

[50]  J. Pauly,et al.  Characterization of atherosclerosis with a 1.5‐T imaging system , 1993, Journal of magnetic resonance imaging : JMRI.

[51]  A. Sterpetti,et al.  Importance of ulceration of carotid plaque in determining symptoms of cerebral ischemia. , 1991, The Journal of cardiovascular surgery.

[52]  Yixia Zhang,et al.  Immunohistochemical study of intimal microvessels in coronary atherosclerosis. , 1993, The American journal of pathology.

[53]  R M Henkelman,et al.  Arterial imaging: comparison of high-resolution US and MR imaging with histologic correlation. , 1997, Radiographics : a review publication of the Radiological Society of North America, Inc.

[54]  C. Warlow,et al.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis , 1991, The Lancet.