Semi-automatic carotid intraplaque hemorrhage detection and quantification on Magnetization-Prepared Rapid Acquisition Gradient-Echo (MP-RAGE) with optimized threshold selection

BackgroundIntraplaque hemorrhage (IPH) is associated with atherosclerosis progression and subsequent cardiovascular events. We sought to develop a semi-automatic method with an optimized threshold for carotid IPH detection and quantification on MP-RAGE images using matched histology as the gold standard.MethodsFourteen patients scheduled for carotid endarterectomy underwent 3D MP-RAGE cardiovascular magnetic resonance (CMR) preoperatively. Presence and area of IPH were recorded using histology. Presence and area of IPH were also recorded on CMR based on intensity thresholding using three references for intensity normalization: the sternocleidomastoid muscle (SCM), the adjacent muscle and the automatically generated local median value. The optimized intensity thresholds were obtained by maximizing the Youden’s index for IPH detection. Using leave-one-out cross validation, the sensitivity and specificity for IPH detection based on our proposed semi-automatic method and the agreement with histology on IPH area quantification were evaluated.ResultsThe optimized intensity thresholds for IPH detection were 1.0 times the SCM intensity, 1.6 times the adjacent muscle intensity and 2.2 times the median intensity. Using the semi-automatic method with the optimized intensity threshold, the following IPH detection and quantification performance was obtained: sensitivities up to 59, 68 and 80 %; specificities up to 85, 74 and 79 %; Pearson’s correlation coefficients (IPH area measurement) up to 0.76, 0.93 and 0.90, respectively, using SCM, the adjacent muscle and the local median value for intensity normalization, after heavily calcified and small IPH were excluded.ConclusionsA semi-automatic method with good performance on IPH detection and quantification can be obtained in MP-RAGE CMR, using an optimized intensity threshold comparing to the adjacent muscle. The automatically generated reference of local median value provides comparable performance and may be particularly useful for developing automatic classifiers. Use of the SCM intensity as reference is not recommended without coil sensitivity correction when surface coils are used.

[1]  Chun Yuan,et al.  Automated in vivo segmentation of carotid plaque MRI with Morphology‐Enhanced probability maps , 2006, Magnetic resonance in medicine.

[2]  N. Altaf,et al.  MR Imaging–Detected Carotid Plaque Hemorrhage Is Stable for 2 Years and a Marker for Stenosis Progression , 2015, American Journal of Neuroradiology.

[3]  W S Kerwin,et al.  Carotid Plaque Composition Differs Between Ethno-Racial Groups: An MRI Pilot Study Comparing Mainland Chinese and American Caucasian Patients , 2005, Arteriosclerosis, thrombosis, and vascular biology.

[4]  Chun Yuan,et al.  Presence of Intraplaque Hemorrhage Stimulates Progression of Carotid Atherosclerotic Plaques: A High-Resolution Magnetic Resonance Imaging Study , 2005, Circulation.

[5]  C. Yuan,et al.  Blood Pressure Is a Major Modifiable Risk Factor Implicated in Pathogenesis of Intraplaque Hemorrhage: An In Vivo Magnetic Resonance Imaging Study , 2016, Arteriosclerosis, thrombosis, and vascular biology.

[6]  K. Iihara,et al.  Assessment of necrotic core with intraplaque hemorrhage in atherosclerotic carotid artery plaque by MR imaging with 3D gradient-echo sequence in patients with high-grade stenosis. Clinical article. , 2010, Journal of neurosurgery.

[7]  C. Yuan,et al.  Sustained acceleration in carotid atherosclerotic plaque progression with intraplaque hemorrhage: a long-term time course study. , 2012, JACC. Cardiovascular imaging.

[8]  Boudewijn P. F. Lelieveldt,et al.  Repeatability of in vivo quantification of atherosclerotic carotid artery plaque components by supervised multispectral classification , 2015, Magnetic Resonance Materials in Physics, Biology and Medicine.

[9]  Chun Yuan,et al.  Association Between Carotid Plaque Characteristics and Subsequent Ischemic Cerebrovascular Events: A Prospective Assessment With MRI—Initial Results , 2006, Stroke.

[10]  C. Yuan,et al.  Carotid intraplaque hemorrhage imaging at 3.0-T MR imaging: comparison of the diagnostic performance of three T1-weighted sequences. , 2010, Radiology.

[11]  Renu Virmani,et al.  Intraplaque hemorrhage and progression of coronary atheroma. , 2003, The New England journal of medicine.

[12]  Chun Yuan,et al.  Classification of Human Carotid Atherosclerotic Lesions With In Vivo Multicontrast Magnetic Resonance Imaging , 2002, Circulation.

[13]  W. Bradley.  MR appearance of hemorrhage in the brain. , 1993, Radiology.

[14]  C. Yuan,et al.  Quantitative Evaluation of Carotid Plaque Composition by In Vivo MRI , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[15]  Dorothee Auer,et al.  Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events. , 2008, Journal of vascular surgery.

[16]  T. Hatsukami,et al.  A multi‐scale method for automatic correction of intensity non‐uniformity in MR images , 2001, Journal of magnetic resonance imaging : JMRI.

[17]  David C. Zhu,et al.  An optimized 3D inversion recovery prepared fast spoiled gradient recalled sequence for carotid plaque hemorrhage imaging at 3.0 T. , 2008, Magnetic resonance imaging.

[18]  D. Parker,et al.  Reduced blood flow artifact in intraplaque hemorrhage imaging using CineMPRAGE , 2013, Magnetic resonance in medicine.

[19]  Yong Wang,et al.  Differences of signal evolution of intraplaque hemorrhage and associated stenosis between symptomatic and asymptomatic atherosclerotic carotid arteries: an in vivo high-resolution magnetic resonance imaging follow-up study , 2010, The International Journal of Cardiovascular Imaging.

[20]  Catherine Oppenheim,et al.  Reproducibility of High-Resolution MRI for the Identification and the Quantification of Carotid Atherosclerotic Plaque Components: Consequences for Prognosis Studies and Therapeutic Trials , 2007, Stroke.

[21]  Anne L. Martel,et al.  Characterization of Complicated Carotid Plaque With Magnetic Resonance Direct Thrombus Imaging in Patients With Cerebral Ischemia , 2003, Circulation.

[22]  C. Yuan,et al.  Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. , 2006, Radiology.

[23]  J. Narula,et al.  Effect of Intensive Statin Therapy on Coronary High-Intensity Plaques Detected by Noncontrast T1-Weighted Imaging: The AQUAMARINE Pilot Study. , 2015, Journal of the American College of Cardiology.

[24]  K. Iihara,et al.  ORIGINAL RESEARCH Association between Signal Hyperintensity on T1-Weighted MR Imaging of Carotid Plaques and Ipsilateral Ischemic Events , 2007 .

[25]  Bostjan Likar,et al.  A Review of Methods for Correction of Intensity Inhomogeneity in MRI , 2007, IEEE Transactions on Medical Imaging.