Ts. Hatsukami et al., Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging, CIRCULATION, 102(9), 2000, pp. 959-964
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-The results of studies of advanced lesions of atherosclerosis su
ggest that the thickness of the fibrous cap that overlies the necrotic core
distinguishes the stable lesion from one that is at high risk for rupture
and thromboembolic events. We have developed a high-resolution MRI techniqu
e that can identify the fine structure of the lesion, including the fibrous
cap, in vivo. The aim of the present study was to determine the agreement
between in vivo MRI and lesion architecture as seen on histology and gross
tissue examination to identify fibrous cap thickness and rupture.
Methods and Results-Twenty-two subjects who were scheduled for carotid enda
rterectomy underwent MRI with a 3-dimensional multiple overlapping thin sla
b angiography protocol. The appearance of the fibrous cap was categorized a
s (1) an intact, thick, (2) an intact, thin, or (3) a ruptured fibrous cap
on MRI, gross, and histological sections. Thirty-six sites were available f
or comparison between MRI and histology. There was a high level of agreemen
t between MRI and histological findings: 89% agreement, kappa (95% CI) = 0.
83 (0.67 to 1.0), weighted kappa = 0.87. Spearman's correlation coefficient
was 0.88 (significant to the 0.01 level).
Conclusions-These findings indicate that high-resolution MRI with a 3-dimen
sional multiple overlapping thin slab angiography protocol is capable of di
stinguishing intact, thick fibrous caps from intact thin and disrupted caps
in atherosclerotic human carotid arteries in vivo. This noninvasive techni
que has the potential to permit studies that examine the relationship betwe
en fibrous cap changes and clinical outcome and to permit trials that evalu
ate therapy intended to "stabilize" the fibrous cap.