Article Figures & Data
Figures
- Fig 1.
Coregistration of MRA and histologic images. MIP image from the TOF-MRA that profiles the narrowed lumen contour (A) used to show the position of 8 reformatted TOF (B) and CE-MRA mask (C) sections (reconstructed thickness, 2 mm), to orient transverse 5-μm histologic sections through the specimen (D). IPH is identified as hyperintense signal intensity compared with adjacent muscle on MRA images (arrows, B and C) and is red on histologic sections (D) stained with Movat pentachrome.
- Fig 2.
Identifying IPH on CE-MRA mask images in a 72-year-old man with a right cerebral ischemic event. Coronal and reconstructed axial (inset) sections from the mask (A) series show hyperintense signal intensity (arrows) in the right carotid artery wall. The high signal intensity (arrows) is again seen on the corresponding postcontrast images (B) but is removed after the mask images are subtracted from this series (C). (Asterisk indicates the lumen.) MIP images are generated from the subtracted series (D), so IPH information is lost.
- Fig 3.
MRA images with matched histology for a 73-year-old man with a right cerebral ischemic event. Hyperintense signal intensity on the postcontrast (arrow, A) and mask (arrow, B) CE-MRA images (asterisk indicates the lumen) corresponds to red staining representing IPH on histology (C, Movat pentachrome stain). Immunostaining for glycophorin A (D) confirms the presence of erythrocytes (dark brown staining) mixed with cholesterol clefts (arrows, D) for a region within the core (box, C).
- Fig 4.
An example of IPH missed on both CE- and TOF-MRA. Reconstructed axial mask (A), postcontrast (B), and TOF-MRA (C) images in matched locations transversely through a carotid plaque show no hyperintense signal intensity to suggest IPH (asterisk indicates the lumen). The corresponding CEA specimen section stained with Movat pentachrome demonstrates an attenuated fibrin network. A high-power view (E) of a region of necrotic core (box, D) shows scattered erythrocytes (arrow, E).
Tables
Agreement between IPH detected by MR imaging and histology
Reader Histology + Histology − Total No. of Images 63 81 144 CE-MRA maska 1 + 57 2 59 − 6 79 85 2 + 53 0 53 − 10 81 91 TOFb 1 + 50 11 61 − 13 70 83 2 + 50 10 60 − 13 71 84 -
a Reader 1: Sensitivity, specificity, PPV, and NPV (95% CI) are 90% (80%–96%), 98% (91%–100%), 97% (87%–99%), and 93% (85%–97%), respectively. Reader 2: Sensitivity, specificity, PPV, and NPV (95% CI) are 84% (72%–92%), 100% (94%–100%), 100% (92%–100%), and 89% (80%–94%), respectively.
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b Reader 1: Sensitivity, specificity, PPV, and NPV (95% CI) are 79% (66%–88%), 86% (77%–93%), 82% (70%–90%), and 84% (74%–91%), respectively. Reader 2: Sensitivity, specificity, PPV, and NPV (95% CI) are 79% (67%–88%), 88% (78%–94%), 83% (71%–91%), and 85% (75%–91%), respectively.
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