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Research ArticleExtracranial Vascular
Open Access

Comparison of Carotid Plaque Ulcer Detection Using Contrast-Enhanced and Time-of-Flight MRA Techniques

M. Etesami, Y. Hoi, D.A. Steinman, S.K. Gujar, A.E. Nidecker, B.C. Astor, A. Portanova, Y. Qiao, W.M.A. Abdalla and B.A. Wasserman
American Journal of Neuroradiology January 2013, 34 (1) 177-184; DOI: https://doi.org/10.3174/ajnr.A3132
M. Etesami
aFrom the Russell H. Morgan Department of Radiology and Radiological Sciences (M.E., S.K.G., Y.Q., W.M.A.A., B.A.W.), The Johns Hopkins Hospital, Baltimore, Maryland
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Y. Hoi
bDepartment of Mechanical & Industrial Engineering (Y.H., D.A.S.), University of Toronto, Toronto, Ontario, Canada
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D.A. Steinman
bDepartment of Mechanical & Industrial Engineering (Y.H., D.A.S.), University of Toronto, Toronto, Ontario, Canada
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S.K. Gujar
aFrom the Russell H. Morgan Department of Radiology and Radiological Sciences (M.E., S.K.G., Y.Q., W.M.A.A., B.A.W.), The Johns Hopkins Hospital, Baltimore, Maryland
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A.E. Nidecker
cDepartment of Radiology (A.E.N.), University of California Davis Medical Center, Sacramento, California
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B.C. Astor
dDepartments of Medicine and Population Health Sciences (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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A. Portanova
eSchool of Medicine (A.P.), University of Rochester Medical Center, Rochester, New York.
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Y. Qiao
aFrom the Russell H. Morgan Department of Radiology and Radiological Sciences (M.E., S.K.G., Y.Q., W.M.A.A., B.A.W.), The Johns Hopkins Hospital, Baltimore, Maryland
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W.M.A. Abdalla
aFrom the Russell H. Morgan Department of Radiology and Radiological Sciences (M.E., S.K.G., Y.Q., W.M.A.A., B.A.W.), The Johns Hopkins Hospital, Baltimore, Maryland
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B.A. Wasserman
aFrom the Russell H. Morgan Department of Radiology and Radiological Sciences (M.E., S.K.G., Y.Q., W.M.A.A., B.A.W.), The Johns Hopkins Hospital, Baltimore, Maryland
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    Fig 1.

    Examples of 3 ulcer orientations shown on CE-MRA MIP images. Perpendicular: If a line is to be drawn connecting the center of the ulcer opening and its tip, it will be perpendicular to the vessel axis. Distally pointing: Ulcer tip is distal to its opening. Proximally pointing: Ulcer tip is proximal to its opening.

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    Fig 2.

    Technique for measuring ulcer dimensions. Ulcer neck (A), maximum craniocaudal dimension (B) and depth (C) were measured on CE-MRA MIP images based on the view that shows the largest dimensions (Fig 2A). Maximum transverse dimension (D) was measured on the reconstructed CE-MRA source image oriented perpendicular to the vessel axis that shows the largest transverse dimension (Fig 2B).

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    Fig 3.

    MIP images of a distally pointing ulcer (A) detected on both CE-MRA and TOF-MRA, and a proximally pointing ulcer (B) detected on CE-MRA but not on TOF-MRA.

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    Fig 4.

    Visualization of flow patterns computed in a 30%-stenosed carotid bifurcation with distally and proximally pointing ellipsoidal ulcers. The leftmost column shows the full CFD models and the initial distribution of particles seeded at end diastole. Subsequent columns show the distribution of particles remaining after each peak systole, with the amount of time since seeding (ie, residence time) also indicated. Colors are used to indicate particle velocity in cm/s, and size indicates the depth of the particles such that large particles are those closest to the symmetry plane and small particle are those closest to the walls.

Tables

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    Table 1:

    Ulcer detection by CE-MRA and TOF-MRA techniques for individual ulcers and vessels for 2 readers

    Reader 1 Number (%)Reader 2 Number (%)
    Individual ulcer detection
        Both CE and TOF45 (63)33 (46.5)
        Only CE24 (34)29 (41)
        Only TOF1 (1.5)1 (1.5)
        Neither CE nor TOF1 (1.5)8 (11)
        Total (all MR sequences)71 (100)71 (100)
    Vessels detected as ulcerated
        Both CE and TOF41 (73)30 (54)
        Only CE14 (25)23 (41)
        Only TOF1 (2)1 (2)
        Neither CE nor TOF0 (0)2 (3)
        Total (all MR sequences)56 (100)56 (100)
    • View popup
    Table 2:

    Characteristics of 69 ulcers detected by CE-MRA by reader 1 and TOF-MRA ulcer-detection percent for each characteristic

    CharacteristicsDetected by CE-MRAaDetected by TOF-MRAb (among Those Detected by CE-MRA)
    IQ score
        128 (41)18 (64)
        241 (59)27 (66)
    Ulcer orientationc
        Perpendicular47 (68)28 (60)
        Distally pointing16 (23)15 (94)
        Proximally pointing6 (9)2 (33)
    Ulcer location relative to point of maximum stenosisc
        Proximal36 (52)26 (72)
        Isolevel14 (20)5 (36)
        Distal19 (28)14 (74)
    Ulcer location relative to FD
        Proximal18 (26)13 (72)
        Isolevel28 (41)19 (68)
        Distal23 (33)13 (57)
    Ulcer circumferential location
        Opposite FD44 (64)29 (66)
        Along FD0 (0)0 (N/A)
        On sidewalls25 (36)16 (64)
    Ulcer neck-to-depth ratioc1.61 (0.56)1.71 (0.57)
    Ulcer volume index (mm3)c67.63 (66.50)81.83 (75.09)
    Degree of stenosis (%)c27.16 (18.06)23.4 (16.10)
    • ↵a Data are presented as number of ulcers (% of 69) or mean (SD).

    • ↵b Data are presented as number of ulcers (% in category) or mean (SD).

    • ↵c P < .05 in univariable regression model.

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    Table 3:

    Multivariable logistic regression model for ulcer detection by TOF-MRA among ulcers detected by CE-MRA

    CharacteristicMultivariable
    OR95% CIP
    Orientation (distally pointing vs perpendicular)5.571.08–28.650.04
    Orientation (proximally-pointing vs perpendicular)0.210.14–0.29<0.001
    Location (proximal vs isolevel)a2.790.94–8.320.06
    Location (distal vs isolevel)a5.172.10–12.70<0.001
    Neck-to-depth ratio1.961.11–3.450.02
    Volume index1.011.00–1.020.06
    Degree of stenosis0.970.94–1.010.23
    • Note:—Robust variance estimate was used to account for 2 readers' results for each ulcer.

    • ↵a Ulcer location relative to point of maximum stenosis.

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American Journal of Neuroradiology: 34 (1)
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M. Etesami, Y. Hoi, D.A. Steinman, S.K. Gujar, A.E. Nidecker, B.C. Astor, A. Portanova, Y. Qiao, W.M.A. Abdalla, B.A. Wasserman
Comparison of Carotid Plaque Ulcer Detection Using Contrast-Enhanced and Time-of-Flight MRA Techniques
American Journal of Neuroradiology Jan 2013, 34 (1) 177-184; DOI: 10.3174/ajnr.A3132

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Comparison of Carotid Plaque Ulcer Detection Using Contrast-Enhanced and Time-of-Flight MRA Techniques
M. Etesami, Y. Hoi, D.A. Steinman, S.K. Gujar, A.E. Nidecker, B.C. Astor, A. Portanova, Y. Qiao, W.M.A. Abdalla, B.A. Wasserman
American Journal of Neuroradiology Jan 2013, 34 (1) 177-184; DOI: 10.3174/ajnr.A3132
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