Intraplaque High-Intensity Signal on 3D Time-of-Flight MR Angiography Is Strongly Associated with Symptomatic Carotid Artery Stenosis

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Fig 1.
A, Axial 3D-TOF source image demonstrates signal hyperintensity in the plaque (arrow) of the high-grade right internal carotid artery stenosis. B, 3D-TOF maximum-intensity projection image of the same right carotid artery bifurcation illustrates a long-segment hyperintense signal (arrow) within the plaque of the right internal carotid artery consistent with IPH.

Table 1:

Vascular risk factors in patients with and without IPH defined on MRA

Risk Factors	IPH-Positive (n = 22)	IPH-Negative (n = 31)	P Value
Age (mean years)	76.4 ± 9.46	77.6 ± 9.43	.6406
Sex: male, n (%)	13 (59)	9 (29)	.0286
Diabetes (%)	9 (41)	13 (42)	.9404
Hypertension (%)	18 (82)	30 (97)	.1474
Hyperlipidemia (%)	18 (82)	26 (84)	.8445
Atrial fibrillation (%)	4 (18)	3 (10)	.3676
Coronary artery disease (%)	9 (41)	14 (45)	.7583
Smoking (%)	15 (68)	19 (61)	.6062
Heart failure (%)	3 (14)	4 (13)	.9381
COPD (%)	2 (9)	4 (13)	.6660
Chronic kidney disease (%)	7 (32)	6 (19)	.2988
Stenosis severity: 95%–99% (%)	1 (5)	3 (10)	.6332

Table 2:

Presence of symptomatic cerebrovascular ischemia with or without IPH on MRA

	IPH-Positive	IPH-Negative	P Value
History of any prior ipsilateral symptomatic disease, n (%)	15 (68)	4 (13)	<.0001
Median time since prior TIA/stroke, days	0 (IQR: 0–10)	0 (IQR: 0–7)	.7619
History of prior ipsilateral stroke, n (%)	10 (67)	3 (75)	.7500
Median time since prior stroke, days	0 (IQR: 0–7)	0 (IQR: 0–0)	.3605
History of prior TIA, n (%)	5 (33)	1 (25)	.7500
Median time since prior TIA, days	0 (IQR: 0–180)	14 (IQR: N/A)	.5338

Table 3:

Summary of effect size and strength of association between IHIS and stroke or TIA

Type of Association	OR	95% CI
IHIS and any prior ischemic event	14.5	3.6–57.6
IHIS and prior ischemic event within 6 months	13.5	3.4–54.1
IHIS on 1.5T and prior ischemic event	17.8	3.0–105.9
IHIS on 3T and prior ischemic event	13.8	1.2–156.6