Giacomo Papini MD, Presenter: Nothing to Disclose

Pietro Restivo, Abstract Co-Author: Nothing to Disclose

Biagio Cotticelli MD, Abstract Co-Author: Nothing to Disclose

Stefania Tritella MD, Abstract Co-Author: Nothing to Disclose

Giovanni Di Leo, Abstract Co-Author: Nothing to Disclose

Francesco Sardanelli MD, Abstract Co-Author: Consultant, Bracco Group

Claudio Clemente MD, Abstract Co-Author: Nothing to Disclose

Domenico Tealdi, Abstract Co-Author: Nothing to Disclose

To assess whether CPCE is associated either with ICI at histopathology or with CCVE at follow-up.

Twenty-eight patients (67±9 years, group I) already scheduled for thromboendarterectomy underwent 1.5-T MR imaging using: (a) unenhanced axial T1-w gradient-echo sequence on carotid bifurcations, with/without fat-sat; (b) MR angiography with 0.1 mmol/kg of Gd-BOPTA; (c) repetition of (a), without fat-sat, 3 min after contrast injection. Two readers in consensus evaluated CPCE on subtracted images as absent, focal, or wide as well as the stenosis degree according to NASCET. ICI was assessed at histopathology using the same 3-point score system. We also studied 81 patients (71±9 years, group II) with known atheromatous carotid plaque using the same imaging protocol and evaluation. After a median of 2.8 years, patients of group II were phoned and asked whether major CCVE occurred, including surgical interventions. Agreement between CPCE and ICI was evaluated using Cohen kappa. Diagnostic performance was obtained collapsing the score system in a binary variable. The correlation among stenosis degree, CCVE, CPCE and ICI was estimated with the χ2 test. Analysis was performed per carotid bifurcation for group I and per patient for group II.

Group I: ICI was absent in 16 plaques, focal in 8, wide in 4. Due to motion artifacts we analyzed only 22 plaques: CPCE was absent in 13, focal in 6, wide in 3 (k=0.57). Sensitivity was 0.78 (7/9), specificity 0.85 (11/13), accuracy 0.82 (18/22), positive predictive value 0.78 (7/9), negative predictive value 0.85 (11/13). Stenosis degree was moderate in 7 and severe in 21 carotid arteries, without correlation either with ICI (p=1.000, n=28) or with CPCE (p=1.000, n=22). Group II: due to motion artifacts, we studied 70 patients. CCVE correlated with both CPCE (p=0.032) and stenosis degree (p=0.006); excluding surgical interventions from CCVE, the correlation holds only for CPCE (p=0.017). At binary analysis, 10% (5/49) of patients with CPCE reported CCVE; none of the 21 patients without CPCE reported CCVE (p=0.129).

CPCE using 0.1 mmol/kg of Gd-BOPTA can be used as a marker of inflammation. Major CCVE occurs in 10% of patients with CPCE.

CPCE may be useful in the definition of patients at risk of major CCVE and could be used in the management of patients. CPCE has a very high negative predictive value for CCVE.

Papini, G, Restivo, P, Cotticelli, B, Tritella, S, Di Leo, G, Sardanelli, F, Clemente, C, Tealdi, D, Carotid Plaque Contrast Enhancement (CPCE) at Magnetic Resonance (MR) Imaging: Association with Inflammatory Cell Infiltration (ICI) or Cerebro- or Cardiovascular Events (CCVE).  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011034.html