The usefulness of Time-of-Flight MR angiography in detection of intraplaque hemorrhage in patients with acute ischemic stroke with symptomatic carotid stenosis

• Published in: PloS one Vol. 15; no. 2; p. e0229024
• Main Authors: Gwak, Dong-Seok, Kim, Baik-Kyun, Chung, Inyoung, Han, Moon-Ku
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.02.2020; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Angiography; Biology and Life Sciences; Brain Ischemia - diagnostic imaging; Cardiac arrhythmia; Carotid arteries; Carotid Stenosis - diagnosis; Cerebral infarction; Evaluation; Female; Hemorrhage; Hemorrhage - diagnostic imaging; Humans; Identification methods; Infarction; Ischemia; Laboratories; Magnetic resonance; Magnetic Resonance Angiography - methods; Magnetic resonance imaging; Male; Medical imaging; Medicine and Health Sciences; Middle Aged; Neurology; Research and Analysis Methods; Resonance; Retrospective Studies; Stenosis; Stroke; Stroke - diagnostic imaging; Thromboembolism; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0229024

Carotid intraplaque hemorrhage (IPH) is a well-known risk indicator of thromboembolism, but it is not easy to rapidly detect IPH in acute symptomatic carotid disease. The aim of this study was to assess the utility of time-of-flight (TOF) magnetic resonance angiography (MRA) in the detection of IPH and evaluate the degree of stenosis and stroke patterns in patients with acute symptomatic carotid disease. We retrospectively identified consecutive patients with acute symptomatic carotid disease who were admitted within 12 h after stroke onset. Fifty-nine patients underwent TOF MRA at admission and were categorized according to the presence or absence of intraplaque high signal intensity (HSI). The severity of carotid stenosis and diffusion-weighted magnetic resonance imaging lesion patterns were evaluated. Intraplaque HSI was detected in 28.8% of the enrolled patients (17/59). Mild-to-moderate symptomatic carotid stenosis was more frequent in the intraplaque HSI-positive group (70.6%) than in the intraplaque HSI-negative group (42.8%) (p = 0.015). The patients with intraplaque HSI more frequently exhibited a disseminated small infarction pattern (76.5% in the intraplaque HSI-positive group, 47.6% in the -negative group), and did not exhibit a border-zone infarction pattern (0% in the positive group, 16.7% in the negative group). TOF MRA may be a useful noninvasive and rapid tool to detect IPH in patients with acute symptomatic carotid disease. IPH was common in those with a lower degree of carotid stenosis and manifested as a disseminated small infarction pattern. Intraplaque HSI on TOF MRA in acute symptomatic carotid disease may help to determine the mechanism of stroke and establish early treatment plans.