• Jean Marie U-King-Im, Allan J Fox, Richard I Aviv, Peter Howard, Robert Yeung, Alan R Moody, and Sean P Symons.
• Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
• Stroke. 2010 Aug 1; 41 (8): 1623-9.

Background And PurposeThe main objective of this study was to evaluate CT angiographic (CTA) features that are able to predict the presence of intraplaque hemorrhage (IPH) as defined by MR-IPH.MethodsOne hundred sixty-seven consecutive patients (mean age 69 years, SD 12.8; 58 females) underwent both MR-IPH and CTA within 3 weeks. MR-IPH, the gold standard, was performed at 1.5 T using a neurovascular phased-array coil as a coronal T1-weighted 3-dimensional fat-suppressed acquisition. CTA was performed using a 4-slice or a 64-slice CT machine and evaluated, blinded to MR-IPH findings, for carotid stenosis, plaque density, and plaque ulceration. Plaque density was defined as the mean attenuation of plaque at the site of maximum stenosis and 2 sections above and below. Plaque ulceration was defined as outpouching of contrast into the plaque at least 2 mm deep on any single plane.ResultsPrevalence of IPH increased at higher degrees of carotid stenosis. Mean CT plaque density was higher for plaques with MRI-defined IPH (47 Hounsfield units) compared with without IPH (43 Hounsfield units; P=0.02). However, significant overlap between distributions of plaque densities limited the value of mean plaque density for prediction of IPH. CTA plaque ulceration had high sensitivity (80.0% to 91.4%), specificity (93.0% to 92.3%), positive predictive value (72.0% to 71.8%), and negative predictive value (95.0% to 97.9%) for prediction of IPH. Interobserver agreement for presence/absence of CTA plaque ulceration was excellent (kappa=0.80).ConclusionsCTA plaque ulceration, but not mean CTA plaque density, was useful for prediction of IPH as defined by the MR-IPH technique.

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