• Jin Li, Dongye Li, Dandan Yang, Hailun Hang, Yawei Wu, Rong Yao, Xiaoyi Chen, Yilan Xu, Wei Dai, Dan Zhou, and Xihai Zhao.
• Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China.
• J Magn Reson Imaging. 2020 Jul 1; 52 (1): 185-194.

BackgroundThe relationship between plaque compositions and irregular plaque surface and its predictive value for vascular events (VEs) are unknown.PurposeTo investigate the relationship between irregular carotid plaque surface and plaque compositional features and its predictive values for future VEs utilizing magnetic resonance (MR) vessel wall imaging.Study TypeProspective study.PopulationIn total, 140 patients with cerebrovascular symptoms were recruited.Field Strength/Sequence3T, black blood T1 -weighted, black blood T2 -weighted, 3D time-of-flight, magnetization-prepared rapid acquisition gradient echo (MP-RAGE), and 3D motion sensitized driven equilibrium rapid gradient echo (MERGE).AssessmentThe carotid artery stenosis and maximum wall thickness (Max WT) were measured. The presence/absence of irregular carotid plaque surface, calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture was determined. After baseline examination, all patients were followed-up for at least 1 year to record the VEs.Statistical TestsIndependent t-test, Mann-Whitney U-test, Chi-square, logistic regression, and Cox regression were used.ResultsIn total, 82 (58.6%) had irregular plaque surfaces. The carotid Max WT, stenosis, and the presence of surface calcification, LRNC and IPH were significantly associated with irregular plaque surface (all P < 0.05). After adjusted for baseline confounding factors, these associations remained statistically significant (all P < 0.05). During the median follow-up time of 12.1 months, 37 (26.4%) patients had VEs. Univariable Cox regression analysis showed that the irregular carotid plaque surface was significantly associated with subsequent VEs (hazard ratio [HR], 11.02; 95% confidence interval [CI], 2.65-45.85; P = 0.001). After adjusted for baseline and follow-up confounding factors, this association remained statistically significant (HR, 13.03; 95% CI, 1.71-99.42, P = 0.013). After further adjusted for intracranial stenosis, this association also remained statistically significant (HR, 12.57; 95% CI, 1.63-96.83, P = 0.015).Data ConclusionThe morphology of carotid atherosclerotic plaque surface determined by MR vessel wall imaging, particularly irregular plaque surface, is an independent predictor for subsequent vascular events.Level Of Evidence1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;52:185-194.© 2020 International Society for Magnetic Resonance in Medicine.

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