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MRI of carotid atherosclerosis to identify TIA and stroke patients who are at risk of a recurrence

Authors

  • Robert M. Kwee MD, PhD,

    Corresponding author
    1. Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
    2. Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
    • Department of Radiology, MUMC, PO Box 5800, 6202 AZ Maastricht, the Netherlands
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  • Robert J. van Oostenbrugge MD, PhD,

    1. Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
    2. Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
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  • Werner H. Mess MD, PhD,

    1. Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
    2. Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, the Netherlands
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  • Martin H. Prins MD, PhD,

    1. Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
    2. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
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  • Rob J. van der Geest PhD,

    1. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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  • Johannes W.M. ter Berg MD, PhD,

    1. Department of Neurology, Orbis Medical Center, Sittard, the Netherlands
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  • Cees L. Franke MD, PhD,

    1. Department of Neurology, Atrium Medical Center Parkstad, Heerlen, the Netherlands
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  • Arthur G.G.C. Korten MD, PhD,

    1. Department of Neurology, Laurentius Hospital, Roermond, the Netherlands
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  • Bé J. Meems MD,

    1. Department of Neurology, VieCuri Medical Center, Venlo, the Netherlands
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  • Jos M.A. van Engelshoven MD, PhD,

    1. Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
    2. Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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  • Joachim E. Wildberger MD, PhD,

    1. Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
    2. Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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  • M. Eline Kooi PhD

    1. Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
    2. Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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Abstract

Purpose:

To evaluate the potential of carotid plaque MRI to predict transient ischemic attack (TIA) and stroke recurrence in previously symptomatic patients.

Materials and Methods:

One hundred twenty-six TIA/stroke patients with ipsilateral 30–69% carotid stenosis underwent multisequence carotid plaque MRI. The presence of a lipid-rich necrotic core (LRNC), fibrous cap (FC) status, and intraplaque hemorrhage (IPH) were assessed. Patients were followed to determine the recurrence of ipsilateral TIA and/or stroke within 1 year after inclusion.

Results:

Thirteen patients suffered from recurrent ipsilateral clinical ischemic events (10 TIAs and 3 strokes). Carotid stenosis grade was not associated with recurrent events (hazard ratio [HR] for 50–69% versus 30–49% stenosis = 1.198; 95% confidence interval [CI], 0.383 to 3.749; P = 0.756). The presence of an LRNC (HR = 3.2001; 95% CI, 1.078 to 9.504; P = 0.036), a thin and/or ruptured FC (HR = 5.756; 95% CI, 1.913 to 17.324; P = 0.002), and IPH (HR = 3.542; 95% CI, 1.058 to 11.856; P = 0.040) were associated with recurrence.

Conclusion:

The presence of MRI-depicted LRNC, a thin and/or ruptured FC, and IPH are associated with the recurrence of clinical cerebrovascular ischemic events in TIA and stroke patients with carotid atherosclerosis. J. Magn. Reson. Imaging 2013;37:1189–1194. © 2013 Wiley Periodicals, Inc.

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