Relationship between carotid plaque surface morphology and perfusion: a 3D DCE-MRI study

OBJECTIVE: This study aims to explore the relationship between plaque surface morphology and neovascularization using a high temporal and spatial resolution 4D contrast-enhanced MRI/MRA sequence. MATERIALS AND METHODS: Twenty one patients with either recent symptoms or a carotid artery stenosis ≥40% were recruited in this study. Plaque surface morphology and luminal stenosis were determined from the arterial phase MRA images. Carotid neovascularization was evaluated by a previously validated pharmacokinetic (PK) modeling approach. K (trans) (transfer constant) and v (p) (partial plasma volume) were calculated in both the adventitia and plaque. RESULTS: Image acquisition and analysis was successfully performed in 28 arteries. Mean luminal stenosis was 44% (range 11–82%). Both adventitial and plaque K (trans) in ulcerated/irregular plaques were significantly higher than smooth plaques (0.079 ± 0.018 vs. 0.064 ± 0.011 min(−1), p = 0.02; 0.065 ± 0.013 vs. 0.055 ± 0.010 min(−1), p = 0.03, respectively). Positive correlations between adventitial K (trans) and v (p) against stenosis were observed (r = 0.44, p = 0.02; r = 0.55, p = 0.01, respectively). CONCLUSION: This study demonstrates the feasibility of using a single sequence to acquire both high resolution 4D CE-MRA and DCE-MRI to evaluate both plaque surface morphology and function. The results demonstrate significant relationships between lumen surface morphology and neovascularization.