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Usefulness of rapid MR angiography using two-point Dixon for evaluating carotid and aortic plaques

  • Diagnostic Neuroradiology
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Abstract

Purpose

Recently, various magnetic resonance imaging (MRI) modalities have been developed to easily detect carotid and aortic plaques, but these techniques are time-consuming and vulnerable to motion artifacts. We investigated the utility of a gradient echo MRI technique known as liver acquisition with volume acceleration flexible (LAVA-Flex) to detect carotid and aortic atherosclerotic plaques.

Methods

Ten patients who underwent carotid endarterectomy (CEA) were assessed regarding the correspondence between LAVA-Flex findings and the histopathology of excised carotid plaques. In addition, 47 patients with cryptogenic ischemic stroke underwent LAVA-Flex and transesophageal echocardiography (TEE) for detection of embolic sources in the thoracic aorta. We analyzed the relationship between the thickness of the aortic plaque measured by TEE and the presence of high-intensity lesions on LAVA-Flex.

Results

Nine of 10 patients (90.0%) who underwent CEA showed a high-intensity carotid lesion on LAVA-Flex, which corresponded pathologically to plaques containing large lipid cores and hemorrhage. Twenty-four (51.1%) of 47 cryptogenic stroke patients showed a high-intensity lesion in the thoracic aorta on LAVA-Flex; of these, 21 (87.5%) also demonstrated a large plaque (thickness ≥4 mm) on TEE. Twenty-two (95.7%) of 23 patients without a high-intensity lesion on LAVA-Flex demonstrated no large plaque on TEE. LAVA-Flex had a sensitivity of 95.5% and a specificity of 88.0% in patients with large plaques.

Conclusion

This study showed that LAVA-Flex successfully detected carotid and aortic plaques. This imaging technique may be useful to rapidly diagnose and evaluate carotid and aortic plaques, which are critical risk factors for aortogenic stroke.

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Author notes

  1. Keisuke Morihara and Tatsu Nakano contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan

    Keisuke Morihara & Tatsu Nakano

  2. Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Keisuke Morihara, Hideyuki Takeuchi, Hiroshi Doi & Fumiaki Tanaka

  3. Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan

    Kentaro Mori, Issei Fukui, Motohiro Nomura & Yoshihisa Kitamura

  4. Department of Radiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan

    Keiichiro Suzuki, Kenichi Hirano & Mitsuyuki Takahashi

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  1. Keisuke Morihara
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Contributions

K.Morihara, T.N., and F.T. contributed to conception and study design. K. Morihara, T.N., K. Mori, I.F., M.N., K.S., K.H., and M.T. contributed to acquisition and analysis of data. H.T., H.D., Y.K., and F.T. advised the interpretation of data. K. Morihara and F.T. contributed to drafting manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fumiaki Tanaka.

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Morihara, K., Nakano, T., Mori, K. et al. Usefulness of rapid MR angiography using two-point Dixon for evaluating carotid and aortic plaques. Neuroradiology 64, 693–702 (2022). https://doi.org/10.1007/s00234-021-02812-w

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