High-Resolution 3T Carotid MRI Identifies the High-Risk Lesion in Patients with Moderate (<70%) Carotid Stenosis

J. Kevin DeMarco¹, Hideki Ota¹, Hunter R. Underhill², David Zhu¹, Mat Reeves¹, Arshad Majid¹, Alonso Collar³, Minako Oikawa², Li Dong², Xihai Zhao², Feiyu Li², Vasily L. Yarnykh², Chun Yuan²

In order to improve the evaluation of carotid stenosis, we combined multi-contrast carotid plaque imaging with very high-resolution (0.28mm3) contrast-enhanced MRA at 3.0 T. Ninety-seven consecutive outpatients were studied. For the population as a whole and for subgroups of <70% and 70-99% stenosis, intraplaque hemorrhage, particularly Type I hemorrhage, was significantly associated with symptom status. In lesions with <70% stenosis by MRA, we found a strong association between fibrous cap status, intraplaque hemorrhage, and the size of the necrotic core with symptom. In patients with <70% stenosis, carotid plaque imaging may be able to distinguish between stable and unstable lesions.