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Research ArticleBrain

Intracranial-Derived Atherosclerosis Assessment: An In Vitro Comparison between Virtual Histology by Intravascular Ultrasonography, 7T MRI, and Histopathologic Findings

S. Majidi, J. Sein, M. Watanabe, A.E. Hassan, P.-F. Van de Moortele, M.F.K. Suri, H.B. Clark and A.I. Qureshi
American Journal of Neuroradiology December 2013, 34 (12) 2259-2264; DOI: https://doi.org/10.3174/ajnr.A3631
S. Majidi
aFrom the Zeenat Qureshi Stroke Research Center (S.M., M.W., A.E.H., M.F.K.S., A.I.Q.)
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J. Sein
bCenter for Magnetic Resonance Research (J.S., P.-F.V.d.M.)
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M. Watanabe
aFrom the Zeenat Qureshi Stroke Research Center (S.M., M.W., A.E.H., M.F.K.S., A.I.Q.)
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A.E. Hassan
aFrom the Zeenat Qureshi Stroke Research Center (S.M., M.W., A.E.H., M.F.K.S., A.I.Q.)
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P.-F. Van de Moortele
bCenter for Magnetic Resonance Research (J.S., P.-F.V.d.M.)
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M.F.K. Suri
aFrom the Zeenat Qureshi Stroke Research Center (S.M., M.W., A.E.H., M.F.K.S., A.I.Q.)
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H.B. Clark
cDepartment of Laboratory Medicine and Pathology (H.B.C.), University of Minnesota, Minneapolis, Minnesota.
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A.I. Qureshi
aFrom the Zeenat Qureshi Stroke Research Center (S.M., M.W., A.E.H., M.F.K.S., A.I.Q.)
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    Fig 1.

    Characteristics of Eagle Eye Gold IVUS imaging catheter.

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    Fig 2.

    Histopathologic sections with corresponding VH-IVUS images. A and B, Fibrous (arrows in A) and fibrofatty (arrowheads in A) tissues in the histologic section are correlated with dark green and light green areas in VH-IVUS, respectively. C and D, attenuated calcium and necrotic area (arrows in C) and its corresponding area in VH-IVUS red (necrosis) and white (attenuated calcium) areas.

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    Fig 3.

    Four different histopathologic sections of intracranial vessels with atherosclerotic plaque and their corresponding 3D SPACE MR imaging (in the middle) and VH-IVUS (on the right) images. Fibrous areas (arrows) and attenuated calcium (arrowheads) consistently visualized as areas with hyperintense and hypointense signals in MR imaging, respectively.

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    Table 1:

    Comparison of different types of atherosclerotic plaques between VH-IVUS and histologic sections (as reference standard)

    Category of PlaquePlaque Classification by Histological AnalysisPlaque Classification by VH-IVUS Analysis
    True-PositiveTrue-NegativeFalse-PositiveFalse-NegativeSensitivitySpecificityPPVNPV
    No plaque223200100100100100
    Pathologic intima thickening6328035010010090.3
    Fibroatheroma1915114478.973.378.973.3
    Calcified fibroatheromaa0033100970100
    Thin-cap fibroatheroma32301166.696.766.696.7
    Calcified thin-cap fibroatheroma2131115096.85096.8
    Fibrocalcific atheroma223200100100100100
    Total34251977973.596.678.195.6
    • PPV indicates positive predictive value; NPV, negative predictive value.

    • ↵a Number is small and requires cautious interpretation of false-positive or false-negative values.

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    Table 2:

    Area of 4 different components of plaque types in histologic sections and VH-IVUS analyses

    Histopathology, % (SD)VH-IVUS, % (SD)Pearson Correlation
    Fibrous45.6 (18.7)50.8 (17.1)0.66
    Fibrofatty35.6 (14.1)12.5 (12.1)0.34
    Dense calcium7.1 (7.6)9.1 (5.2)0.64
    Necrosis5.1 (4.6)20.9 (10.9)0.23
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American Journal of Neuroradiology: 34 (12)
American Journal of Neuroradiology
Vol. 34, Issue 12
1 Dec 2013
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S. Majidi, J. Sein, M. Watanabe, A.E. Hassan, P.-F. Van de Moortele, M.F.K. Suri, H.B. Clark, A.I. Qureshi
Intracranial-Derived Atherosclerosis Assessment: An In Vitro Comparison between Virtual Histology by Intravascular Ultrasonography, 7T MRI, and Histopathologic Findings
American Journal of Neuroradiology Dec 2013, 34 (12) 2259-2264; DOI: 10.3174/ajnr.A3631

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Intracranial-Derived Atherosclerosis Assessment: An In Vitro Comparison between Virtual Histology by Intravascular Ultrasonography, 7T MRI, and Histopathologic Findings
S. Majidi, J. Sein, M. Watanabe, A.E. Hassan, P.-F. Van de Moortele, M.F.K. Suri, H.B. Clark, A.I. Qureshi
American Journal of Neuroradiology Dec 2013, 34 (12) 2259-2264; DOI: 10.3174/ajnr.A3631
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  • High-resolution intracranial vessel wall imaging: imaging beyond the lumen
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  • Multicontrast High-Resolution Vessel Wall Magnetic Resonance Imaging and Its Value in Differentiating Intracranial Vasculopathic Processes
  • Imaging the Intracranial Atherosclerotic Vessel Wall Using 7T MRI: Initial Comparison with Histopathology
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