Optimal Prediction of Carotid Intraplaque Hemorrhage Using Clinical and Lumen Imaging Markers

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Fig 1.
Carotid plaque imaging markers. Stenosis is measured by using percentage diameter stenosis [(a − b) / a] and millimeter stenosis (b) (A, cursors). The presence of ulceration is determined on contrast MRA images by using a 2-mm measurement threshold (B, arrow). Intraluminal thrombus is defined as a filling defect on contrast MRA images (C, arrow). IPH is defined by MPRAGE-positive plaque, by using a signal threshold of 2-fold signal intensity over the adjacent sternocleidomastoid muscle (D, right carotid artery is MPRAGE-positive; left side of image). Maximum plaque thickness is measured in the transverse plane on 3D MPRAGE image (D, cursors).
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Fig 2.
Receiver operating characteristic comparison analysis. The final model IPH discriminatory value is excellent (blue, AUC = 0.932). The final model discriminatory value (blue) is significantly higher than a model with maximum plaque thickness only (yellow, AUC = 0.881, P < .001), a model with millimeter stenosis only (red, AUC = 0.830, P < .001), and a model with ulceration only (green, AUC = 0.715, P < .001).

Table 1:

Patient demographics

Carotid Stroke Predictor	Demographics by Vessel
Male sex (No./total No.) (%)	387/726 (53.3)
Age (yr) (mean) (SD)	64.2 (15.6)
BMI (mean) (SD) (kg/m²)	28.4 (6.4)
Smoking (No./total No.) (%)
Current smoker	138/726 (19.0)
Prior smoker	158/726 (21.8)
Never smoked	430/726 (59.2)
Hypertension (No./total No.) (%)	499/726 (68.7)
Hyperlipidemia (No./total No.) (%)	358/726 (49.3)
Diabetes (No./total No.) (%)	227/726 (31.3)
Cardiovascular medications
Antihypertension (No./total No.) (%)	412/726 (56.8)
Statins (No./total No.) (%)	316/726 (43.5)
Antiplatelet (No./total No.) (%)	294/726 (40.5)
Anticoagulation (No./total No.) (%)	74/726 (10.2)
Carotid plaque imaging markers
Stenosis (mean) (SD) (%)	12.2 (23.1)
Mild stenosis (0%–49%) (No./total No.) (%)	647/726 (89.1)
Moderate stenosis (50%–69%) (No./total No.) (%)	45/726 (6.2)
Severe stenosis (70%–99%) (No./total No.) (%)	34/726 (4.7)
Stenosis (mean) (SD) (mm)	4.1 (1.2)
Maximum plaque thickness (mean) (SD) (mm)	3.0 (1.6)
Ulceration (No./total No.) (%)	96/726 (13.2)
Intraluminal thrombus (No./total No.) (%)	19/726 (2.6)
Intraplaque hemorrhage (No./total No.) (%)	65/726 (9.0)
Magnet strength = 3T (No./total No.) (%)	58/726 (8.0)

Table 2:

Multivariable logistic regression

Carotid-IPH Predictor	IPH+ (n = 65)	IPH− (n = 661)	OR	P Value	95% CI
Cardiovascular risk factors
Male sex (No./total No.) (%)	55/65 (70.0)	332/661 (50.2)	3.05	.104	0.79	11.7
Age (yr) (mean) (SD)	76.0 (9.7)	63.1 (15.6)	1.11	.003	1.04	1.19
BMI (yr) (mean) (kg/m²)	26.8 (4.0)	28.5 (6.6)	0.94	.325	0.84	1.06
Smoking (No./total No.) (%)
Current smoker	12/65 (18.5)	126/661 (19.1)	1.52	.620	0.29	7.88
Prior smoker	24/65 (36.9)	134/661 (20.3)	1.74	.399	0.48	6.36
Hypertension (No./total No.) (%)	46/65 (70.8)	453/661 (68.5)	0.30	.126	0.06	1.41
Hyperlipidemia (No./total No.) (%)	46/65 (70.8)	312/661 (47.2)	1.08	.895	0.33	3.62
Diabetes (No./total No.) (%)	23/65 (35.4)	204/661 (30.9)	1.04	.948	0.33	3.30
Cardiovascular medications (No./total No.) (%)
Antihypertension	43/65 (66.2)	369/661 (55.8)	2.70	.170	0.65	11.1
Statin	42/65 (64.6)	274/661 (41.5)	1.24	.749	0.33	4.70
Antiplatelet	38/65 (58.5)	256/661 (38.7)	1.07	.922	0.29	3.88
Anticoagulation	7/65 (10.8)	67/661 (10.1)	0.63	.628	0.10	4.00
Carotid plaque imaging markers
Stenosis (mean) (SD) (%)	46.5 (30.1)	8.9 (19.3)	.09	.409	0.0003	25.7
Stenosis (mean) (SD) (mm)	2.5 (1.5)	4.3 (1.0)	0.31	.052	0.09	1.01
Maximum plaque thickness (mean) (SD) (mm)	5.4 (1.9)	2.8 (1.4)	2.26	<.001	0.09	1.01
Ulceration (No./total No.) (%)	34/65 (52.3)	62/661 (9.4)	4.36	.017	1.30	14.7
Intraluminal thrombus (No./total No.) (%)	5/65 (7.7)	14/661 (2.1)	0.49	.496	0.06	3.85
Magnet strength = 3T (No./total No.) (%)	16/65 (24.6)	42/661 (6.4)	1.63	.544	0.34	7.82