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Research ArticleExtracranial Vascular

Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraplaque Hemorrhage: A Preliminary Analysis

L. Saba, G. Lanzino, P. Lucatelli, F. Lavra, R. Sanfilippo, R. Montisci, J.S. Suri and C. Yuan
American Journal of Neuroradiology September 2019, 40 (9) 1538-1545; DOI: https://doi.org/10.3174/ajnr.A6160
L. Saba
aFrom the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
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G. Lanzino
bDepartment of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota
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P. Lucatelli
cDepartment of Radiological, Oncological and Anatomopathological Sciences-Radiology (P.L.), Sapienza University of Rome, Rome, Italy
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F. Lavra
aFrom the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
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R. Sanfilippo
aFrom the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
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R. Montisci
aFrom the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
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J.S. Suri
dDiagnostic and Monitoring Division (J.S.S.), Atheropoint, Roseville, California
eDepartment of Electrical Engineering (J.S.S.), University of Idaho, Moscow, Idaho
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C. Yuan
fCenter for Biomedical Imaging Research (C.Y.), Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
gDepartment of Radiology (C.Y.), University of Washington, Seattle, Washington.
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    Fig 1.

    Flow chart.

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    Fig 2.

    Example of semiautomatic segmentation of the carotid artery plaque of a 63-year-old subject. Both right (A–C) and left (D–F) carotid arteries are shown, and the red lines in the axial (B and D) and coronal planes (C and F) show the IPH components.

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    Fig 3.

    Boxplot analysis of the volume of the plaque components (A) and percentages (B) for symptomatic (blue plots) and asymptomatic (red plots) sides.

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    Fig 4.

    Regression analysis diagrams between total plaque and IPH volume on asymptomatic sides (A and B, respectively) and between total plaque and IPH volume on symptomatic sides (C and D, respectively).

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    Fig 5.

    ROC curve analysis of the volume of the plaque components (A) and percentages (B) versus the presence of symptoms.

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    Fig 6.

    Bland-Altman plot analysis for the interobserver agreement in total volume (A) and fatty (B), IPH (C), lipid (D), calcified (E), and mixed (F) tissue.

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    Table 1:

    Clinical characteristics of the 21 subjects with bilateral IPH

    Mean or No. (%)
    Age (yr)70 ± 11
    Male sex15 (71.4%)
    Symptomatic side (right)9 (42.8%)
    Smoking11 (52.4%)
    Hypertension14 (67%)
    Hyperlipidemia13 (61.9%)
    Diabetes mellitus8 (38%)
    History of CHD9 (42.8%)
    Family history of CVD9 (42.8%)
    • Note:—CHD indicates coronary heart disease; CVD, cardiovascular disease.

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    Table 2:

    Wilcoxon analysisa

    IpsilateralContralateralP Value
    Total plaque788 (548–941)689 (551–1189).543
    Volume (mm3)b
        IPH65 (36–161)15 (12–46).001
        Fatty154 (80–279)141 (91–205).375
        Lipid86 (44–115)103 (62–157).095
        Mixed460 (352–555)424 (313–713).339
        Calcium118 (66–206)119 (99–261).182
    Percentage
        IPH15% (6%–19%)3% (2%–5%).001
        Fatty23% (18%–30%)18% (14%–21%).011
        Lipid11% (7%–13%)15% (10%–16%).016
        Mixed57% (52%–63%)61% (56%–65%).312
        Calcium17% (12%–22%)18% (15%–26%).498
    IPH/fatty ratio0.596 (0.344–0.754)0.171 (0.126–0.1991).001
    • ↵a Wilcoxon Analysis between carotid plaque components and subcomponents between symptomatic and asymptomatic side. Data are expressed in cubic mm.

    • ↵b Voxel size is 0.5 mm isotropic.

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    Table 3:

    ROC curve analysis

    AUCSE95% CIP Value
    Percentage
        IPH (<25 HU)0.8890.05060.754–0.965.001
        Fatty0.7070.08320.547–0.837.013
        Lipid0.710.08190.549–0.839.01
        Mixed0.5950.0910.433–0.744.295
        Calcium0.5510.09150.390–0.705.577
    Volume
        IPH (<25 HU)0.7960.06950.643–0.904.001
        Fatty0.5530.0910.392–0.707.558
        Lipid0.6510.08570.488–0.791.077
        Mixed0.5290.09440.370–0.685.755
        Calcium0.5820.09070.420–0.732.368
    IPH/fatty ratio0.5820.09070.420–0.732.368
    • Note:—AUC indicates area under the curve; SE, standard error.

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American Journal of Neuroradiology: 40 (9)
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L. Saba, G. Lanzino, P. Lucatelli, F. Lavra, R. Sanfilippo, R. Montisci, J.S. Suri, C. Yuan
Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraplaque Hemorrhage: A Preliminary Analysis
American Journal of Neuroradiology Sep 2019, 40 (9) 1538-1545; DOI: 10.3174/ajnr.A6160

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Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraplaque Hemorrhage: A Preliminary Analysis
L. Saba, G. Lanzino, P. Lucatelli, F. Lavra, R. Sanfilippo, R. Montisci, J.S. Suri, C. Yuan
American Journal of Neuroradiology Sep 2019, 40 (9) 1538-1545; DOI: 10.3174/ajnr.A6160
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