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Research ArticleORIGINAL RESEARCH

Plaque RADS Related to Cerebrovascular Event Risk with Mild/moderate Stenosis: a CARE II study

Maoxue Wang, Yin Guo, Daniel S. Hippe, Xihai Zhao, Chun Yuan, Luca Saba, Bing Zhang and Mahmud Mossa-Basha
American Journal of Neuroradiology April 2025, ajnr.A8819; DOI: https://doi.org/10.3174/ajnr.A8819
Maoxue Wang
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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Yin Guo
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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Daniel S. Hippe
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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Xihai Zhao
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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Chun Yuan
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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Luca Saba
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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Bing Zhang
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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Mahmud Mossa-Basha
From the Department of Radiology (M.W., M.M.B.) and Department of Bioengineering (Y.G.), University of Washington, Seattle, Washington, USA; Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Biomedical Engineering (X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China; Department of Radiology and Imaging Sciences (C.Y.), University of Utah, Salt Lake City, Utah, USA; Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy.
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ABSTRACT

BACKGROUND AND PURPOSE: Carotid Plaque-Reporting And Data System (Plaque-RADS) provides a standardized approach for evaluating carotid plaque morphology and composition. The aim of this study was to evaluate carotid Plaque-RADS, and its relationship with clinical risk factors and ipsilateral cerebrovascular symptoms, in a prospectively-acquired multi-center, vessel-wall MRI dataset.

MATERIALS AND METHODS: Symptomatic patients were recruited from the CARE-II (Chinese Atherosclerosis Risk Evaluation, NCT 02017756) study. This cross-sectional study included patients with recent stroke or transient ischemia attack and atherosclerotic plaques in at least one carotid artery. Lipid-rich necrotic core, ulceration, intraplaque hemorrhage, thick or thin fibrous cap, fibrous cap rupture and intraluminal thrombi were identified from multiple contrast vessel wall imaging and used to determine carotid Plaque-RADS. In addition, ancillary features including calcification and plaque burden via maximum normalized wall index (max_NWI) were collected. Degree of stenosis was classified as mild (<30%), moderate (30-69%), and severe (70-99%). Generalized Estimating Equation-based logistic regression was performed to assess the relationship between the Plaque-RADS score and cerebrovascular events.

RESULTS: A total of 433 patients (62 years ± 9.97, 302 males (69.7%)) with 866 carotid arteries were included in this study. Symptomatic carotid arteries had higher stenosis degree (11.8%±24.7 vs 8.6%±18.8, p=0.01), plaque-RADS score (≥3: 33.9% vs 28.4%, p=0.02) and max_NWI (0.53±0.14 vs 0.51±0.13, p=0.002) compared to the asymptomatic side. Plaque RADS was significantly associated with cerebrovascular events (OR=1.11 per 1-level increase, 95%CI=1.01-1.24; p=0.04). In patients with mild/moderate bilateral carotid artery stenosis, plaque RADS≥3 was significantly associated with symptomatic events (OR=1.30, 95%CI=1.01-1.68; p=0.04). Higher plaque-RADS on the symptomatic side was related to advanced age (OR=1.27 per 10-year increase, 95%CI=1.03-1.56; p=0.03), male sex (OR=1.90, 95%CI=1.05-3.43; p=0.03), and smoking history (OR=1.99, 95%CI=1.20-3.31; p=0.007).

CONCLUSIONS: Male patients of advanced age and with a smoking history were associated with an increased risk of higher plaque-RADS scores. Plaque-RADS demonstrated the ability to stratify patients experiencing cerebrovascular events, even in cases with mildto-moderate stenosis. However, this association did not retain statistical significance after adjusting for stenosis or max_NWI.

ABBREVIATIONS: IPH = intraplaque hemorrhage; Max-NWI = maximum normalized wall index; MWT = maximum wall thickness; RADS = Reporting And Data System; VWI = vessel wall imaging.

Footnotes

  • The authors declare no conflicts of interest related to the content of this article.

  • © 2025 by American Journal of Neuroradiology

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Accepted Manuscript
Maoxue Wang, Yin Guo, Daniel S. Hippe, Xihai Zhao, Chun Yuan, Luca Saba, Bing Zhang, Mahmud Mossa-Basha
Plaque RADS Related to Cerebrovascular Event Risk with Mild/moderate Stenosis: a CARE II study
American Journal of Neuroradiology Apr 2025, ajnr.A8819; DOI: 10.3174/ajnr.A8819

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Accepted Manuscript
Plaque RADS Related to Cerebrovascular Event Risk with Mild/moderate Stenosis: a CARE II study
Maoxue Wang, Yin Guo, Daniel S. Hippe, Xihai Zhao, Chun Yuan, Luca Saba, Bing Zhang, Mahmud Mossa-Basha
American Journal of Neuroradiology Apr 2025, ajnr.A8819; DOI: 10.3174/ajnr.A8819
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