Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct

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FIG 1.
Flow chart of the study sample.
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FIG 2.
Boxplots of the SIR of carotid IPH on different T1-weighted MR imaging sequences in patients with and without ACI. Patients with ipsilateral ACI lesions had significantly higher SIRs of carotid IPH on T1-weighted images than those without.
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FIG 3.
Comparison of the SIR of carotid IPH on T1-weighted MR imaging sequences, including T1-weighted, TOF, and MPRAGE, between patients with ACI (4 images above, hyperintense on DWI as the arrow indicates) and without ACI (4 images below, no abnormality on DWI). It shows that the patient with the higher SIR on T1-weighted images had ACI lesions in the ipsilateral hemisphere.

Table 1:

Parameters of carotid MR vessel wall and brain imaging

Note:—FFE indicates fast-field echo; TSE, turbo spin echo; EPI, echo planar imaging; TR, repetition time; TE, echo time; FOV, field of view.
↵a DWI: b = 0, 1000 s/mm².
↵b Values represent the acquired slice thickness.

Table 2:

Clinical characteristics of study population

	Mean ± SD or (No.) (%)		P Value^{^a}
	Patients with ACI (n = 40)	Patients without ACI (n = 69)	P Value^{^a}
Age (yr)	64.2 ± 10.2	68.3 ± 9.5	.035
Sex, male	37 (92.5)	59 (85.5)	.366
Body mass index (kg/m²)	25.1 ± 3.6	24.0 ± 2.7	.117
History of smoking	30 (75.0)	38 (55.1)	.038
History of hypertension	33 (82.5)	58 (84.1)	.833
Systolic blood pressure (mm Hg)	144.2 ± 20.9	143.9 ± 21.3	.840
Diastolic blood pressure (mm Hg)	85.2 ± 9.2	85.8 ± 14.1	.720
History of hyperlipidemia	21 (52.5)	39 (56.5)	.684
LDL (mmol/L)	2.7 ± 1.0	3.0 ± 1.0	.182
HDL (mmol/L)	1.1 ± 0.2	1.1 ± 0.2	.780
TC (mmol/L)	4.3 ± 1.2	4.7 ± 1.1	.161
TG (mmol/L)	1.9 ± 1.2	2.0 ± 1.1	.519
History of diabetes mellitus	15 (37.5)	25 (36.2)	.895
History of coronary heart disease	11 (27.5)	14 (20.3)	.388
Statin use	15 (37.5)	25 (36.2)	.895
Antihypertension medication use	28 (70.0)	49 (71.0)	.911
TIA	12 (30.0)	32 (46.4)	.108
Recent stroke	28 (70.0)	37 (53.6)	.108

Note:—LDL indicates low-density lipoprotein cholesterol; HDL, high-density lipoprotein cholesterol; TC, total cholesterol; TG, triglycerides; TIA, transient ischemia attack.
↵a P values were calculated by the Mann-Whitney U test or Fisher exact test.

Table 3:

Comparison of carotid plaque morphologic and compositional characteristics between patients with and without ipsilateral ACI lesions

	Mean ± SD. (No.) (%) or Median (25–75 Percentiles)		P Value^{^a}
	Patients with ACI (n = 40)	Patients without ACI (n = 69)	P Value^{^a}
Mean lumen area (mm²)	35.5 ± 13.5	36.5 ± 12.4	.555
Mean wall area (mm²)	48.3 ± 14.9	41.5 ± 11.1	.028
Mean total vessel area (mm²)	83.8 ± 20.6	78.0 ± 18.6	.172
Mean wall thickness (mm)	1.9 ± 0.6	1.6 ± 0.4	.010
Mean normalized wall index (%)	57.9 ± 11.3	53.6 ± 9.1	.087
Total luminal occlusion	21 (52.5%)	11 (15.9%)	<.001
Plaque volume (mm²)	1240.7 ± 535.2	1064.4 ± 414.1	.159
Presence of calcification	33 (82.5)	60 (87.0)	.526
Presence of FCR	14 (35.0)	23 (33.3)	.859
Volume of calcification (mm³)^{^b}	35.8 (12.4–87.3)	36.2 (15.8–79.6)	.794
Percentage calcification volume (%)^{^b}	3.1 (1.3–6.4)	3.5 (1.9–7.7)	.312
Volume of LRNC (mm³)^{^b}	312.7 (174.1–625.3)	227.7 (122.1–351.4)	.038
Percentage LRNC volume (%)^{^b}	29.4 (17.9–42.1)	23.6 (14.0–34.0)	.039
Volume of IPH (mm³)^{^b}	93.2 (31.4–201.2)	56.4 (21.9–104.9)	.016
Percentage IPH volume (%)^{^b}	7.9 (3.0–17.0)	5.4 (2.5–10.1)	.074
IPH length (mm)	12.0 (4.5–17.5)	10.0 (4.0–14.0)	.101

Note:—FCR indicates fibrous cap rupture.
↵a P values are based on the Mann-Whitney U test or Fisher exact test between patients with and without ipsilateral ACI lesions.
↵b Only patients with the corresponding component present were included in the comparison.

Table 4:

Association between signal intensity ratio of carotid IPH and the presence of ipsilateral ACI lesions

Note:—SIR_{IPH-to-muscle} indicates the maximum signal intensity of carotid IPH/the mean signal intensity of the sternocleidomastoid muscle.
↵a Multivariate model 1 was adjusted for age, sex, and history of smoking; model 2 was further adjusted using model 1 and total luminal occlusion of the carotid artery. Model 3 was further adjusted using model 1 and the volume of carotid IPH and LRNC.
↵b Associations between patients with and without ipsilateral ACI lesions were assessed using the OR values.