Published Online
on June 25, 2009

A more recent version of this article appeared on September 1, 2009

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Submitted on April 7, 2009
Accepted on May 20, 2009

Reproducibility of Fibrous Cap Status Assessment of Carotid Artery Plaques by Contrast-Enhanced MRI

Robert M. Kwee MD^*; Jos M.A. van Engelshoven MD; Werner H. Mess MD; Johannes W.M. ter Berg MD; Floris H.B.M. Schreuder MD; Cees L. Franke MD; Arthur G.G.C. Korten MD; Bé J. Meems MD; Robert J. van Oostenbrugge MD; Joachim E. Wildberger MD; and Marianne E. Kooi PhD

From the Department of Radiology (R.M.K., J.M.A.v.E., J.E.W., M.E.K.), the Cardiovascular Research Institute Maastricht (R.M.K., J.M.A.v.E., W.H.M., R.J.v.O., J.E.W., M.E.K.), the Department of Clinical Neurophysiology (W.H.M.), and the Department of Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; the Department of Neurology (J.W.M.t.B.), Orbis Medical Center, Sittard, The Netherlands; the Department of Neurology (C.L.F.), Atrium Medical Center, Heerlen, The Netherlands; the Department of Neurology (A.G.G.C.K.), Laurentius Hospital, Roermond, The Netherlands; and the Department of Neurology (B.J.M.), Vie Curi Medical Center, Venlo, The Netherlands.

^* To whom correspondence should be addressed. E-mail: rmkwee{at}gmail.com.

Background and Purpose—Reproducibility in identifying the fibrous cap (FC) of carotid artery plaques by noncontrast-enhanced MRI has been shown to be poor. The objective of this study was to assess the reproducibility of multisequence MRI, including contrast-enhanced images, in assessing FC status.

Methods—Forty-five symptomatic patients with 30% to 69% carotid artery stenosis underwent a multisequence MRI protocol, which included contrast-enhanced images. FC status (ie, discrimination between fibrotic and/or calcified plaques, plaques with a lipid-rich necrotic core and an intact and thick FC, and plaques with a lipid-rich necrotic core and a thin and/or ruptured FC) was independently assessed by 3 observers of which one also scored all images on a different occasion. Linear weighted kappa coefficients () were calculated as indicators of inter- and intraobserver agreement.

Results—On a per-slice basis, interobserver agreement was good (=0.60, 0.64, and 0.71), whereas intraobserver agreement was very good (=0.86). On a per-plaque basis, interobserver agreement was good (=0.64, 0.69, and 0.78), whereas intraobserver agreement was very good (=0.96).

Conclusion—This study found good interobserver and very good intraobserver agreement in assessing FC status of carotid artery plaques. Future studies are warranted to determine the predictive value of FC status assessment by multisequence MRI, including contrast-enhanced images, on the occurrence of (recurrent) cerebral ischemic events.

Key words: carotid plaque • fibrous cap • magnetic resonance imaging • stroke

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