This Article Full Text Full Text (PDF) All Versions of this Article: 40/9/3017    most recent STROKEAHA.109.555052v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Kwee, R. M. Articles by Kooi, M. E. PubMed PubMed Citation Articles by Kwee, R. M. Articles by Kooi, M. E. Related Collections Imaging CT and MRI Carotid Stenosis Computerized tomography and Magnetic Resonance Imaging

(Stroke. 2009;40:3017.)
© 2009 American Heart Association, Inc.

Original Contributions

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 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.

Correspondence to Robert M. Kwee, MD, Department of Radiology, Maastricht University Medical Center, the Netherlands, PO Box 5800, 6202 AZ Maastricht, The Netherlands. 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

This article has been cited by other articles:

				R. M. Kwee, G. J. J. Teule, R. J. van Oostenbrugge, W. H. Mess, M. H. Prins, R. J. van der Geest, J. W.M. ter Berg, C. L. Franke, A. G.G.C. Korten, B. J. Meems, et al. Multimodality Imaging of Carotid Artery Plaques: 18F-Fluoro-2-Deoxyglucose Positron Emission Tomography, Computed Tomography, and Magnetic Resonance Imaging Stroke, December 1, 2009; 40(12): 3718 - 3724. [Abstract] [Full Text] [PDF]