Diagnostic accuracy of a clinical carotid plaque MR protocol using a neurovascular coil compared to a surface coil protocol

Waleed Brinjikji, J. Kevin Demarco, Robert Shih, Giuseppe Lanzino, Alejandro Rabinstein, Christopher A. Hilditch, Patrick J. Nicholson, John Huston

Research output: Contribution to journalArticle

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Abstract

Background: Carotid plaque imaging with MRI is becoming more commonplace, but practical challenges exist in performing plaque imaging with surface coils. Purpose: To compare the diagnostic performance of a carotid plaque MRI protocol using a standard neurovascular coil (Neurovascular Coil Protocol) to a higher-resolution carotid plaque MRI using carotid surface coils (Surface Coil Protocol) in characterizing carotid plaque. Study Type: Prospective study comparing two MR techniques in plaque characterization. Population: Thirty-eight consecutive carotid artery disease patients. Field Strength/Sequence: Patients underwent 3T MRI using 1) a Neurovascular Coil Protocol including the following sequences: 3D-FSE T1 pre/postcontrast and precontrast 3D IR-FSPGR, and 2) a Surface Coil Protocol using standard multicontrast MRI sequences. Assessment: Plaque characteristics analyzed by two independent neuroradiologists included intraplaque hemorrhage (IPH), lipid-rich necrotic-core (LRNC), and thin/ruptured fibrous cap (TRFC). Statistical Tests: Diagnostic performance of the Neurovascular Coil Protocol was compared to the Surface Coil Protocol reference standard using receiver-operating curves. Results: For IPH, sensitivity, specificity, and area under the curve (AUC) of the Neurovascular Coil Protocol were 91.1% (95% confidence interval [CI]=78.8-97.5%), 87.0% (95% CI=66.4-97.2%), and 0.92, respectively. For LRNC without IPH sensitivity, specificity, and AUC were 73.3% (95% CI=44.9-92.2%), 85.7% (95% CI=67.3-96.0%), and 0.84, respectively. For TRFC, sensitivity, specificity, and AUC were 35.3% (95% CI=14.2-61.7%), 97.6% (95% CI=87.4-99.9%), and 0.66 respectively. Interobserver agreement for IPH, LRNC, and TRFC using the Neurovascular Coil Protocol were k=0.87 (95% CI=0.75-0.99), k=0.54 (95% CI=0.29-0.80), and k=0.41 (95% CI=0.08-0.74), respectively. Data Conclusion: Our Neurovascular Coil Protocol has high sensitivity, specificity, and accuracy in identifying IPH and LRNC but is limited in assessment of TRFC.

Original languageEnglish (US)
JournalJournal of Magnetic Resonance Imaging
DOIs
StateAccepted/In press - Jan 1 2018

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Confidence Intervals
Hemorrhage
Area Under Curve
Lipids
Sensitivity and Specificity
Carotid Artery Diseases
Routine Diagnostic Tests
Prospective Studies
Population

Keywords

  • Carotid plaque
  • MRI
  • Vessel wall imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Diagnostic accuracy of a clinical carotid plaque MR protocol using a neurovascular coil compared to a surface coil protocol. / Brinjikji, Waleed; Demarco, J. Kevin; Shih, Robert; Lanzino, Giuseppe; Rabinstein, Alejandro; Hilditch, Christopher A.; Nicholson, Patrick J.; Huston, John.

In: Journal of Magnetic Resonance Imaging, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Carotid plaque imaging with MRI is becoming more commonplace, but practical challenges exist in performing plaque imaging with surface coils. Purpose: To compare the diagnostic performance of a carotid plaque MRI protocol using a standard neurovascular coil (Neurovascular Coil Protocol) to a higher-resolution carotid plaque MRI using carotid surface coils (Surface Coil Protocol) in characterizing carotid plaque. Study Type: Prospective study comparing two MR techniques in plaque characterization. Population: Thirty-eight consecutive carotid artery disease patients. Field Strength/Sequence: Patients underwent 3T MRI using 1) a Neurovascular Coil Protocol including the following sequences: 3D-FSE T1 pre/postcontrast and precontrast 3D IR-FSPGR, and 2) a Surface Coil Protocol using standard multicontrast MRI sequences. Assessment: Plaque characteristics analyzed by two independent neuroradiologists included intraplaque hemorrhage (IPH), lipid-rich necrotic-core (LRNC), and thin/ruptured fibrous cap (TRFC). Statistical Tests: Diagnostic performance of the Neurovascular Coil Protocol was compared to the Surface Coil Protocol reference standard using receiver-operating curves. Results: For IPH, sensitivity, specificity, and area under the curve (AUC) of the Neurovascular Coil Protocol were 91.1{\%} (95{\%} confidence interval [CI]=78.8-97.5{\%}), 87.0{\%} (95{\%} CI=66.4-97.2{\%}), and 0.92, respectively. For LRNC without IPH sensitivity, specificity, and AUC were 73.3{\%} (95{\%} CI=44.9-92.2{\%}), 85.7{\%} (95{\%} CI=67.3-96.0{\%}), and 0.84, respectively. For TRFC, sensitivity, specificity, and AUC were 35.3{\%} (95{\%} CI=14.2-61.7{\%}), 97.6{\%} (95{\%} CI=87.4-99.9{\%}), and 0.66 respectively. Interobserver agreement for IPH, LRNC, and TRFC using the Neurovascular Coil Protocol were k=0.87 (95{\%} CI=0.75-0.99), k=0.54 (95{\%} CI=0.29-0.80), and k=0.41 (95{\%} CI=0.08-0.74), respectively. Data Conclusion: Our Neurovascular Coil Protocol has high sensitivity, specificity, and accuracy in identifying IPH and LRNC but is limited in assessment of TRFC.",
keywords = "Carotid plaque, MRI, Vessel wall imaging",
author = "Waleed Brinjikji and Demarco, {J. Kevin} and Robert Shih and Giuseppe Lanzino and Alejandro Rabinstein and Hilditch, {Christopher A.} and Nicholson, {Patrick J.} and John Huston",
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AU - Brinjikji, Waleed

AU - Demarco, J. Kevin

AU - Shih, Robert

AU - Lanzino, Giuseppe

AU - Rabinstein, Alejandro

AU - Hilditch, Christopher A.

AU - Nicholson, Patrick J.

AU - Huston, John

PY - 2018/1/1

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N2 - Background: Carotid plaque imaging with MRI is becoming more commonplace, but practical challenges exist in performing plaque imaging with surface coils. Purpose: To compare the diagnostic performance of a carotid plaque MRI protocol using a standard neurovascular coil (Neurovascular Coil Protocol) to a higher-resolution carotid plaque MRI using carotid surface coils (Surface Coil Protocol) in characterizing carotid plaque. Study Type: Prospective study comparing two MR techniques in plaque characterization. Population: Thirty-eight consecutive carotid artery disease patients. Field Strength/Sequence: Patients underwent 3T MRI using 1) a Neurovascular Coil Protocol including the following sequences: 3D-FSE T1 pre/postcontrast and precontrast 3D IR-FSPGR, and 2) a Surface Coil Protocol using standard multicontrast MRI sequences. Assessment: Plaque characteristics analyzed by two independent neuroradiologists included intraplaque hemorrhage (IPH), lipid-rich necrotic-core (LRNC), and thin/ruptured fibrous cap (TRFC). Statistical Tests: Diagnostic performance of the Neurovascular Coil Protocol was compared to the Surface Coil Protocol reference standard using receiver-operating curves. Results: For IPH, sensitivity, specificity, and area under the curve (AUC) of the Neurovascular Coil Protocol were 91.1% (95% confidence interval [CI]=78.8-97.5%), 87.0% (95% CI=66.4-97.2%), and 0.92, respectively. For LRNC without IPH sensitivity, specificity, and AUC were 73.3% (95% CI=44.9-92.2%), 85.7% (95% CI=67.3-96.0%), and 0.84, respectively. For TRFC, sensitivity, specificity, and AUC were 35.3% (95% CI=14.2-61.7%), 97.6% (95% CI=87.4-99.9%), and 0.66 respectively. Interobserver agreement for IPH, LRNC, and TRFC using the Neurovascular Coil Protocol were k=0.87 (95% CI=0.75-0.99), k=0.54 (95% CI=0.29-0.80), and k=0.41 (95% CI=0.08-0.74), respectively. Data Conclusion: Our Neurovascular Coil Protocol has high sensitivity, specificity, and accuracy in identifying IPH and LRNC but is limited in assessment of TRFC.

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