Research Article| Volume 26, ISSUE 2, P273-279, February 2017

Download started.


T1-Weighted Magnetic Resonance Carotid Plaque Imaging: a Comparison between Conventional and Fast Spin-Echo Techniques


      Magnetic resonance imaging is widely used to evaluate the intraplaque components of the cervical carotid artery. The non–gated T1-weighted spin-echo (SE) technique has been reported to have an excellent ability for discriminating stable and unstable plaques. However, the diagnostic performance of various SE-based techniques remains unclear. Hence, we compared plaque signals obtained by 3 kinds of SE-based methods with histological findings.


      We prospectively examined 40 patients who underwent carotid endarterectomy by using 1.5-T scanners and obtained 2-dimensional (2D) conventional spin-echo (CSE), 2D fast spin-echo (FSE), and 3-dimensional (3D)-FSE images with identical repetition times. We calculated contrast ratios (CRs) of the plaques against adjacent muscles and compared these values with the pathological classification of the specimens.


      The CRs of type VII-VIII (calcific/fibrous), IV-V (lipid-rich/necrotic), and VI (complex/hemorrhagic) plaques were significantly different between all the methods (P <.001) and were discriminated from each other at sensitivities of 83%-100% and specificities of 94%-100%. The CRs of type IV-V plaques significantly differed between the methods (low to high, 2D-FSE, 2D-CSE, and 3D-FSE; P <.05); those of the type VI plaques were significantly lower with the 2D-FSE method than with the other methods (P <.01).


      The SE-based T1-weighted images can readily discriminate plaque characteristics with high sensitivities and specificities, although the signal intensity of unstable plaques was significantly high on the 3D-FSE images and significantly low on the 2D-FSE images.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • North American Symptomatic Carotid Endarterectomy Trial Collaborators
        Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
        N Engl J Med. 1991; 325: 445-453
        • Altaf N.
        • MacSweeney S.T.
        • Gladman J.
        • et al.
        Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis.
        Stroke. 2007; 38: 1633-1635
        • Takaya N.
        • Yuan C.
        • Chu B.
        • et al.
        Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI—initial results.
        Stroke. 2006; 37: 818-823
        • Yoshida K.
        • Narumi O.
        • Chin M.
        • et al.
        Characterization of carotid atherosclerosis and detection of soft plaque with use of black-blood MR imaging.
        AJNR Am J Neuroradiol. 2008; 29: 868-874
        • Altaf N.
        • Beech A.
        • Goode S.D.
        • et al.
        Carotid intraplaque hemorrhage detected by magnetic resonance imaging predicts embolization during carotid endarterectomy.
        J Vasc Surg. 2007; 46: 31-36
        • Esposito-Bauer L.
        • Saam T.
        • Ghodrati I.
        • et al.
        MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients.
        PLoS ONE. 2013; 8 (e67927)
        • Yoshimura S.
        • Yamada K.
        • Kawasaki M.
        • et al.
        High-intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting.
        Stroke. 2011; 42: 3132-3137
        • Watanabe Y.
        • Nagayama M.
        • Suga T.
        • et al.
        Characterization of atherosclerotic plaque of carotid arteries with histopathological correlation: vascular wall MR imaging vs. color Doppler ultrasonography (US).
        J Magn Reson Imaging. 2008; 28: 478-485
        • Yamada N.
        • Higashi M.
        • Otsubo R.
        • et al.
        Association between signal hyperintensity on T1-weighted MR imaging of carotid plaques and ipsilateral ischemic events.
        AJNR Am J Neuroradiol. 2007; 28: 287-292
        • Moody A.R.
        • Murphy R.E.
        • Morgan P.S.
        • et al.
        Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia.
        Circulation. 2003; 107: 3047-3052
        • Narumi S.
        • Sasaki M.
        • Natori T.
        • et al.
        Carotid plaque characterization using 3D T1-weighted MR imaging with histopathologic validation: a comparison with 2D technique.
        AJNR Am J Neuroradiol. 2015; 36: 751-756
        • Saito A.
        • Sasaki M.
        • Ogasawara K.
        • et al.
        Carotid plaque signal differences among four kinds of T1-weighted magnetic resonance imaging techniques: a histopathological correlation study.
        Neuroradiology. 2012; 54: 1187-1194
        • Cai J.M.
        • Hatsukami T.S.
        • Ferguson M.S.
        • et al.
        Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging.
        Circulation. 2002; 106: 1368-1373
        • Narumi S.
        • Sasaki M.
        • Ohba H.
        • et al.
        Prediction of carotid plaque characteristics using non-gated MR imaging: correlation with endarterectomy specimens.
        AJNR Am J Neuroradiol. 2013; 34: 191-197
        • Yamaguchi M.
        • Sasaki M.
        • Ohba H.
        • et al.
        Quantitative assessment of changes in carotid plaques during cilostazol administration using three-dimensional ultrasonography and non-gated magnetic resonance plaque imaging.
        Neuroradiology. 2012; 54: 939-945
        • Narumi S.
        • Sasaki M.
        • Ohba H.
        • et al.
        Predicting carotid plaque characteristics using quantitative color-coded T1-weighted MR plaque imaging: correlation with carotid endarterectomy specimens.
        AJNR Am J Neuroradiol. 2014; 35: 766-771
        • Listerud J.
        • Einstein S.
        • Outwater E.
        • et al.
        First principles of fast spin echo.
        Magn Reson Q. 1992; 8: 199-244
        • Melki P.S.
        • Mulkern R.V.
        Magnetization transfer effects in multislice RARE sequences.
        Magn Reson Med. 1992; 24: 189-195
        • Matsumoto N.
        • Kimura K.
        • Uno M.
        • et al.
        Enhanced carotid plaque on contrast-enhanced ultrasound is associated with plaque instability and rupture.
        Int J Stroke. 2012; 7: E12
        • Saito K.
        • Nagatsuka K.
        • Ishibashi-Ueda H.
        • et al.
        Contrast-enhanced ultrasound for the evaluation of neovascularization in atherosclerotic carotid artery plaques.
        Stroke. 2014; 45: 3073-3075