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Abstract
Purpose
To determine the value of the appearance of the high signal intensity halo sign for detecting carotid intraplaque hemorrhage (IPH) on maximum intensity projection (MIP) of time-of-flight (TOF) MR angiography (MRA), based on high signal intensity on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequencing.
Materials and Methods
A total of 78 carotid arteries in 65 patients with magnetization-prepared rapid acquisition gradient-echo (MPRAGE) positive on carotid plaque MR imaging were included in this study. High-resolution MR imaging was performed on a 3.0-T scanner prior to carotid endarterectomy or carotid artery stenting. Fast spin-echo T1- and T2-weighted axial imaging, TOF, and MPRAGE sequences were obtained. Carotid plaques with high signal intensity on MPRAGE > 200% that of adjacent muscle on at least two consecutive slices were defined as showing IPH. Halo sign of high signal intensity around the carotid artery was found on MIP from TOF MRA. Continuous and categorical variables were compared among groups using the Mann-Whitney test and Fisher's exact tests.
Results
Of these 78 carotid arteries, 53 appeared as a halo sign on the TOF MRA. The total IPH volume of patients with a positive halo sign was significantly higher than that of patients without a halo sign (75.0 ± 86.8 vs. 16.3 ± 18.2, P = 0.001). The maximum IPH axial wall area in patients with a positive halo sign was significantly higher than that of patients without a halo sign (11.3 ± 9.9 vs. 3.7 ± 3.6, P = 0.000).
References
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Fig. 1.
Intraplaque hemorrhage and measurement of intraplaque hemorrhage volume. (a) Intraplaque hemorrhage of high signal intensity on MPRAGE (magnetization-prepared rapid acquisition gradient-echo) sequence (arrows). (b) Semiautomatic measurement of intraplaque hemorrhage volume of the area of signal intensity of > 200% of signal intensity of the adjacent muscle. (c) Intraplaque hemorrhage-positive on maximum intensity projection images of time-of-flight MR angiography shows a hyperintense region in the vessel wall without connection to the lumen (arrows).
Fig. 2.
Intraplaque hemorrhage (IPH) volume and maximal axial wall area of IPH between positive halo sign and negative halo sign on maximum intensity projection (MIP) images of time-of-flight MR angiography. (a) Total IPH volume is significantly larger in the positive halo sign group than in the negative halo sign group on MIP images. (b) The maximal axial wall area of IPH is also significantly larger in the positive halo sign group than in the negative halo sign group on MIP images.
Fig. 3.
Intraplaque hemorrhage (IPH) volume and maximal axial wall area of IPH as carotid stenosis categories. (a) Total volume of IPH of carotid arteries with 16–50% and 51–99% was significantly larger than that of carotid arteries with 0–15%. (b) Maximal axial wall area of IPH of carotid arteries with 16–50% and 51–99% was significantly larger than that of carotid arteries with 0–15%.
Table 1.
Patient Demographics
Table 2.
IPH and Carotid Stenosis: Positive Halo Sign and Negative Halo Sign on MIP Images of TOF MRA
Table 3.
Carotid Stenosis and IPH on MIP Images of TOF MRA
| Stenosis, % | N* (%) | N (%) with positive halo sign on MIP images | Total IPH volume (mm3) | Maximal axial IPH area (mm2) | ||||
|---|---|---|---|---|---|---|---|---|
| Positive halo sign | Negative halo sign | P | Positive halo sign | Negative halo sign | P | |||
| 0–15 | 15 (19.2) | 8 (53.3) | 31.7 ± 26.9 | 17.3 ± 17.4 | 0.248 | 6.1 ± 3.8 | 4.1 ± 3.6 | 0.316 |
| 16–49 | 43 (55.1) | 31 (72.1) | 79.3 ± 86.81 | 13.4 ± 15.1 | 0.013 | 11.9 ± 9.61 | 3.2 ± 3.4 | 0.004 |
| 50–99 | 20 (25.5) | 14 (70.0) | 90.2 ± 100.31 | 21.0 ± 23.1 | 0.117 | 12.9 ± 11.81 | 4.0 ± 3.8 | 0.094 |
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