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Characterization of Hyperintense Plaque With Noncontrast T₁-Weighted Cardiac Magnetic Resonance Coronary Plaque Imaging

Comparison With Multislice Computed Tomography and Intravascular Ultrasound

Tomohiro Kawasaki, MD^_*,_*, Shoichi Koga, MD, Nobuhiko Koga, MD^_*, Teruo Noguchi, MD, Hidenori Tanaka, MD^_*, Hisashi Koga, MD^_*, Takeshi Serikawa, MD^_*, Yoshiya Orita, MD^_*, Shinsuke Ikeda, MD^_*, Takahiro Mito, MD^_*, Yoshitaka Goto, MD^_*, Yoshiaki Shintani, MD^_*, Atsushi Tanaka, MD, Takaya Fukuyama, MD^_*

^_* Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan
Department of Cardiology, Koga Hospital 21, Kurume, Japan
Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita, Japan

^_* Reprint requests and correspondence: Dr. Tomohiro Kawasaki, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume 830-8577, Japan (Email: to-kawasaki{at}mug.biglobe.ne.jp).

Objectives: This study sought to characterize coronary hyperintense plaques (HIP) using noncontrast T₁-weighted imaging (T1WI) in cardiac magnetic resonance, which was then compared with multislice computed tomography and intravascular ultrasound.

Background: Carotid plaque components such as intraplaque hemorrhages and/or lipid-rich necrotic cores can be detected as HIP by noncontrast T1WI. Although coronary HIPs have been successfully detected using this technique, the properties of hyperintense signals in coronary plaques have not yet been systematically evaluated.

Methods: Thirty-eight lesions from 37 patients with angina pectoris who demonstrated >70% coronary stenosis on multislice computed tomography were evaluated by noncontrast T1WI using a 1.5-T magnetic resonance imager, and 25 lesions were evaluated by intravascular ultrasound. Signal intensity of coronary plaque to cardiac muscle ratio >1.0 was defined as HIP. We divided 25 lesions into the 2 groups, according to the presence or absence of HIP: HIP (n = 18) and non-HIP (n = 7) groups.

Results: In comparison with the non-HIP group, the HIP group demonstrated significantly higher coronary plaque to cardiac muscle ratio (1.7 ± 0.7 vs. 0.9 ± 0.1, p < 0.01), higher frequency of positive remodeling as observed by both multislice computed tomography (89% vs. 0%, p<0.0001) and intravascular ultrasound (94% vs. 14%, p < 0.001) and ultrasound attenuation (100% vs. 14.3%, p < 0.0001). The frequency of spotty calcification tended to be higher in HIP (89% vs. 50%, p = 0.079). The HIP group also exhibited a significantly lower computed tomography density (–23.2 ± 20.7 Hounsfield units [HU] vs. 9.6 ± 20.5 HU, p < 0.01). In addition, the incidence of transient slow-flow phenomena was significantly higher in the HIP group than in the non-HIP group (83% vs. 14%, p < 0.01).

Conclusions: The typical HIP case was associated with ultrasound attenuation, positive remodeling, remarkably low computed tomography density, and a high incidence of slow-flow phenomena. Noncontrast T1WI in cardiac magnetic resonance imaging may be useful for the assessment of coronary plaque characterization in patients with coronary artery disease.

Key Words: coronary plaque imaging • cardiac magnetic resonance • multislice computed tomography • intravascular ultrasound

Abbreviations and Acronyms   CMR = cardiac magnetic resonance   HIP = hyperintense plaque   IVUS = intravascular ultrasound   MSCT = multislice computed tomography   PCI = percutaneous coronary intervention   PMR = coronary plaque to cardiac muscle ratio   RI = remodeling index   T1WI = T1-weighted imaging

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