Added value of femoral artery atherosclerosis for determining severity of white matter lesion by carotid atherosclerosis: a magnetic resonance imaging study

Abstract

Background Previous studies reported that single vascular atherosclerosis was an effective indicator for white matter lesions (WMLs). Purpose To investigate the added value of femoral atherosclerosis for determining severity of WMLs by carotid atherosclerosis using three-dimensional vessel wall magnetic resonance imaging (MRI). Material and Methods Elderly individuals without cardiovascular symptoms within the previous six months were recruited. The plaque features of carotid and femoral arteries were evaluated and compared between individuals with WML score ≤ 3 and those with WML score > 3. Logistic regression and receiver operating characteristic (ROC) analyses were used to determine the value of plaque features in discriminating WMLs with score > 3. Results In total, 112 individuals (49 men, mean age 72.0±5.6 years) were included. Participants with a WML score > 3 showed a significantly greater carotid wall area and femoral artery stenosis and higher incidence of carotid calcification and femoral artery calcification and lipid-rich necrotic cores (LRNC) compared to those with a WML score ≤ 3 (all P < 0.05). Carotid artery calcification and femoral artery calcification, LRNC, and stenosis were found to be significantly associated with severe WMLs before and after adjustment for clinical factors (odds ratio 1.51–3.79, all P < 0.05). ROC analysis showed, in discriminating severe WMLs, the area under the curve increased from 0.615 to 0.754 after combining femoral artery LRNC and stenosis with carotid calcification compared to the carotid calcification alone. Conclusion Characteristics of femoral artery atherosclerosis determined by vessel wall MRI have added value for carotid atherosclerosis in determining the severity of WMLs.

Peripheral Arterial Disease: A Narrative Review

“…The importance of imaging is highlighted in a study where DUS results varied from symptoms like pulsation (femoral artery [25%] and popliteal artery [34%], respectively) [ 6 ]. On imaging, the arterial disease presents with a lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), calcification [ 12 ], intermittent claudication (43.5% [ 13 ] to 65.4% [ 14 ]), chronic limb-threatening ischemia (CLTI) (56.4%), rest pain (26.5%), foot ulcers, or ischemic gangrene. A greater than normal (1.0-1.4) ankle-brachial index (ABI) is a strong indicator of loss of elasticity, as seen in calcification and stenosis [ 15 ].…”

“…DUS is a superior vascular mapping tool because it is cost-effective and eliminates complications associated with iodine contrast and ionizing radiation, especially in patients with renal disease [ 18 ]. DUS is a valuable tool to detect lipid-rich plaques [ 12 ], luminal stenosis, and arterial wall thickness. It can also be used to diagnose focal intra-stent stenosis [ 19 ].…”

“…Moreover, DUS underestimates the degree of stenosis compared to CTA (degree of concordance has been reported in more studies [ 5 , 24 ] between DUS and CTA: common iliac: 0.8 (0.71-0.88), right external iliac: 0.84 (0.76-0.92), left external iliac: 0.71 (0.61-0.81)) or MRA (degree of concordance between DUS and MRA: 86%). DUS provides a moderate to strong correlation with MRI [ 12 ]. In aortoiliac segments, DUS demonstrated 90% sensitivity, 85.0% specificity, 89.6% positive predictive value (PPV), 85.4% negative predictive value (NPV), and 88% accuracy [ 25 ].…”

“…PSV >200 denotes significant stenosis [ 27 ]. The limitations of using DUS are obesity, abdominal bloating (inadequate bowel preparation), calcification of the common iliac in aortoiliac segments [ 28 ], and IPH due to the vulnerability of atherosclerotic plaque in all arteries [ 12 ].…”

“…In Buerger’s disease, MRA and DUS were found to be more accurate diagnostic modalities than CTA. MRA provided 40% longitudinal coverage with white matter lesions (WMLs) visualization (severe → >3 (31.3%, P = 0.003)) [ 12 ]. MRA was not found to be useful in visualizing the anatomy of the popliteal fossa due to the gastrocnemius muscle being sensitive to motion artifacts caused by a longer duration of the procedure [ 35 ].…”