Purpose
MRI detects intraplaque hemorrhage (IPH) with high accuracy using the magnetization-prepared rapid acquisition gradient echo (MPRAGE) sequence. Still, MRI is not readily available for all patients, and many receive CTA instead. Our goal was to determine essential clinical and lumen imaging predictors of IPH as indicators of its presence and clues to its pathogenesis.
Methods
In this retrospective cross sectional study, patients undergoing stroke workup with MRI/MRA underwent carotid IPH imaging. A total of 726 carotid plaques were analyzed, excluding vessels with non-carotid stroke sources (420), occlusions (7), or near-occlusions (3). Potential carotid imaging predictors of IPH included percent diameter and mm stenosis, plaque thickness, ulceration, and intraluminal thrombus. Clinical predictors were recorded and a multivariable logistic regression model was fitted. Backward-elimination was used to determine essential IPH predictors with a threshold two-sided p<.10. Receiver operating characteristic (ROC) analysis was also performed.
Results
Predictors of carotid IPH included plaque thickness (odds ratio, OR=2.20, p<.001), mm stenosis (OR=0.46, p<.001), ulceration (OR=4.25, p=.020), age (OR=1.11, p=.001) and male sex (OR=3.23, p=.077). The final model discriminatory value was excellent (area under the curve, AUC=0.932). This was significantly higher than models using only plaque thickness (AUC=0.881), mm stenosis (AUC=0.830) or ulceration (AUC=0.715) p<.001.
Conclusions
Optimal discrimination of carotid IPH requires information on plaque thickness, mm stenosis, ulceration, age and male sex. These factors predict IPH with high discriminatory power, and may provide clues to the pathogenesis of IPH. This model could be used to predict the presence of IPH when MRI is contraindicated.