Document Detail

Dynamic Contrast-enhanced MR Imaging of Carotid Atherosclerotic Plaque: Model Selection, Reproducibility, and Validation.
MedLine Citation:
PMID:  23151823     Owner:  NLM     Status:  Publisher    
Purpose:To compare four known pharmacokinetic models for their ability to describe dynamic contrast material-enhanced magnetic resonance (MR) imaging of carotid atherosclerotic plaques, to determine reproducibility, and to validate the results with histologic findings.Materials and Methods:The study was approved by the institutional medical ethics committee. Written informed consent was obtained from all patients. Forty-five patients with 30%-99% carotid stenosis underwent dynamic contrast-enhanced MR imaging. Plaque enhancement was measured at 16 time points at approximately 25-second image intervals by using a gadolinium-based contrast material. Pharmacokinetic parameters (volume transfer constant, K(trans); extracellular extravascular volume fraction, v(e); and blood plasma fraction, v(p)) were determined by fitting a two-compartment model to plaque and blood gadolinium concentration curves. The relative fit errors and parameter uncertainties were determined to find the most suitable model. Sixteen patients underwent imaging twice to determine reproducibility. Carotid endarterectomy specimens from 16 patients who were scheduled for surgery were collected for histologic validation. Parameter uncertainties were compared with the Wilcoxon signed rank test. Reproducibility was assessed by using the coefficient of variation. Correlation with histologic findings was evaluated with the Pearson correlation coefficient.Results:The mean relative fit uncertainty (±standard error) for K(trans) was 10% ± 1 with the Patlak model, which was significantly lower than that with the Tofts (20% ± 1), extended Tofts (33% ± 3), and extended graphical (29% ± 3) models (P < .001). The relative uncertainty for v(p) was 20% ± 2 with the Patlak model and was significantly higher with the extended Tofts (46% ± 9) and extended graphical (35% ± 5) models (P < .001). The reproducibility (coefficient of variation) for the Patlak model was 16% for K(trans) and 26% for v(p). Significant positive correlations were found between K(trans) and the endothelial microvessel content determined on histologic slices (Pearson ρ = 0.72, P = .005).Conclusion:The Patlak model is most suited for describing carotid plaque enhancement. Correlation with histologic findings validated K(trans) as an indicator of plaque microvasculature, and the reproducibility of K(trans) was good.© RSNA, 2012.
Michaela E Gaens; Walter H Backes; Stefan Rozel; Matthijs Lipperts; Stefan N Sanders; Karolien Jaspers; Jacques P M Cleutjens; Judith C Sluimer; Sylvia Heeneman; Mat J A P Daemen; Rob J T J Welten; Jan-Willem H Daemen; Joachim E Wildberger; Robert M Kwee; M Eline Kooi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-14
Journal Detail:
Title:  Radiology     Volume:  -     ISSN:  1527-1315     ISO Abbreviation:  Radiology     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Radiology, Cardiovascular Research Institute Maastricht, Department of Pathology, and Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
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