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  • Clinical Research
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Cross-sectional, prospective study of MRI reproducibility in the assessment of plaque burden of the carotid arteries and aorta

Nature Reviews Cardiology volume 6, pages 219–228 (2009)Cite this article

Abstract

Background The reliability of imaging techniques to assess early atherosclerosis remains unclear. We did a cross-sectional, prospective study to test reproducibility of MRI when imaging arteries, to assess risk of cardiovascular disease and correlations with age and sex.

Methods Between January 2003 and December 2006 we performed black-blood MRI of both common carotid arteries and the thoracic descending aorta in patients with cardiovascular risk factors who were referred from clinics in New York, NY, USA. Mean wall area, wall thickness, lumen area, total vessel area, and ratio of the mean wall area to the mean total vessel area (WA/TVA) were manually measured. Reproducibility within and between readers was tested on subsets of images from randomly chosen patients.

Results MRI was performed on 300 patients. Intrareader reproducibility, assessed in images from 20 patients, was high for all parameters (intraclass correlation coefficients >0.8), except WA/TVA ratio in the descending aorta. The inter-reader reproducibility, assessed in images from 187 patients, was acceptable (intraclass correlation coefficients >0.7) for the mean wall, lumen, and total vessel areas. Values for all MRI parameters in all vessels increased with increasing age for both sexes (all P <0.0005) but were always significantly higher in men than in women, except for aortic mean wall thickness and WA/TVA ratio in the carotid arteries. Mean wall area values correlated well between the carotid arteries and aorta, reflecting the systemic nature of atherosclerosis.

Conclusions Our findings support MRI as a reproducible measurement of plaque burden and demonstrate the systemic distribution of atherosclerosis.

Key Points

  • MRI is quickly becoming the preferred method for the noninvasive evaluation of the vessel wall in advanced atherosclerotic cardiovascular disease

  • MRI measurements of atherosclerotic plaque burden are reproducible

  • The MRI values for the mean wall areas correlated strongly between carotid arteries and aorta, suggesting a systemic distribution of disease

  • Similar to other clinical variables for cardiovascular diseases, values for MRI parameters were higher in men than in women

  • MRI measures of plaque burden increased with increasing age

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Figure 1: Manual tracing of arterial inner and outer walls.
Figure 2: MRI outcomes in the right common carotid arteries of three patients with atherosclerosis.
Figure 3: Bland–Altman plots illustrating between-reader reproducibility for the ratio of mean wall area to total vessel area, assessed for 187 patients.
Figure 4: The correlation between vessels for the different MRI parameters.
Figure 5: The relation between age for all MRI parameters.
Figure 6: The relations between sex and mean wall area and sex and ratio of mean wall area to total vessel area, after adjustment for age.

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Acknowledgements

This investigation was partially supported by NIH/NHLBI grant R01 HL071021 (ZA Fayad). H El Aidi was supported by the Huygens Scholarship Programme of the Dutch Ministry of Education, Culture and Science. V Mani is supported by a postdoctoral fellowship from the Founders Affiliate of the American Heart Association. We thank the study participants and Hannah Oltarzewska and Frank Macaluso for technical assistance. We further acknowledge Verheugt Freek for his assistance.

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Authors and Affiliations

  1. Translational and Molecular Imaging Institute, Mount Sinai School of Medicine, New York, NY, USA

    Hamza El Aidi, Venkatesh Mani, Karen B Weinshelbaum, Silvia H Aguiar, Hiroaki Taniguchi, Daniel D Samber, Jessica Stern & Zahi A Fayad

  2. Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA

    Venkatesh Mani, Karen B Weinshelbaum, Hiroaki Taniguchi, Daniel D Samber, Emil I Cohen, Jessica Stern & Zahi A Fayad

  3. Department of Cardiology, Zena and Michael A Weiner Cardiovascular Institute and Marie-Josée and Henry R Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, NY, USA

    Hamza El Aidi, Venkatesh Mani, Silvia H Aguiar, Valentin Fuster & Zahi A Fayad

  4. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    John E Postley

  5. Division of Image Processing. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Rob J van der Geest & Johan HC Reiber

  6. Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Mark Woodward

  7. Nemours Cardiac Center, A I duPont Hospital for Children, Wilmington, DE, USA

    Samuel S Gidding

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Correspondence to Zahi A Fayad.

Supplementary information

Supplementary Figure 1

Non-overlapping cross-sectional MRI slices of the carotid arteries were obtained using the rapid extended coverage double inversion recovery turbo spin echo black blood (REX) pulse sequence (DOC 584 kb)

Supplementary Figure 2

Non-overlapping cross-sectional MRI slices of the aorta were obtained using the rapid extended coverage double inversion recovery turbo spin echo black blood (REX) pulse sequence. (DOC 709 kb)

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Aidi, H., Mani, V., Weinshelbaum, K. et al. Cross-sectional, prospective study of MRI reproducibility in the assessment of plaque burden of the carotid arteries and aorta. Nat Rev Cardiol 6, 219–228 (2009). https://doi.org/10.1038/ncpcardio1444

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