One-step evaluation of intraplaque hemorrhage in the carotid artery and vertebrobasilar artery using simultaneous non-contrast angiography and intraplaque hemorrhage

Purpose: To investigate the one-step detection of intraplaque hemorrhage (IPH) in the carotid artery (CA) and vertebrobasilar artery (VBA) using simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP). Methods: From January 2019 to March 2020, 1820 consecutive patients who visited our emergency room for evaluation of neurologic symptoms underwent brain MR imaging, including the SNAP sequence. SNAP imaging examined the coronal section from the CA to the VBA. IPH was defined as plaque in the CA and VBA with 200 % higher signal intensity on SNAP than in adjacent muscle in at least two consecutive slices. Results: Of these patients, 360 (19.8 %) had carotid plaque (both sides = 141, 39.2 %; single side = 219, 61.8 %). Of patients with carotid plaque, 185 (51.4 %) had IPH. Of 141 patients with plaques on both sides, 35 (24.8 %) had bilateral IPH. In total, 73 (4.0 %) patients had VBA IPH (30 with carotid plaque, 43 without carotid plaque). In addition, 18 (1.0 %) patients had carotid IPH and VBA IPH. Maximal wall thickness was significantly higher in the carotid IPH groups (4.5 +/- 0.1 vs. 4.1 +/- 0.1, p = 0.009). Prevalence of high grade stenosis (>70 %) was significantly higher in the carotid IPH group (17.5 % vs. 6.2 %, p < 0.001). Conclusions: SNAP imaging can be evaluated with a one-step examination of CA and VBA IPH.

Automated summary

This study investigated the one-step detection of intraplaque hemorrhage in the carotid artery and vertebrobasilar artery using SNAP technology. Results showed a high prevalence of IPH in patients, with significantly higher wall thickness in the carotid IPH group and a higher prevalence of high grade stenosis in that group as well.