Intraplaque Hemorrhage: A Comparative Study of Vulnerable Plaque With Magnetic Resonance Imaging and Doppler Ultrasonography

We compared various plaque features including intraplaque hemorrhage (IPH) by carotid Doppler ultrasonography (USG) and MRA in individuals with symptomatic and asymptomatic carotid artery disease (CAD). Symptomatic and asymptomatic CAD cases were included in the study. Surface features and constituents of the atherosclerotic plaque were examined, and internal carotid artery (ICA) systolic flow velocity was measured. Intra-plaque hemorrhage was assessed with a 3D TFE sequence. Each carotid artery was inspected separately, and evaluations were made on 52 vessels for Doppler and 3D TFE analysis. In Doppler USG, heterogeneous plaques were found in 65% of symptomatic ICAs and 39% of asymptomatic ICAs (p = 0.08). There was a moderate correlation between the presence of IPH and heterogeneous plaque (Cramer V = 0.36, p = 0.01), moderate correlation with the presence of irregular plaque surface (Cramer V = 0.45, p = 0.003), mild correlation with the presence of flow acceleration (Cramer's V = 0.26 p = 0.064); strong association of 50% or more stenosis according to NASCET criteria (Cramer's V = 0.53 p = 0.00) were found. Heterogeneous plaque and surface irregularity that show moderate association with IPH can be used as a helpful tool in the screening, follow-up, and management of patients at high risk of ischemic stroke and determining risk groups for cerebrovascular diseases.