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CLINICAL RESEARCH: INTRAVASCULAR IMAGING AND VULNERABLE PLAQUE

Diagnosis of Thin-Cap Fibroatheromas by a Self-Contained Intravascular Magnetic Resonance Imaging Probe in Ex Vivo Human Aortas and In Situ Coronary Arteries

Jacob Schneiderman, MD^_*, Robert L. Wilensky, MD, FACC^,_*, Assaf Weiss, BSc, Eitzek Samouha, BSc, Lev Muchnik, BSc, Malca Chen-Zion, PhD, Mordechay Ilovitch, PhD, Erez Golan, MSc, Aharon Blank, PhD, Moshe Flugelman, MD, Yosef Rozenman, MD, FACC^|| and Renu Virmani, MD, FACC^¶

^_* Department of Vascular Surgery and Gottesdiener Vascular Biology Laboratory, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
TopSpin Medical Israel, Lod, Israel
Department of Cardiology Carmel Hospital, Haifa, Israel
^|| Wolfson Hospital, Holon, Israel
^¶ Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC

Manuscript received July 7, 2004; revised manuscript received August 14, 2004, accepted September 21, 2004.

^_* Reprint requests and correspondence: Dr. Robert L. Wilensky, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Gates, Philadelphia, Pennsylvania 19104 (Email: Robert.Wilensky{at}uphs.upenn.edu).

OBJECTIVES: We sought to correlate findings obtained from a self-contained magnetic resonance imaging (MRI) probe with plaque morphology of ex vivo human aortas and coronary arteries.

BACKGROUND: Early detection of thin-cap fibroatheromas (TCFAs) may allow for early preventive treatment of acute coronary syndromes. We developed an intravascular MRI catheter capable of imaging the arterial wall without external magnets or coils by differentiating lipid-rich and fibrotic-rich areas of the atherosclerotic plaque on the basis of differential water diffusion.

METHODS: Aortic samples (n = 16) and coronary arteries were obtained within 12 h of death. Coronary specimens were intermediate in angiographic severity (30% to 60% luminal narrowing, n = 18). Blinded histologic and immunohistochemical analyses of the tissues were performed and correlated to MRI findings.

RESULTS: The 16 aortic lesions included four ulcerated plaques, two TCFAs, two thick-cap fibrous atheromas, two intimal xanthomas, and six adaptive intimal thickenings. The MRI scan correctly correlated with the histologic diagnosis in 15 (94%) of 16 lesions. The 18 coronary lesions included one plaque rupture, three TFCAs, seven thick-cap fibrous atheromas, four fibrocalcific plaques, two intimal xanthomas, and one adaptive intimal thickening. The MRI scan correlated with the histologic diagnosis in 16 of 18 lesions (sensitivity 100%, specificity 89%).

CONCLUSIONS: The self-contained intravascular MRI catheter successfully identified TCFA and may prove to be an important diagnostic approach to determining the presence of lesions with increased risk of causing death or myocardial infarction.

Abbreviations and Acronyms   ADC = apparent diffusion coefficient   DOV = depth of view   FOV = field of view   LF = lipid fraction   MRI = magnetic resonance imaging   SNR = signal to noise ratio   TCFA = thin-cap fibroatheroma

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