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1 Characterization of Carotid Atherosclerotic Plaque with MR Imaging 1) Department of Radiology, Kurashiki Central Hospital 2) Department of Neurosurgery, Kurashiki Central Hospital NICHIDOKU-IHO Vol. 53 No (2008) Yuji Watanabe, M.D., Ph.D, 1) Masako Nagayama, M.D., 1) Kazumichi Yoshida, M.D., 2) Sen Yamagata, M.D., 2) Akira Okumura, M.D., 1) Yoshiki Amoh, M.D., 1) Takayoshi Ishimori, M.D., Ph.D., 1) and Yoshihiro Dodo M.D., Ph.D. 1) Summary The most common source of emboli in transient ischemic attacks and embolic stroke originates from atherosclerotic disease at the carotid bifurcation. Severity of atherosclerosis may be determined by assessing both luminal stenosis and plaque morphology. Plaque constituents such as lipid core, hemorrhage, fibrosis, and calcification, as well as fibrous cap rupture are important factors in predicting the clinical outcome and the natural history of the disease. Identification of liquid plaque constituents, such as granular lipid cores and intraplaque hemorrhage, allows the assessment of plaque vulnerability and for the determination of a treatment plan, carotid endarterectomy or carotid angioplasty with stent placement. MR imaging of carotid arteries has been shown to play an important role in accurately characterizing plaque components of lipid cores, intraplaque hemorrhage, fibrosis and calcification by using a black-blood technique. The MRI categories based on a combination of the signal intensity index of FS T1- and FS T2-weighted images have a high potential to accurately distinguish at-risk soft and unstable plaques with liquid constituents from solid hard and stable plaques. Fibrous cap rupture can be detected with thin-section source images of time-of-flight MR angiography. This paper comprehensively describes MR imaging of carotid atherosclerotic plaque including black-blood techniques, assessment of plaque components and fibrous cap, usefulness for determining treatment plans and so on. transient ischemic attacktia Doppler-USMRCTPET-CT MR MR

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13 MR-T1-T2 3MRT1T2 MR 1Golledge J, Greenhalgh RM, Davies AH: The symptomatic carotid plaque. Stroke : , North American Symptomatic Carotid Endarterectomy

53 2 2008 -T2ADSAB CEA D Trial: Methods, patient characteristics, and progress.

14 T2ADSAB CEA D Trial: Methods, patient characteristics, and progress. Stroke : , Yuan C, Zhang SX, Polissar NL, et al: Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation : , Imparato AM, Riles TS, Mintzer R, et al: The importance of hemorrhage in the relationship between gross morphologic characteristics and cerebral symptoms in 376 carotid artery plaques. Ann Surg : , Murphy RE, Moody AR, Morgan PS, et al: Prevalence of complicated carotid atheroma as detected by magnetic resonance direct thrombus imaging in patients with suspected carotid artery stenosis and previous acute cerebral ischemia. Circulation : , Ouhlous M, Flach HZ, de Weert TT, et al: Carotid plaque composition and cerebral infarction: MR imaging study. AJNR Am J Neuroradiol : , Moody AR, Murphy RE, Morgan PS, et al: Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation : , blackblood MRI Simonetti OP, Finn JP, White RD, et al: Black bloodt2- weighted inversion-recovery MR imaging of the heart. Radiology : 49-57, Watanabe Y, Nagayama M, Suga T, et al: Characterization of atherosclerotic plaque of carotid arteries with histopathological correlation: vascular wall MR imaging vs. color Doppler ultrasonography (US). J Magn Reson Imaging (in press) 11Stary HC, Chandler AB, Dinsmore RE, et al: A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Atherosclerosis, American Heart Association. Circulation : , Maynor CH, Chatles HC, Herfkens RJ, et al: Chemical shift imaging of atherosclerosis at 7.0 Tesla. Invest Radiol : 52-60, Serfaty JM, Chaabane L, Tabib A, et al: Atheroscretotic plaques: classification and characterization with T2- weighted high-spatial-resolution MR imagingan in vitro study. Radiology : , Chu B, Kampschulte A, Ferguson MS, et al. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke : , Yuan C, Mitsumori LM, Ferguson MS, et al: In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques.

15 Circulation : , Yuan C, Mitsumori LM, Beach KW, et al: Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology : , Cai JM, Hatsukami TS, Ferguson MS, et al: Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation : , Cappendijk VC, Cleutjens KB, Kessels AG, et al: Assessment of human atherosclerotic carotid plaque components with multisequence MR imaging: initial experience. Radiology : , Toussaint JF, LaMuraglia GM, Southern JF, et al: Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo. Circulation : , Hatsukami TS, Ross R, Polissar NL, et al: Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation : , Mitsumori LM, Hatsukami TS, Ferguson MS, et al: In vivo accuracy of multisequence MR imaging for identifying unstabale fibrous caps in advanced human carotid plaques. J Magn Reson Imaging : , Barnett HJ, Taylor DW, Eliasziw M, et al: Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med : , Biller J, Feinberg WM, Castaldo JE, et al: Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke : , Rothwell PM, Slattery J, Warlow CP: A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. Stroke : , Kirsch EC, Khangure MS, van Schie GP, et al: Carotid arterial stent placement: results and follow-up in 53 patients. Radiology : , Mas JL, Chetellier G, Beyssen B, et al: Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA- 3S) trial. Stroke : e18-e20, McKevitt FM, Macdonald S, Venables GS, et al: Complications following carotid angioplasty and carotid stenting in patients with symptomatic carotid artery disease. Cerebrovasc Dis : 28-34,

JCAS 対象および方法 prospective registry CEA CAS JCAS RCT 2 JCAS TIA minor stroke major stroke mrs CEA CAS 1 3 SPECT case volume CEA CAS 結果

JCAS 対象および方法 prospective registry CEA CAS JCAS RCT 2 JCAS TIA minor stroke major stroke mrs CEA CAS 1 3 SPECT case volume CEA CAS 結果 Online publication January 14, 2011 原著第 50 回総会シンポジウム 5 日本脳神経血管内治療学会 : 頭頸部頭蓋内血管に対する血行再建術本邦における頸動脈治療の前向き登録 (JCAS 研究 ) 1 1 JCAS 要旨 :JCAS 5053 1164 69.8 87 45 CAE 34 CAS 2130 major adverse events CEA 3.2