Association Between The Imaging Characteristics Of Coronary And Carotid Atherosclerosis

Part One Association between Coronary Artery Calcium Score and Carotid Atherosclerotic DiseaseObjective:To evaluate the association between coronary calcification and carotid atherosclerosis.Materials and methods:One hundred and twenty-three subjects with suspected coronary artery disease were recruited in this study.A pre-contrast low-dose CT scan was performed for all the subjects to measure the coronary artery calcium score(CACS) by a Dual Source CT scanner.Multi-contrast carotid magnetic resonance imaging(MRI) was performed by a 3.0T MR scanner within two weeks after coronary CT scan.The parameters of the carotid morphological measurement,including lumen area(LA),wall area(WA),total vessel area(TVA), mean wall thickness(MWT),and normalized wall index(NWI),were measured for each location.The mean value of each measurement was calculated for bilateral carotid arteries of each subject.The presence or absence of carotid plaque tissue compositions,including calcification(CA),lipid-rich necrotic core (LRNC),and intraplaque hemorrhage(IPH),was recorded for each subject.The plaque surface disruption was also recorded.Two reviewers blinded to CACS results interpreted MR images with consensus using customer-designed software (CASCADE).All subjects were divided into two groups:high-CACS group (CACS≥400) and low-CACS group(CACS＜400).Furthermore,CACS was partitioned as following categories:scores of 0 as grade 0,scores of 1-100 as grade 1,101-400 as grade 2,and＞400 as grade 3.The carotid morphological measurements in all the CACS groups and categories were compared using independent t test and one way ANOVA,respectively.The correlation between CACS and presence of carotid plaque compositions was analyzed using Spearman's correlation analysis.A P-value less than 0.05 was considered statistical significance.Results:CACS showed moderate correlation with carotid WA(r=0.521) and MWT(r=0.556),weak correlation with TVA(r=0.215) and NWI(r=0.377).There was no significant correlation between CACS and carotid LA(p＞0.05).Compared to low-CACS group,high-CACS group showed larger carotid WA,TVA and MWT.In the entire cohort,carotid plaque burden showed an increasing trend with CACS increasing.Significant correlation was found between CACS and presence of carotid CA and LRNC.There was no significant correlation of CACS with carotid IPH and surface disruption.CACS showed moderate correlation with carotid calcification volume and LRNC volume,weak correlation with carotid IPH volume.Conclusion:CACS significantly associates with carotid atherosclerotic plaque burden and the presence of tissue compositions.CACS may be a predictor for carotid plaque burden and tissue compositions. Part Two Association between Coronary Stenosis and Carotid Artery RemodelingObjective:To investigate the relationship between coronary stenosis on CT and carotid artery remodeling on MRI.Materials and Methods:One hundred and twenty-three subjects with suspected coronary artery disease were recruited in this study All the patients obtained CT angiography(CTA) by a Dual Source CT scanner.Multi-contrast carotid magnetic resonance imaging(MRI) was performed in bilateral carotid arteries within two weeks after coronary CT scan.Coronary segmental evaluation was performed according to AHA classification and subdivision of coronary arteries into 15 segments.Coronary artery luminal stenosis was partitioned into five grades:grade 0(normal coronary artery),grade 1(1%-29%stenosis),grade 2(30%-49% stenosis),grade 3(50%-69%stenosis),and grade 4(70%-100%stenosis).Two reviewers blinded to coronary results interpreted MR images with consensus using customer-designed software(CASCADE).The parameters of the carotid morphological measurement,including lumen area(LA),wall area(WA),total vessel area(TVA),mean wall thickness(MWT),and normalized wall index (NWI),were measured for each location.The overall mean value of each measurement was calculated for bilateral carotid arteries of each subject.In addition,the mean value of these morphological measurements was also calculated in three segments of carotid artery:in internal carotid artery(ICA), bulb,and common carotid artery(CCA).The association of coronary stenosis with carotid morphological measurements was analyzed using Spearman's correlation analysis.Results:Coronary stenosis showed positive correlation with carotid WA(r=0.396), MWT(r=0.438) and NWI(r=0.348).In the segment of ICA,LA and WA showed negative and positive correlation with coronary stenosis,respectively.However, there was no significant correlation between TVA and coronary stenosis.In the segment of CCA,WA and TVA showed positive correlation with coronary stenosis. No significant correlation between LA and coronary stenosis can be found.In the segment of Bulb,WA showed positive correlation with coronary stenosis.There was no significant correlation of coronary stenosis with LA and TVA.Conclusions:Coronary stenosis is significantly positive correlated with carotid plaque burden.There might be positive remodeling in CCA and negative remodeling in ICA with coronary stenosis progressing. Part Three Correlation of Atherosclerotic Plaque Compositions in Coronary and Carotid ArteriesObjective:To evaluate the relationship between coronary and carotid plaque compositions.Materials and methods:One hundred and twenty-three subjects with suspected coronary artery disease were recruited in this study.All the patients obtained CT angiography(CTA) examination by a Dual Source CT scanner.Carotid multi-contrast magnetic resonance imaging(MRI) was performed in bilateral arteries within two weeks after coronary CT scan.Coronary segmental evaluation was performed according to AHA classification and subdivision of coronary arteries into 15 segments.Coronary plaques were classified into three types based on CT attenuation value(HU):non-calcified,calcified,and mixed plaques.The presence or absence of coronary plaques was visually scored.Each type of plaque score was recorded according to the number of corresponding type of plaque for each subject.The presence or absence of carotid plaque tissue compositions, including calcification(CA),lipid-rich necrotic core(LRNC),and intraplaque hemorrhage(IPH),was identified for each subject.The relationship between different type of coronary plaques and carotid tissue compsitions was evaluated.Results:Significant correlation of carotid IPH with mixed plaque score (OR=1.50 ) was found.There was significant correlation between three types of plaque scores in coronary artery and LRNC and calcification in carotid artery.In classifying subjects with and without carotid IPH,coronary mixed plaque score showed the highest AUC(0.74).In classifying subjects with and without carotid LRNC and calcification,coronary calcified plaque score showed the highest AUC (0.75).Conclusions:Coronary plaque types significantly associate with carotid plaque compositions.Coronary mixed plaque might be a predictor for carotid high risk plaque features...