| Objective: to investigate the association between IPH and stability of plaque by carotid high-resolution magnetic resonance imaging (HRMRI).Materials and methods:1. To investigate the association between plaque stability and bilateral IPHs: A retrospective analysis was conducted among 44 patients with IPH in carotid plaque detected by MR imaging in our hospital from December 2009 to December 2012. All patients were divided into two groups: unilateral IPH group (n=30) and bilateral IPHs group (n=14). The age, maximum wall thickness and the incidence of fibrous cap rupture between two groups were compared by Wilcoxon rank analysis, Chi-square test,and logistic regression analysis.2. To investigate the association between different ages of IPH and FCR in carotid arteries and the predicted value of the volume of IPH in different stages on FCR: A retrospective analysis was conducted among 37 patients with IPH in carotid plaque detected by MR imaging in our hospital from December 2009 to December 2012. 41 plaques were included in the study. All plaques were divided into two groups: plaques with FCR (n=27) and those without FCR (n= 14). The age of IPH including fresh and recent stage was evaluated and the relationship between FCR and the volume of different stages were evaluated by Wilcoxon rank analysis, Chi-square test, Spearman's correlation analysis and logistic regression analysis.Results:1. Compared with the patients with unilateral IPH, those with bilateral IPHs were younger (66.62 ± 9.36 years vs. 73.70 ± 9.06 years, P = 0.027). In addition, patients with bilateral IPHs were found to have significantly greater maximum plaque thickness(6.34 ± 1.93mm vs 5.05±1.25 mm, P = 0.035) and incidence of ulcer (50% vs. 13.3%,P = 0.025) compared with those with unilateral IPH. Logistic regression analysis revealed a significant association between bilateral IPHs and presence of ulcer (odd ratio [OR] = 6.50, 95% confidence interval [CI] 1.47-28.70, P = 0.014). Adjusted for sex in Model 1, bilateral IPHs were still significantly associated with presence of ulcer(OR =5.71, 95%CI 1.12-29.21, P =0.036). However, after adjusted for age (P= 0.131)or maximum plaque thickness (P = 0.139) in model 2, there was no significant correlation between bilateral IPHs and presence of ulcer.2. Fresh IPH volume in plaques with FCR was significantly larger than that of those without FCR (109.83±75.49 mm3 vs.30.54±20.62 mm3, P=0.002). Logistic regression showed that the odds ratio (OR) of fresh IPH volume and recent IPH volume was 1.74(95% CI, 1.13-2.67, P=0.012), 1.36 (95%CI, 0.84-2.18, P=0.208) in discriminating presence of FCR, respectively. In predicting FCR, the OR of fresh IPH volume and recent IPH volume was 1.78 (95%CI,1.12-2.82, P=0.015) and 1.43 (95%CI,0.86-2.38,P=0.172) after adjusting confounding factors, respectively. In discriminating FCR,fresh IPH volume had higher area-under-the-curve (AUC) than recent IPH (AUC: 0.79 vs. 0.64).Conclusions:1. Compared with patients with unilateral IPH, those with bilateral IPHs were younger and had greater plaque burden and incidence of fibrous cap rupture,suggesting that carotid plaque was more vulnerable in patients with bilateral carotid IPHs than that in those with unilateral carotid IPH.2. Fresh intraplaque hemorrhage volume is independently associated with presence of fibrous cap rupture in carotid atherosclerotic plaques, suggesting the volume of different ages of IPH might be an effective indicator for plaque fibrous cap rupture. |
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