Images in cardiovascular medicine. Healing of an asymptomatic carotid plaque ulceration.
Images in cardiovascular medicine. Healing of an asymptomatic carotid plaque ulceration.
复制标题
心血管医学中的图像。无症状的颈动脉斑块溃疡的愈合。
DOI：
10.1161/circulationaha.108.764779
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发表时间：
2008-09-02
期刊：
影响因子：
37.8
通讯作者：
Hamilton JA
中科院分区：
文献类型：
--
作者：
Qiao Y;Farber A;Semaan E;Hamilton JA
A72-year-old man with asymptomatic, bilateral, 80% carotid stenoses diagnosed by duplex ultrasound was scheduled for a left carotid endarterectomy (CEA) and a right CEA 2 months later. He underwent in vivo neck magnetic resonance imaging (MRI) examination 1 week before each scheduled CEA. Carotid plaque specimens were subsequently evaluated with ex vivo MRI and histological analysis. 1 Histology sections were coregistered with ex vivo (0.5-mm thick) and in vivo (3-mm thick) MR slices using the carotid bifurcation as a point of reference. All in vivo and ex vivo MRI images were measured in millimeters from the bifurcation. The entire CEA sample (10-mm thick) was sectioned every 0.25 mm. Measurements in all modalities were referenced to the superior edge of the bifurcation. The gross morphology and calcified regions of each MR image were used to confirm registration with histology sections. 1 The initial neck MRI performed before the left CEA revealed a small dark region protruding into the plaque from the lumen, a characteristic of plaque ulceration (Figure 1A). An ulcer was visualized at the same location in the ex vivo specimen (Figure 1B). Matched ex vivo MRI of the specimen showed a dark region in T1W consisting of a hemorrhage filling the ulcerated plaque (Figure 1C). Histological analysis revealed intraplaque hemorrhage consisting of fibrin and intact red blood cells (Figure 1D). Two months later, a second MR evaluation was performed before the right CEA. A significant signal change was noted in the right common carotid artery (Figure 2J and 2K). The initial MR study revealed a dark lumen with 2 small protrusions suggestive of plaque ulceration (Figure 2J). The second MRI demonstrated a new bright region overlaying the region of ulceration in the right carotid artery (Figure 2K). Subsequent histological analysis of the right CEA specimen showed a collagen-rich fibrous cap (Figure 2L), which corresponds to the bright region in the T1W image (Figure 2K). Histological analysis of the specimen using Sirius red stain under polarized light indicated that the newly formed fibrous cap contained a mixture of type I and III collagen (Figure 2M).
