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Hyperintense Plaque With Noncontrast T1-Weighted Magnetic Resonance Coronary Plaque Imaging Leading to Acute Coronary Syndrome

2009; Lippincott Williams & Wilkins; Volume: 120; Issue: 23 Linguagem: Inglês

10.1161/circulationaha.108.895482

1524-4539

Atsushi Tanaka, Tomohiro Kawasaki, Teruo Noguchi, Shoichi Koga, Yoshihiro Hiramatsu, Takaya Fukuyama, Nobuhiko Koga,

Advanced MRI Techniques and Applications

HomeCirculationVol. 120, No. 23Hyperintense Plaque With Noncontrast T1-Weighted Magnetic Resonance Coronary Plaque Imaging Leading to Acute Coronary Syndrome Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBHyperintense Plaque With Noncontrast T1-Weighted Magnetic Resonance Coronary Plaque Imaging Leading to Acute Coronary Syndrome Atsushi Tanaka, MD, Tomohiro Kawasaki, MD, Teruo Noguchi, MD, Shoichi Koga, MD, Yoshihiro Hiramatsu, MD, Takaya Fukuyama, MD and Nobuhiko Koga, MD Atsushi TanakaAtsushi Tanaka From the Department of Cardiology, Koga Hospital 21, Kurume (A.T., S.K., Y.H.), Cardiovascular Center, Shin-Koga Hospital, Kurume (T.K., T.F., N.K.), and Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita (T.N.), Japan. , Tomohiro KawasakiTomohiro Kawasaki From the Department of Cardiology, Koga Hospital 21, Kurume (A.T., S.K., Y.H.), Cardiovascular Center, Shin-Koga Hospital, Kurume (T.K., T.F., N.K.), and Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita (T.N.), Japan. , Teruo NoguchiTeruo Noguchi From the Department of Cardiology, Koga Hospital 21, Kurume (A.T., S.K., Y.H.), Cardiovascular Center, Shin-Koga Hospital, Kurume (T.K., T.F., N.K.), and Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita (T.N.), Japan. , Shoichi KogaShoichi Koga From the Department of Cardiology, Koga Hospital 21, Kurume (A.T., S.K., Y.H.), Cardiovascular Center, Shin-Koga Hospital, Kurume (T.K., T.F., N.K.), and Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita (T.N.), Japan. , Yoshihiro HiramatsuYoshihiro Hiramatsu From the Department of Cardiology, Koga Hospital 21, Kurume (A.T., S.K., Y.H.), Cardiovascular Center, Shin-Koga Hospital, Kurume (T.K., T.F., N.K.), and Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita (T.N.), Japan. , Takaya FukuyamaTakaya Fukuyama From the Department of Cardiology, Koga Hospital 21, Kurume (A.T., S.K., Y.H.), Cardiovascular Center, Shin-Koga Hospital, Kurume (T.K., T.F., N.K.), and Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita (T.N.), Japan. and Nobuhiko KogaNobuhiko Koga From the Department of Cardiology, Koga Hospital 21, Kurume (A.T., S.K., Y.H.), Cardiovascular Center, Shin-Koga Hospital, Kurume (T.K., T.F., N.K.), and Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita (T.N.), Japan. Originally published8 Dec 2009https://doi.org/10.1161/CIRCULATIONAHA.108.895482Circulation. 2009;120:2400–2401A 73-year-old diabetic man underwent multislice computed tomography (MSCT) and noncontrast T1-weighted (T1W) magnetic resonance imaging (MRI) for the evaluation of atypical chest discomfort after an exercise ECG was nondiagnostic. The MSCT demonstrated a low-density positive remodeling plaque and spotty calcification without significant stenosis in the proximal segment of the right coronary artery (Figure 1A and 1B). Noncontrast T1W MRI, using a 1.5-T MR system (Intera, Philips Medical Systems, Best, the Netherlands), revealed a hyperintense plaque (HIP) in the right coronary artery in an area corresponding to the plaque visualized by MSCT (Figure 1C and 1D). With clear evidence of atherosclerotic disease, the patient was given glimepiride and voglibose with recommendations for strict diet therapy for treatment of diabetes mellitus; he continued to take aspirin. One year after these examinations, the patient presented with sudden-onset crushing chest pain at our emergency room. Despite the modifications to his medications, his coronary risk factors had not improved (hemoglobin A1c, 7.1–6.4%, low-density lipoprotein cholesterol, 124–110 mg/dL; high-density lipoprotein cholesterol, 34–32 mg/dL). On admission, an ECG showed ST-segment elevation in leads II, III, and aVF. Emergent coronary angiography revealed an obstructive lesion in the proximal segment of the right coronary artery in a region corresponding to the HIP previously identified by MRI (Figure 2A). Intravascular ultrasound confirmed extensive attenuation (Figure 2B) at that segment, and a bare metal stent was successfully implanted with a distal protection device. After stent implantation, a large amount of debris was collected. Download figureDownload PowerPointFigure 1. Multislice computed tomography (A, curved multiplanar reconstruction; B, horizontal) demonstrates low-density plaque (−36 Hounsfield units, remodeling index 1.6, arrowheads) with spotty calcification (arrow) in the proximal segment of the right coronary artery. On the corresponding noncontrast T1-weighted magnetic resonance imaging (C, oblique image; D, horizontal), this low-density plaque was visualized as a hyperintense lesion (arrowheads).Download figureDownload PowerPointFigure 2. Right coronary angiography revealed an occlusion of the proximal segment of the right coronary artery (A). On intravascular ultrasound examination (B), a near-circumferential attenuation (arrowheads) was observed at the culprit lesion, corresponding with the plaque observed both by multislice computed tomography and by noncontrast T1-weighted magnetic resonance imaging.Recently, Kawasaki et al1 reported that the presence of HIP on noncontrast T1W MRI is associated with positive coronary remodeling, low CT density, and ultrasound attenuation by MSCT or intravascular ultrasound. However, it is unknown whether HIP has a greater potential for plaque rupture and subsequent acute coronary syndrome. To our knowledge, this is the first report documenting the progression of HIP to acute coronary syndrome. Thus, HIP detected by noncontrast T1W MRI has the potential to identify vulnerable coronary lesions.DisclosuresNone.FootnotesCorrespondence to Tomohiro Kawasaki, MD, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume, 830–8577, Japan. E-mail [email protected]Reference1 Kawasaki T, Koga S, Koga N, Noguchi T, Tanaka H, Koga H, Serikawa T, Orita Y, Ikeda S, Mito T, Goto Y, Shintani Y, Tanaka A, Fukuyama T. Characterization of hyperintense plaque with non-contrast T1-weighted cardiovascular magnetic resonance coronary plaque imaging: comparison with multislice computed tomography and intravascular ultrasound. J Am Coll Cardiol Cardiovasc Imaging. 2009; 6: 720–728.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Lavin-Plaza B, Phinikaridou A, Andia M, Lacerda S, Henningsson M, Makowski M and Botnar R (2019) Atherosclerotic Plaque Imaging Cardiovascular Magnetic Resonance Imaging, 10.1007/978-1-4939-8841-9_14, (229-248), . Noguchi T, Nakao K, Asaumi Y, Morita Y, Otsuka F, Kataoka Y, Hosoda H, Miura H, Fukuda T and Yasuda S (2018) Noninvasive Coronary Plaque Imaging, Journal of Atherosclerosis and Thrombosis, 10.5551/jat.RV17019, 25:4, (281-293), . 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December 8, 2009Vol 120, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.895482PMID: 19996024 Originally publishedDecember 8, 2009 PDF download Advertisement SubjectsAcute Coronary SyndromesComputerized Tomography (CT)Imaging