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Open Access Highly Accessed Research article

MRI plaque imaging reveals high-risk carotid plaques especially in diabetic patients irrespective of the degree of stenosis

L Esposito1*, T Saam2, P Heider3, Angelina Bockelbrink4, Jaroslav Pelisek3, D Sepp1, R Feurer1, C Winkler1, T Liebig5, K Holzer1, O Pauly6, S Sadikovic1, B Hemmer1 and H Poppert1

Author Affiliations

1 Department of Neurology, Klinikum rechts der Isar, Technische Universität, Munich, Germany

2 Department of Radiology, Ludwig Maximilians Universität, Munich, Germany

3 Department of Vascular Surgery, Klinikum rechts der Isar, Technische Universität, Munich, Germany

4 Social Medicine, Epidemiology, and Health Economics, Charité University, Berlin, Germany

5 Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany

6 Department of Informatics, Klinikum rechts der Isar, Technische Universität, Munich, Germany

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BMC Medical Imaging 2010, 10:27  doi:10.1186/1471-2342-10-27

Published: 30 November 2010



Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics.


191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available.


Eleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis.


DM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients.

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