Multi-contrast and three-dimensional assessment of the aortic wall using 3 T MRI

Highlights: • Complex atherosclerotic plaques of the aorta are a potential source of stroke. • 3D plaque MRI has the potential to identify vulnerable plaques. • Eleven volunteers and eleven acute stroke patients were studied to test feasibility. • 3D-multi-contrast MRI was performed with high image quality and in reasonable time. • Plaque MRI may help determine the source of stroke in clinical routine. - Abstract: Objectives: To develop a 3D-multi-contrast MRI protocol allowing for high resolution imaging of the wall and of atheroma in the thoracic aorta. Methods: Eleven healthy volunteers and eleven acute stroke patients with aortic plaques detected by TEE underwent MRI at 3 T. The MRI-protocol consisted of a T1w-bright-blood, a T2w- and a PDw-black-blood sequence (spatial resolution = 1.15 mm³). Image quality was assessed by two blinded investigators using a 3-point score and intra- and inter-rater agreement was tested. In patients, atherosclerotic plaques were graded according to the modified American Heart Association (AHA) classification. Results: Total examination time was 35:42 ± 7:48 min in volunteers and 41:07 ± 3:15 min in patients. Image quality was graded with the highest score in 80–94% of T1w, 89–96% of T2w and 79–86% of PDw datasets. Intra- and inter-rater reliability regarding image quality grading was high. Five stroke patients showed AHA type III lesions, three had AHA type VII and two had type VIII plaques. One patient had a vulnerable appearing AHA VI plaque. Conclusions: 3D-multi-contrast MR-imaging of the aorta was performed with high image quality and in reasonable time. It allows evaluation of atherosclerotic plaque composition throughout the aortic arch and can be used to identify vulnerable plaques in acute stroke patients.