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9 programma abstracts & abstracts Sessie 9 Neuro- en Hoofdhals radiologie Vrijdag 30 september, 10.45 - 12.15 uur O9.1 ARTERIAL CALCIFICATION IN RELATION TO COGNITION AND STRUCTURAL BRAIN CHANGES D. Bos, M.W. Vernooij, S.E. Elias-Smale, G.P. Krestin, A. Hofman, W.J. Niessen, J.C.M. Witteman, A. van der Lugt, M.A. Ikram Erasmus Medisch Centrum, Rotterdam Purpose: Atherosclerosis plays an important role in the pathogenesis of cognitive decline and dementia. Calcified plaque measured with CT is a marker of atherosclerosis. This study investigates associations between CT-measured arterial calcifications measured at four locations, with cognition and macro- and microstructural brain changes. Method and materials: From the general population, 2437 participants underwent CT of the coronary arteries, aortic arch, extracranial and intracranial carotid arteries to quantify calcification volume. Cognitive function was assessed in the following domains: memory, executive function, information processing speed and motor speed. In a random subgroup of 844 participants brain MRI was performed to obtain measures of brain atrophy. Automated quantification of brain MRI scans yielded tissue-specific brain volumes. Furthermore, microstructural integrity of white matter was quantified using diffusion tensor imaging (DTI). Associations between arterial calcification and cognition, brain tissue volumes and DTI-measures were assessed with linear regression, adjusted for relevant confounders. Results: Larger calcification load was associated with worse cognitive scores in all domains. Calcification in all vessel beds was also associated with smaller total brain volume. Specifically, coronary calcification was associated with smaller grey matter volume, whilst both extra- and intracranial carotid artery calcification was associated with smaller white matter volume. Calcification in all vessel beds was associated with worse microstructural integrity of white matter. Conclusion: Arterial calcification load is associated with worse cognitive performance. Moreover, larger calcification load is associated with smaller brain tissue volumes and with worse white matter microstructural quality, elucidating possible mechanisms through which atherosclerosis leads to poorer cognition. O9.2 TIA AND STROKE PATIENTS WITH CAROTID STENOSIS: PRESENCE OF COMPLICATED PLAQUE FEATURES AT MRI IS ASSOCIATED WITH RECURRENT EVENTS R.M. Kwee 1 , R.J. van Oostenbrugge 1 , W.H. Mess 1 , M.H. Prins 1 , R.J. van der Geest 2 , J.W.M. ter Berg 3 , C.L. Franke 4 , A.G.G.C. Korten 5 , B.J. Meems 6 , J.M.A. van Engelshoven 1 , J.E. Wildberger 1 , M.E. Kooi 1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Leids Universitair Medisch Centrum, Leiden 3 Orbis Medisch Centrum, Sittard 4 Atrium Medisch Centrum Parkstad, Heerlen 5 Laurentius Ziekenhuis, Roermond 6 VieCuri Medisch Centrum, Venlo Purpose: There is a need for improved risk stratification of TIA and stroke patients with carotid atherosclerosis. The purpose of the present study was to prospectively investigate whether certain MRI-based carotid plaque characteristics are associated with recurrent ischemic events. Materials and Methods: One hundred TIA/stroke patients with ipsilateral 30-69% carotid stenosis underwent multisequence MRI, including contrast-enhanced images, of the carotid plaque within 32.7±19.9 days after the initial event. For each plaque, vessel wall volume and volumes of lipidrich necrotic core (LRNC), calcifications, and fibrous tissue were assessed. Maximum vessel wall thickness, minimum lumen area, fibrous cap status, and intraplaque hemorrhage (IPH) were also assessed. Patients were followed by structured interviews and chart review to determine the recurrence of ipsilateral TIA and/or ischemic stroke within one year. 62 k i j k o o k o p w w w . c o n g r e s s c o m p a n y . c o m o f w w w . r a d i o l o g e n . n l
Neuro- en Hoofdhals radiologie 9 Results: Ten of hundred included patients suffered from recurrent ipsilateral clinical ischemic events (9 TIAs and 1 ischemic stroke). The presence of IPH was associated with recurrence (Pearson Chi-Square= 7.373, P=0.007). Patients with recurrent events also had plaques with larger LRNC volume and larger maximum vessel wall thickness, although these findings were borderline significant (P=0.032 and P=0.055, respectively). Other MRI-based parameters were not related to recurrent ischemic events. Conclusion: The results of this study indicate that the presence of IPH, larger LRNC volume, and larger maximum vessel wall thickness of carotid plaques are associated with recurrent TIA and ischemic stroke. Assessment of carotid plaque characteristics by MRI may help identifying high-risk patients, which could improve patient selection for carotid endarterectomy or stenting. O9.3 CAROTID PLAQUE MORPHOLOGY AND ISCHEMIC VASCULAR BRAIN DISEASE ON MRI Q.J.A. van den Bouwhuijsen, M.W. Vernooij, W.J. Niessen, G.P. Krestin, M.A. Ikram, J.C.M. Witteman, A. van der Lugt Erasmus Medisch Centrum, Rotterdam Purpose: Vulnerable plaque components in carotid arteries can be detected non-invasively with magnetic resonance imaging (MRI). In asymptomatic persons, the relation between carotid plaque composition and vascular brain disease is not well studied. We studied the association between carotid atherosclerotic plaque characteristics and ischemic brain disease on MRI. Methods: From the population-based Rotterdam Study, 952 participants with carotid wall thickening on ultrasound >2.5 mm underwent both carotid MRI and brain MRI. Maximum carotid wall thickening, degree of stenosis and presence of intraplaque hemorrhage, lipid core and calcification were assessed in both carotid arteries. Associations between plaque characteristics and white matter lesions (WMLs), lacunar and cortical infarcts were investigated per participant and additionally per carotid artery. Analysis were adjusted for cardiovascular risk factors. Results: Carotid stenosis (OR per 10% stenosis increase 1.2 95% confidence interval (1.0-1.4), maximum carotid wall thickness (per mm increase 1.3,1.1-1.6) en presence of intraplaque hemorrhage (1.9,1.1-3.3), were all found to be significantly associated with presence of cortical infarcts, both in the participant based analysis and in the carotid artery based analysis. There were no associations between any plaque characteristics and presence of lacunar infarcts. In the subject based analysis maximum plaque thickness, presence of intraplaque hemorrhage and calcification were associated with WML-volume. In the artery based analysis only the association for calcifications remained. Conclusion: Presence of carotid intraplaque hemorrhage and measures of carotid plaque size are independently associated with cortical infarcts, but not with lacunar infarcts. Plaque calcification, but not vulnerable plaque components, is related to WML volume. Clinical relevance: This MRI study gives insight into the importance of atherosclerotic plaque composition, also in small plaques, for development of ischemic brain disease. O9.4 A COMPUTER BASED DIAGNOSTIC SYSTEM TO FACILITATE THE EARLY AND DIFFERENTIAL DIAGNOSIS OF DEMENTIA B. Jasperse, H.A. Vrooman, M. Koek, M.W. Vernooij, R. de Boer, F. van der Lijn, M.A. Ikram, M. Smits, W. Niessen, A. van der Lugt Erasmus Medisch Centrum, Rotterdam Purpose: Patterns of brain atrophy, hippocampal atrophy and vascular changes, as visualized on brain-MRI, play an important role in determining the underlying cause of dementia syndromes. The visual interpretation of these pathological changes can be very challenging due to intercurrent agerelated brain changes.To facilitate the distinction between abnormal and ‘normal age-related’ brain changes, we developed an automated system that provides individualspecific lobar brain volumes, hippocampal volumes and white matter lesion volume taking into account age- and sex-specific reference data from a ‘healthy’ aging population. Methods and Materials: Automated brain tissue segmentation and atlas-based registration is performed on T1, T2 and FLAIR MR-images, generating lobar brain volumes, hippocampal volumes and white matter lesion volume. For each resulting volume, reference curves are used to generate age- and sex-specific percentile values. The results are then presented in an on-line viewer to interpret the quality of tissue and structure segmentation and the quantitative results. Reference curves are generated from 867 healthy aging individuals (age-range (years): 61-91, Male/female-ratio (N): 425/422). 1 6 E R A D I O L O G E N D A G E N - 2 9 e n 3 0 S E P T E M B E R 2 0 1 1 63
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