Quantitative assessment of coronary artery plaque vulnerability by high-resolution magnetic resonance imaging and computational biomechanics: A pilot study ex vivo

The risk of atherosclerotic plaque disruption is thought to be closely related to plaque composition and rupture triggers such as external mechanical forces. The purpose of this study was to integrate MR imaging and computational techniques for the quantification of plaque vulnerability with morphologic data and biomechanical stress/strain distributions that were all based on high-resolution MR images of coronary artery plaque specimens ex vivo. Twenty-two coronary artery plaque specimens were selectively collected from 10 cadavers. Multislice T-2-weighted spin echo images were acquired with a resolution of 100 x 100 mu m(2). Histopathological images were used as the gold standard for the identification of plaque components and vulnerability. Plaque components were classified on MR images, and the stress/strain components were calculated with a two-dimensional computational model with fluid-structure interactions. As expected, vulnerable plaques appeared to result from a large lipid pool, a thin fibrous cap, and some critical stress/strain conditions. An empiric vulnerability marker was derived and was closely related to the vulnerability score that was determined through pathologic examination. Noninvasive quantification of the MR contrast and mechanical properties of plaque may provide a comprehensive biomarker for the assessment of vulnerability of atherosclerotic plaques.