Comparison of Carotid Plaque Characteristics Between Men and Women Using Magnetic Resonance Vessel Wall Imaging: A Chinese Atherosclerosis Risk Evaluation Study

Abstract

Background: Carotid vulnerable plaque is a major cause of stroke and differs between men and women. Few studies have investigated the differences in carotid plaque features between sexes in a Chinese population.

Purpose: To compare carotid atherosclerotic plaque features between men and women in a Chinese population using magnetic resonance imaging.

Study type: Cross-sectional.

Subjects: A total of 567 patients (mean age: 61.5 ± 10.1 years; 404 men) who had recent stroke or transient ischemia attack and atherosclerotic plaque in at least one carotid artery.

Field strength: A 3.0 T.

Sequence: T1- and T2-weighted turbo spin echo, three-dimensional time-of-flight (TOF) fast field echo and magnetization-prepared rapid acquisition gradient echo sequences.

Assessment: Plaque characteristics including lumen area (LA), wall area (WA), total vessel area (TVA), mean wall thickness (MWT), and mean normalized wall index (NWI); presence of calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR); and percent composition area (%area) were evaluated and compared between men and women.

Statistical tests: Independent-sample t test, Mann-Whitney U test, chi-square test, and multiple linear and logistic regressions.

Results: In symptomatic arteries, men had significantly greater LA (46.2 ± 15.6 mm² vs. 40.7 ± 12.9 mm² , P < 0.05), WA (33.9 ± 11.5 mm² vs. 26.3 ± 7.5 mm² , P < 0.05), and TVA (80.1 ± 20.4 mm² vs. 67.0 ± 18.0 mm² , P < 0.05); higher MWT (1.2 ± 0.4 mm vs. 1.0 ± 0.2 mm, P < 0.05); and higher prevalence of LRNC (72.3% vs. 46.0%, P < 0.05) and IPH (18.6% vs. 4.9%, P < 0.05) compared with women. In asymptomatic arteries, men had significantly greater LA (48.3 ± 16.9 mm² vs. 42.1 ± 12.6 mm² , P < 0.05), WA (32.9 ± 11.0 mm² vs. 25.8 ± 6.1 mm² , P < 0.05), and TVA (81.2 ± 22.1 mm² vs. 67.9 ± 16.5 mm² , P < 0.05); higher MWT (1.2 ± 0.3 mm vs. 1.0 ± 0.2 mm, P < 0.05); higher prevalence of LRNC (67.8% vs. 42.9%, P < 0.05), IPH (14.9% vs. 1.2%, P < 0.05), and FCR (6.4% vs. 1.2%, P < 0.05); and higher %LRNC area (24.8 ± 17.2% vs. 17.8 ± 14.1%, P < 0.05) compared with women.

Data conclusion: Men have similar plaque burden but more vulnerable atherosclerotic plaques compared with women in both symptomatic and asymptomatic carotid arteries in a Chinese population.

Evidence level: 4 TECHNICAL EFFICACY: Stage 3.

Keywords: atherosclerosis; carotid artery; magnetic resonance imaging; sex.