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Comparison of Femoral Artery Atherosclerotic Plaque Characteristics between Patients with and without Diabetes Mellitus: A 3D MR Vessel Wall Imaging Study1Center for Brain Disorders Research, Capital Medical University and Beijing Institute of Brain Disorders, Beijing, China, 2Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China, 3Department of Radiology, Yangzhou University Affiliated Hospital, Yangzhou, China
Synopsis
Diabetes mellitus is a documented high risk factor for the development of atherosclerosis. This study investigated the characteristics of atherosclerotic plaque in diabetic patients in comparison with non-diabetic patients using 3D multi-contrast MR vessel wall imaging. We found that patients in diabetic group had higher plaque burden, prevalence of plaque and more complex composition than those in non-diabetic group.
Introduction
Lower extremity atherosclerotic disease (LEAD) is the third leading cause of cardiovascular events after coronary disease and stroke. It has been shown that diabetes mellitus is one of the most harmful risks factors of LEAD 1, 2. Previous study reported that patients with diabetes mellitus and coronary artery disease or coronary artery disease risk factors had higher atherosclerotic burden in superficial femoral artery than the general population 3. However, the differences in characteristics of femoral artery atherosclerotic plaque in LEAD population with and without diabetes remains unclear. The study sought to compare the characteristics of burden and compositions of femoral artery atherosclerotic plaques between diabetic and non-diabetic patients using three-dimensional (3D) multi-contrast magnetic resonance (MR) vessel wall imaging.Methods
Study sample: Forty-eight diabetic patients (mean age, 69.5 ± 8.2 years; 26 males) and fifty non-diabetic patients (mean age, 71.9 ± 5.7 years; 28 males) with LEAD were recruited and underwent MR vessel wall imaging for femoral arteries. The study protocol was approved by local institutional review board and written consent form was obtained from each patient. MR imaging: The MR imaging was conducted on a 3.0T Philips MR scanner (Achievia TX, Philips Healthcare, Best, The Netherlands) with a 32- channel phased array heart coil. A 3D multi-contrast MR imaging protocol, including MERGE 4, T2-VISTA 5 and SNAP 6 sequences, was performed for all subjects. The imaging parameters are detailed in Table 1. Image analysis: All MR images were reviewed by two experienced radiologists using a custom-designed software (3D-CASCADE) with consensus. The femoral arteries divided into four segments: common femoral artery (CFA), proximal of superficial femoral artery (pSFA), adductor canal segment (AC) and popliteal artery segment (PA). The MR morphological characteristics including lumen area (LA), wall area (WA), maximum wall thickness (MaxWT), minimum wall thickness (MinWT), normalized wall index (NWI = WA / [LA + WA] × 100%), eccentricity index (EI = [MaxWT - MinWT] / MaxWT) and luminal stenosis (LS = [1- LAstenosis / LAinference] ×100%) were measured. The presence of atherosclerotic plaque which is defined as eccentric wall thickness for each slice was identified. In addition, the plaque compositional characteristics including calcification, lipid-rich necrotic core (LRNC), and intraplaque hemorrhage (IPH) were also determined on multi-contrast 3D vessel wall images. Statistical analysis: The morphological characteristics and the prevalence of plaques between diabetic and non-diabetic groups were compared among different femoral artery segments using in independent t test or Chi-square test. The prevalence of plaque compositional characteristics of each segment was calculated. A value of p < 0.0125 was considered statistically significant after adjusted for segments factor.Results
In total, 392 arteries segments from 98 patients were included in the final statistical analysis. The comparison of MR morphological and the prevalence of plaque among different femoral arteries between diabetic and non-diabetic groups are shown in Table 2. Although diabetic group showed greater MaxWT, EI, and LS compared with non-diabetic group in all 4 segments, most of the differences were not statistically significant except for EI in CFA and AC segments (both p <0.012) and LS in AC segment (p = 0.003). Compared with patients in non-diabetic group, those in diabetic group had significantly higher prevalence of atherosclerotic plaque in pSFA (53.1% vs. 34.0%) and AC (49.0% vs. 23.0%) segments (both p < 0.010). There were no significant differences in LA, WA and NWI in any segments and prevalence of plaque in CFA and PA segments between diabetic and non-diabetic groups. Additionally, the prevalence of plaque compositions between diabetic and non-diabetic groups among different segments are presented in Figure 1. Patients in diabetic group had significantly higher prevalence of calcification in pSFA and AC segments (both p < 0.010), LRNC in AC and PA segments (both p < 0.0125) and IPH in PA segment (p = 0.027) than patients in non-diabetic group. Figure 2 represents an example for a diabetic patient with multiple atherosclerotic plaques.Discussion and Conclusion
In this study population, patients with diabetes had significantly higher atherosclerotic plaque burden, prevalence of plaque and more complex composition of calcification, LRNC and IPH in femoral artery than those without diabetes. This may explain the increased cardiovascular events in diabetic patients 7, 8. Previous studies have reported that hyperglycemia might play an important role in atherosclerotic plaque formation 9. However, the interventions and treatments in atherosclerotic plaques of diabetic patients need to be prospectively studied in order to reduce the prevalence of cardiovascular events.Acknowledgements
None.References
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