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

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 mm(2) vs. 40.7 +/- 12.9 mm(2), P < 0.05), WA (33.9 +/- 11.5 mm(2) vs. 26.3 +/- 7.5 mm(2), P < 0.05), and TVA (80.1 +/- 20.4 mm(2) vs. 67.0 +/- 18.0 mm(2), 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 mm(2) vs. 42.1 +/- 12.6 mm(2), P < 0.05), WA (32.9 +/- 11.0 mm(2) vs. 25.8 +/- 6.1 mm(2), P < 0.05), and TVA (81.2 +/- 22.1 mm(2) vs. 67.9 +/- 16.5 mm(2), 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