{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T10:07:43Z","timestamp":1775902063241,"version":"3.50.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Carotid artery atherosclerotic plaques undergo various pathological changes during disease progression, and their characterization relies on MRI, CT, and ultrasound imaging. The diagnosis of calcified lesions using only MRI is challenging because of irregular low-signal areas across all sequences. Conventionally, a diagnosis is made by combining multiple modalities such as contrast-enhanced CT (CECT) and carotid ultrasonography. Field echo resembling CT using restricted echo-spacing (FRACTURE) is a new MRI sequence with enhanced bone contrast that uses a 3D gradient echo pulse sequence. The aim of this study was to evaluate the ability of FRACTURE to detect carotid plaque calcification by comparing its images with pathological findings from carotid endarterectomy (CEA). The study also compared the accuracy of conventional CECT and MRI plaque imaging with that of FRACTURE and assessed its accuracy in stenosis rate evaluation using fusion imaging with MR angiography (MRA).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This retrospective analysis included 21 consecutive patients (average age 74 years, 16 males) who underwent FRACTURE, CECT, and MRA (including time-of-flight and black-blood techniques) as preoperative examinations for CEA. Pathological specimens from extracted plaques were analyzed, and the calcified areas were measured and statistically compared across imaging modalities. Digital subtraction angiography (DSA) was used as the reference standard for stenosis rate evaluation.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The sensitivity and specificity of FRACTURE in detecting calcified lesions in pathological specimens were comparable with those of CECT (sensitivity 91.7% vs 95.8%, specificity 96.6% vs 93.1%) and superior to those of MRA (sensitivity 75.0%, specificity 93.1%). Furthermore, for lesions < 2 mm\n 2<\/jats:sup>\n , significant differences in the measured calcified areas were observed between pathological specimens and both CECT and MRA, whereas no significant difference was found with FRACTURE, suggesting its superiority for small lesions. In stenosis rate assessment, no significant differences were found among FRACTURE\/MRA, CECT, and DSA in overall stenosis measurements. However, in cases in which calcified lesions directly faced the vascular lumen, CECT tended to overestimate stenosis because of beam-hardening artifacts, while FRACTURE\/MRA showed a higher agreement with DSA, indicating greater accuracy.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n FRACTURE is a useful MRI sequence with higher sensitivity and specificity than those of MRA and accuracy comparable with that of CECT for calcified lesion detection. Additionally, it may provide superior detection of small, calcified lesions and more accurate stenosis assessment in cases with calcified plaques.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.4.jns241803","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T01:30:22Z","timestamp":1755912622000},"page":"1596-1605","source":"Crossref","is-referenced-by-count":1,"title":["Advanced MRI of calcified carotid artery plaques: pathological validation of accuracy"],"prefix":"10.3171","volume":"143","author":[{"given":"Tomotaka","family":"Ishizaki","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuya","family":"Kurono","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Nakano","sequence":"additional","affiliation":[{"name":"Radiological Physics and Technology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Fujii","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Otone","family":"Endo","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Okada","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Circulation","first-page":"1355","article-title":"A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association","volume":"92","author":"Stary HC","year":"1995","unstructured":"Stary HC, Chandler AB, Dinsmore RE, A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995;92(5):1355\u20131374."},{"issue":"5","key":"b2","series-title":"Arterioscler Thromb Vasc Biol","first-page":"1177","article-title":"Natural history and histological classification of atherosclerotic lesions: an update","volume":"20","author":"Stary HC","year":"2000","unstructured":"Stary HC. Natural history and histological classification of atherosclerotic lesions: an update. Arterioscler Thromb Vasc Biol. 2000;20(5):1177\u20131178."},{"issue":"1","key":"b3","series-title":"J Neurosurg","first-page":"27","article-title":"Contemporary carotid imaging: from degree of stenosis to plaque vulnerability","volume":"124","author":"Brinjikji W","year":"2016","unstructured":"Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg. 2016;124(1):27\u201342."},{"issue":"11","key":"b4","series-title":"Stroke","first-page":"3040","article-title":"Analysis of calcium in carotid plaques with Agatston scores for appropriate selection of surgical intervention","volume":"38","author":"Katano H","year":"2007","unstructured":"Katano H, Yamada K. Analysis of calcium in carotid plaques with Agatston scores for appropriate selection of surgical intervention. Stroke. 2007;38(11):3040\u20133044."},{"issue":"6","key":"b5","series-title":"J Stroke Cerebrovasc Dis","first-page":"1341","article-title":"Calcified carotid plaques show double symptomatic peaks according to Agatston calcium score","volume":"24","author":"Katano H","year":"2015","unstructured":"Katano H, Mase M, Nishikawa Y, Yamada K. Calcified carotid plaques show double symptomatic peaks according to Agatston calcium score. J Stroke Cerebrovasc Dis. 2015;24(6):1341\u20131350."},{"issue":"4","key":"b6","series-title":"Neurosurgery","first-page":"531","article-title":"High-risk factors in symptomatic patients undergoing carotid artery stenting with distal protection: Buffalo Risk Assessment Scale (BRASS)","volume":"77","author":"Fanous AA","year":"2015","unstructured":"Fanous AA, Natarajan SK, Jowdy PK, High-risk factors in symptomatic patients undergoing carotid artery stenting with distal protection: Buffalo Risk Assessment Scale (BRASS). Neurosurgery. 2015;77(4):531\u2013543."},{"issue":"11","key":"b7","series-title":"Circulation","first-page":"1368","article-title":"Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging","volume":"106","author":"Cai JM","year":"2002","unstructured":"Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL, Yuan C. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation. 2002;106(11):1368\u20131373."},{"issue":"5","key":"b8","series-title":"Circulation","first-page":"932","article-title":"Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo","volume":"94","author":"Toussaint JF","year":"1996","unstructured":"Toussaint JF, LaMuraglia GM, Southern JF, Fuster V, Kantor HL. Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo. Circulation. 1996;94(5):932\u2013938."},{"issue":"7","key":"b9","series-title":"Radiol Med","first-page":"921","article-title":"Characterisation of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology","volume":"111","author":"Puppini G","year":"2006","unstructured":"Puppini G, Furlan F, Cirota N, Characterisation of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology. Radiol Med. 2006;111(7):921\u2013930."},{"issue":"8","key":"b10","series-title":"Skeletal Radiol","first-page":"1705","article-title":"Fast field echo resembling a CT using restricted echo-spacing (FRACTURE): a novel MRI technique with superior bone contrast","volume":"50","author":"Johnson B","year":"2021","unstructured":"Johnson B, Alizai H, Dempsey M. Fast field echo resembling a CT using restricted echo-spacing (FRACTURE): a novel MRI technique with superior bone contrast. Skeletal Radiol. 2021;50(8):1705\u20131713."},{"issue":"1","key":"b11","series-title":"Biometrics","first-page":"159","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis JR","year":"1977","unstructured":"Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159\u2013174."},{"issue":"2","key":"b12","series-title":"Radiology","first-page":"487","article-title":"Assessment of human atherosclerotic carotid plaque components with multisequence MR imaging: initial experience","volume":"234","author":"Cappendijk VC","year":"2005","unstructured":"Cappendijk VC, Cleutjens KB, Kessels AG, Assessment of human atherosclerotic carotid plaque components with multisequence MR imaging: initial experience. Radiology. 2005;234(2):487\u2013492."},{"issue":"1","key":"b13","series-title":"Arterioscler Thromb Vasc Biol","first-page":"234","article-title":"Quantitative evaluation of carotid plaque composition by in vivo MRI","volume":"25","author":"Saam T","year":"2005","unstructured":"Saam T, Ferguson MS, Yarnykh VL, Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol. 2005;25(1):234\u2013239."},{"issue":"5","key":"b1","series-title":"Circulation","first-page":"1355","article-title":"A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association","volume":"92","author":"Stary HC","year":"1995","unstructured":"Stary HC, Chandler AB, Dinsmore RE, A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995;92(5):1355\u20131374."},{"issue":"5","key":"b2","series-title":"Arterioscler Thromb Vasc Biol","first-page":"1177","article-title":"Natural history and histological classification of atherosclerotic lesions: an update","volume":"20","author":"Stary HC","year":"2000","unstructured":"Stary HC. Natural history and histological classification of atherosclerotic lesions: an update. Arterioscler Thromb Vasc Biol. 2000;20(5):1177\u20131178."},{"issue":"1","key":"b3","series-title":"J Neurosurg","first-page":"27","article-title":"Contemporary carotid imaging: from degree of stenosis to plaque vulnerability","volume":"124","author":"Brinjikji W","year":"2016","unstructured":"Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg. 2016;124(1):27\u201342."},{"issue":"11","key":"b4","series-title":"Stroke","first-page":"3040","article-title":"Analysis of calcium in carotid plaques with Agatston scores for appropriate selection of surgical intervention","volume":"38","author":"Katano H","year":"2007","unstructured":"Katano H, Yamada K. Analysis of calcium in carotid plaques with Agatston scores for appropriate selection of surgical intervention. Stroke. 2007;38(11):3040\u20133044."},{"issue":"6","key":"b5","series-title":"J Stroke Cerebrovasc Dis","first-page":"1341","article-title":"Calcified carotid plaques show double symptomatic peaks according to Agatston calcium score","volume":"24","author":"Katano H","year":"2015","unstructured":"Katano H, Mase M, Nishikawa Y, Yamada K. Calcified carotid plaques show double symptomatic peaks according to Agatston calcium score. J Stroke Cerebrovasc Dis. 2015;24(6):1341\u20131350."},{"issue":"4","key":"b6","series-title":"Neurosurgery","first-page":"531","article-title":"High-risk factors in symptomatic patients undergoing carotid artery stenting with distal protection: Buffalo Risk Assessment Scale (BRASS)","volume":"77","author":"Fanous AA","year":"2015","unstructured":"Fanous AA, Natarajan SK, Jowdy PK, High-risk factors in symptomatic patients undergoing carotid artery stenting with distal protection: Buffalo Risk Assessment Scale (BRASS). Neurosurgery. 2015;77(4):531\u2013543."},{"issue":"11","key":"b7","series-title":"Circulation","first-page":"1368","article-title":"Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging","volume":"106","author":"Cai JM","year":"2002","unstructured":"Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL, Yuan C. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation. 2002;106(11):1368\u20131373."},{"issue":"5","key":"b8","series-title":"Circulation","first-page":"932","article-title":"Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo","volume":"94","author":"Toussaint JF","year":"1996","unstructured":"Toussaint JF, LaMuraglia GM, Southern JF, Fuster V, Kantor HL. Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo. Circulation. 1996;94(5):932\u2013938."},{"issue":"7","key":"b9","series-title":"Radiol Med","first-page":"921","article-title":"Characterisation of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology","volume":"111","author":"Puppini G","year":"2006","unstructured":"Puppini G, Furlan F, Cirota N, Characterisation of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology. Radiol Med. 2006;111(7):921\u2013930."},{"issue":"8","key":"b10","series-title":"Skeletal Radiol","first-page":"1705","article-title":"Fast field echo resembling a CT using restricted echo-spacing (FRACTURE): a novel MRI technique with superior bone contrast","volume":"50","author":"Johnson B","year":"2021","unstructured":"Johnson B, Alizai H, Dempsey M. Fast field echo resembling a CT using restricted echo-spacing (FRACTURE): a novel MRI technique with superior bone contrast. Skeletal Radiol. 2021;50(8):1705\u20131713."},{"issue":"1","key":"b11","series-title":"Biometrics","first-page":"159","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis JR","year":"1977","unstructured":"Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159\u2013174."},{"issue":"2","key":"b12","series-title":"Radiology","first-page":"487","article-title":"Assessment of human atherosclerotic carotid plaque components with multisequence MR imaging: initial experience","volume":"234","author":"Cappendijk VC","year":"2005","unstructured":"Cappendijk VC, Cleutjens KB, Kessels AG, Assessment of human atherosclerotic carotid plaque components with multisequence MR imaging: initial experience. Radiology. 2005;234(2):487\u2013492."},{"issue":"1","key":"b13","series-title":"Arterioscler Thromb Vasc Biol","first-page":"234","article-title":"Quantitative evaluation of carotid plaque composition by in vivo MRI","volume":"25","author":"Saam T","year":"2005","unstructured":"Saam T, Ferguson MS, Yarnykh VL, Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol. 2005;25(1):234\u2013239."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/143\/6\/article-p1596.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/143\/6\/article-p1596.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/143\/6\/article-p1596.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:27:12Z","timestamp":1772720832000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/143\/6\/article-p1596.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":26,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.4.jns241803","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}