2024/7 - Signal intensity and volume of carotid intraplaque hemorrhage on MRI and the risk of ipsilateral cerebrovascular events: the Plaque At RISK (PARISK) study [Journal Club]-July JCMR Journal Club

Video Transcription

Video Summary

This JCMR Journal Club session, moderated by Dr. Valentina Puntzmann and presented by Kelly Nyes from Maastricht University, focused on carotid intraplaque hemorrhage (IPH) and its ability to predict future stroke risk in the PARIS study.<br /><br />IPH is a well-established marker of vulnerable carotid plaque and is strongly associated with ipsilateral ischemic stroke. The study asked whether quantitative MRI measures of IPH—signal intensity ratio and volume—added prognostic value beyond simple IPH presence. In 87 symptomatic patients with IPH, followed for a median of 5.1 years, neither IPH signal intensity ratio nor IPH volume independently predicted future ipsilateral cerebrovascular events. Results remained nonsignificant after adjustment for age, sex, and stenosis severity. Secondary analysis of follow-up brain MRI also showed no meaningful association with new ipsilateral infarcts.<br /><br />The take-home message was that identifying whether IPH is present may be sufficient for clinical risk stratification; more complex quantification did not improve prediction. The discussion also highlighted the broader IMPROVE model, which combines IPH presence with stenosis, age, sex, and index event type to better estimate stroke risk and may outperform usual care.<br /><br />Overall, the session emphasized that carotid MRI has practical value, but simple, clinically usable markers may be more useful than more elaborate quantitative measurements.

Keywords

carotid intraplaque hemorrhage

stroke risk prediction

carotid plaque vulnerability

MRI biomarkers

PARIS study

signal intensity ratio

IPH volume

ipsilateral cerebrovascular events

IMPROVE model