Evidence map›Paper›PMID 41999130›Full record

ArticleJournal of magnetic resonance imaging : JMRI2026

Hypointensity on Carotid Plaque MRI and Its Relationship to Calcification: Histopathologic Validation With Quantitative Susceptibility Mapping.

Ayano Ishiyama, Hideki Ishimaru, Shinji Okano, Yohei Ikebe, Tsuyoshi Izumo, Yoichi Morofuji, Minoru Morikawa, Reiko Ideguchi, Ryo Toya

Abstract read
In one paragraph

Article in Journal of magnetic resonance imaging : JMRI, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Ayano IshiyamaDepartment of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Hideki IshimaruDepartment of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.ORCID https://orcid.org/0000-0002-7817-0507
Shinji OkanoDepartment of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Yohei IkebeCenter for Cause of Death Investigation, Faculty of Medicine, Hokkaido University, Sapporo, Japan.ORCID https://orcid.org/0000-0001-9129-0979
Tsuyoshi IzumoDepartment of Neurosurgery, Gifu University, Graduate School of Medicine, Gifu, Japan.ORCID https://orcid.org/0000-0001-8778-2698
Yoichi MorofujiDepartment of Neurosurgery, Showa Medical University, School of Medicine, Tokyo, Japan.ORCID https://orcid.org/0000-0001-7135-2220
Minoru MorikawaDepartment of Radiology, Nagasaki University Hospital, Nagasaki, Japan.ORCID https://orcid.org/0000-0003-3423-3008
Reiko IdeguchiDepartment of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.ORCID https://orcid.org/0000-0003-4283-2473
Ryo ToyaDepartment of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.ORCID https://orcid.org/0000-0001-9764-5718

Funding

Japan Society for the Promotion of Science JP20K08030
6 · The paper itself

Abstract

backgroundOn conventional carotid plaque MRI, calcification is commonly defined as a region that is hypointense across multiple contrast weightings. However, iron-containing components such as hemosiderin may exhibit similar signal characteristics, raising concerns regarding substrate specificity. PURPOSE: To evaluate whether quantitative susceptibility mapping (QSM) can distinguish hemosiderin from calcification in carotid atherosclerotic plaques using ex vivo MRI with direct histopathologic correlation. STUDY TYPE: Ex vivo specimen study. SPECIMEN: Twenty-four carotid endarterectomy specimens obtained between October 2017 and August 2021. FIELD STRENGTH/SEQUENCE: 3T MRI including spin-echo T1-weighted, spin-echo T2-weighted, time-of-flight-equivalent gradient-echo (FLASH) imaging, and multi-echo FLASH-based QSM reconstruction. ASSESSMENT: Histologic sections were stained with hematoxylin-eosin, von Kossa (calcification), and Berlin blue (hemosiderin). With histopathologic findings as reference, two radiologists defined corresponding regions of interest on MRI for substrate-level signal characterization. Contrast-to-noise ratios (CNR) were measured on conventional sequences, and relative susceptibility values (rSV) were measured on QSM. STATISTICAL TEST: Group comparisons were performed using the Wilcoxon rank-sum test. A two-sided p < 0.05 was considered statistically significant.

resultsSeventy-nine matched cross-sections yielded 41 calcifications and 25 hemosiderin deposits, including 16 sections with both components. On T1-, T2-, and FLASH imaging, CNR values did not differ significantly between calcification and hemosiderin (p = 0.12, p = 0.096, and p = 0.67, respectively), with substantial signal overlap. On QSM, hemosiderin exhibited positive rSVs (mean ± SD: 506.8 ± 320.5 ppb), whereas calcification exhibited negative rSVs (-440.5 ± 296.3 ppb), without polarity overlap in this dataset and with a significant group difference. Hemosiderin deposition was identified in 25 of 79 matched sections, and calcification and hemosiderin coexisted in 16 sections. DATA

conclusionsHypointensity on conventional carotid plaque MRI may not reliably indicate calcification at the substrate level. QSM enables robust differentiation between diamagnetic calcium and paramagnetic iron with histopathologic validation. LEVEL OF EVIDENCE: 2: TECHNICAL EFFICACY: Stage 2.

Indexed as

CalcinosisCarotid StenosisMagnetic Resonance ImagingPlaque, AtheroscleroticAgedCarotid ArteriesFemaleHemosiderinHumansMaleMiddle AgedReproducibility of ResultsHemosiderincalcificationcarotid plaquehemosiderinmagnetic susceptibilityquantitative susceptibility mapping

Identifiers

PMID41999130
PMCPMC13356289

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.