Objective: Carotid magnetic resonance imaging (MRI) may be a useful tool in characterizing carotid plaque vulnerability, but large studies are still lacking. The purpose of this study was to assess carotid MRI features of vulnerable plaque in a large study and the changes in carotid plaque morphology with respect to time since the neurological event.

Methods: We included 161 patients with carotid plaque more than 3 mm thick. All patients underwent carotid MRI to obtain 3-T high-resolution magnetic resonance sequences. Large lipid core, intraplaque hemorrhage (IPH), fibrous cap rupture (FCR), and gadolinium enhancement (GE) were assessed and classified as present or absent. Prevalences of these features were then compared between symptomatic and asymptomatic patients and time since stroke.

Results: Seven patients were excluded because of poor image quality. Of the remaining 154 patients, 52 were symptomatic and 102 were asymptomatic. The prevalences of IPH (39 vs 16%; P = .002), FCR (30 vs 9%; P = .001), and GE (75 vs 55%; P = .015) were significantly higher in symptomatic than asymptomatic patients. After multivariate analysis, the prevalences of IPH (odds ratio, 2.6; P = .023) and FCR (odds ratio, 2.8; P = .038) were still significantly higher. The prevalence of IPH was significantly higher in symptomatic patients with plaque regardless of the time since the neurological event. For FCR, the difference between symptomatic and asymptomatic patients was significant only during the first 15 days after the neurological event.

Conclusions: Carotid MRI can identify plaque features that are associated with symptomatic presentation and may be indicative of plaque vulnerability. These features may ultimately be used in the management of extracranial carotid stenosis.