ORIGINAL RESEARCH article
Front. Mol. Biosci.
Sec. Molecular Diagnostics and Therapeutics
This article is part of the Research TopicInnovations in Molecular Diagnostics and Treatments for Cerebrovascular DisordersView all articles
Exploring the risk stratification of carotid plaque hemodynamic based on four-dimensional blood flow technology
Provisionally accepted
- 1The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- 2Beijing Tsinghua Changgung Hospital, Beijing, China
- 3IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China
- 4Center for Biomedical Imaging Research, Tsinghua University, Beijing, China., Beijing, China
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Introduction: Carotid plaque rupture is a major cause of cerebrovascular events. This study explores the integration of hemodynamic parameters with structural biomarkers for improved risk stratification. Methods: Fifty-seven patients with moderate-severe carotid stenosis underwent 4D-flow MRI and high-resolution MRI. Hemodynamic parameters (Wall Shear Stress, velocity) were analyzed using GT-Flow software at upstream, throat, and downstream plaque regions. After comparison of characteristic values between symptomatic plaques and asymptomatic plaques, variables with p < 0.1 were included in the multivariate logistic regression model to identify independent risk factors. Results: Wall Shear Stress (WSS) was significantly higher at plaque throat (0.891± 0.422 Pa) and downstream (0.971±0.587 Pa) versus upstream (0.649±0.297 Pa; p<0.001). Symptomatic plaques showed elevated 3D-WSSmean (1.041±0.418 vs. 0.797±0.402 Pa, p=0.032), WSS up_max (1.345±0.570 vs. 0.970±0.383 Pa, p=0.004), and stenosis velocity (31.7±9.9 vs. 25.8±10.3 cm/s, p=0.036). Thin Fibrous Cap (TFC, OR=5.34, p=0.007) and Normalized Wall Index (NWI, adjusted OR=59.89, p=0.029) independently predicted symptomatic plaques. Combined model (NWI+TFC+WSS down_max) predicted cerebral ischemic events within six months with AUC=0.809 (95%CI: 0.699-0.919). Conclusion: Integration of downstream hemodynamic profiling (WSS) with structural biomarkers (TFC, NWI) provides a robust stratification tool for cerebrovascular risk assessment. These quantitative parameters offer potential as molecular diagnostics for plaque vulnerability.
Keywords: 4D-flow MRI, high-resolution magnetic resonance imaging, Carotidartery plaque, Hemodynamics, risk stratification
Received: 13 Aug 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Zhang, Zhao, Song, Wu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jian Wu, wujianxuanwu@126.com
Rui Li, leerui@tsinghua.edu.cn
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