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In Vivo UTE MRI can Evaluate Plaque Morphology Changes after Endovascular Intervention for CLTI
Alexander B Crichton, Eniko B Pomozi, Janak B Lamichhane, Christof B Karmonik, Alan B Lumsden, Trisha B Roy
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
IntroductionRestenosis after endovascular therapy for CLTI is common, with some studies suggesting it to be as high as 70% at 3 months. Typically, surveillance imaging is performed with ultrasound. However, ultrasound often struggles to clearly define disease in the below the knee arteries due to significant calcification. Ultrashort echo time (UTE) MRI is a non-contrast MRI technique that can evaluate plaque morphology and composition with 0.5 mm isotropic resolution with 3D reconstructions for enhanced arterial evaluation. In this study, we aimed to show how UTE MRI can evaluate underlying vessel wall response to endovascular treatment in patients with below the knee CLTI.
MethodsPatients attending an academic vascular center with CLTI were included in the study. All patients underwent a non-contrast UTE research MRI prior to their endovascular procedure. The surgeon was blinded to the findings of the MRI, and proceeded to treatment based on pre-clinical and intraprocedural imaging. Patients then underwent follow up UTE MRI. The primary outcome of interest was restenosis/occlusion of the treated artery following treatment. Other outcomes included how plaque composition related to restenosis, and documented restenosis in clinical follow up imaging.
Results5 patients with 15 arterial lesions (4 popliteal, 3 tibioperoneal trunk and 8 tibial) that were treated endovascularly were included and underwent at least one follow up MRI scan. 1 lesion was non-crossable and did not undergo treatment. Median follow time for MRI was 5 months (4-11m). Clinical ultrasound was performed in 3 patients (10 arterial lesions). Ultrasound was non-diagnostic in 20% of arterial lesions. Restenosis was seen in 40% and patency remained in 40% of lesions. MRI evaluation identified 11 hard lesions (calcium/collagen) and 3 soft lesions (thrombus/lipid/smooth muscle) and follow up imaging of lesions was 100% diagnostic (figure 1). Restenosis occurred in 64% of lesions. In those where restenosis occurred, 78% were hard lesions. UTE MRI allowed 3D evaluation of plaque composition, and of the patent area retained/lost after treatment. Figures one and two show two cases of hard plaque lesions that a had maintained increase in patent area after POBA and intravascular lithotripsy/DCB
respectively. In both cases a sustained increase in overall vessel area also occurred, suggesting positive arterial remodeling.
ConclusionNon-contrast UTE MRI can provide detailed insights into morphological changes following endovascular treatment, delivering superior spatial resolution to understand real-time vessel wall response to revascularization treatments.
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