1. C004 (Subject CG)-Right Carotid Review of the patient diagnosis In vivo image data Tissue matching between in-vivo and ex-vivo MRI. Matching MR and CT Ex-vivo and PCA Manual labeling 3-D reconstruction Example labeled slices, with raw data, labeled Data and histology Issues and Questions

2. Ron Wolf’s Diagnosis Probably primarily Type VII plaque, heavily calcified distal CCA/bulb with distal CCA fibrous tissue laterally High grade focal stenosis Bifurcation at about C3-4

3. AVPAS (Automated Vulnerable Plaque Assessment System) This slide shows multi- contrast MR images of four slices. This image sequence served as a check matching those provided to us by Ron Wolf for this subject (C004/CG). Ron’s version is shown on the following slide). TOF slices were shifted in the z-axis to achieve column-wise alignment.

4. MR 1/5/04 (From Ron) T1W (multislice) PDW (multislice) TOF 1/5/04 MRI

5. Matching Ex-vivo and In-Vivo Images Ca Ex-vivo MRI Slice In-vivo TOF MR slice 4 of 12. * * Notes 1.Red asterisk indicates a morphological landmark common to in-vivo and ex-vivo, the tail-like structure of the lumen. Lumen is indicated by ‘L’. 2.Intimal calcium surrounds the lumen ‘tail’. Fiberous tissue encases much the calcium. L L

6. This figure shown is from Yuan’s In-Vivo Accuracy of Multispectral Magnetic Resonance Imaging for Identifying Lipid Rich Necrotic Core. It displays a pathology appearing similar to c004: large intimal calcifications protruding into the lumen, giving the TOF a mis-shapen ‘tail’ flow area. The close resemblance in shape and composition suggests similar stages of the disease and provided guidance in labeling. Ex-vivo and in-vivo (TOF) MR Tissue Matching Ex-vivo and In-Vivo Images

7. Finding a match between CT and MRI proved to be difficult for subject C004. Landmarks are indicated by : Asterisk - Calcium nodule ‘L’ – Lumen ‘D’ – Disrupted, broken tissue -C004 CT was sent to us in Analyze format and seemed to suffer a loss in contrast relative to the CT scans sent to us in tif format (truncation loss?). As seen in the 2 CT images shown below, the data was examined with 2 different tools: MRIcro and GEHC Microview In-vivo and ex-vivo MRI Ca * * * * L L D CT using MRIcro CT using GEHC MicroView Matching CT and MR

8. Matching Ex-vivo and CT Images This figure is taken from Ron’s Mineral Volume and Morphology if Carotid Plaque It shows close agreement between MR and CT for what appears to be subject c004. Duplicating this match proved to be difficult.

9. C004 Ex-vivo MRI Slices 5-9 and PCA This slide shows all of the contrast weightings for ex- vivo slices 5-9. The column on the right side shows an RGB overlay of the first three principle components PCA

10. Labeling and Classifying Lesion Types The tables shown above and to the right provide labeling references for classifying tissues and AHA disease stages according to MR appearance.

11. 1234 5 678 Consecutive 3D TOF Sections Flow Gap lumen Calcium (black) C004 Left Carotid Labeling and Notes from Ron

12. Labeling of slide with Lumen ‘Tail’ Legend Lumen: Red Fibrous Tissue: Blue Calcium: white Wall: Green Note: The following slide shows the slices without the labeling

13. Slice shown without labeling

14. Labelings on Multiple Slices This screen shot shows the labels overlayed on the gray scale MR images. Unfortunately, the tools lacks a satisfactory dot size makes to show the label without obscuring the image. In this screen shot the labels appear as very vague clouds of red, green, blue and white dots.

15. 3D Rendering of Labels Legend Lumen: Red (solid) Fibrous Tissue: Blue (transparent) Calcium: gray (solid) Wall: transparent These are 3D images of the labeled tissue. The image on the right is shown without the fiberous tissue so that calcium can be seen more clearly. The labeling shows a nodule (or region of high calcium content) encased in fibrous tissue.

16. Distal region question These panels show an abrupt transition from fibrous tissue to lumen. Does this seem correct?