Enhancing Lipid Detection and Spatial Accuracy in Carotid Plaques Using Mass Spectrometry Imaging Techniques

Matrix-assisted laser desorption/ionisation mass spectrometry imaging (MALDI-MSI) is a powerful technique for studying lipid distribution in carotid plaques, key to understanding atherosclerosis. This study aimed to improve sample preparation for MALDI-MSI-based spatial lipidomics of carotid plaques by improving both matrix application and tissue handling. Human carotid plaques were collected from endarterectomy patients with ethical approval and sectioned at 10 {micro}m thickness for MALDI-MSI. We compared eight sample preparation methods, including hydroxypropyl methylcellulose-polyvinylpyrrolidone (HPMC-PVP) embedding media and Cryofilm-type IMS(R) to provide support and maintain tissue structural integrity during sectioning. Methods were assessed for signal intensity, lipid diffusion, lipid coverage, tissue morphology, and image co-registration which each criterion scored from 1-3. Cryofilm-based methods scored highest for preserving tissue morphology and minimising folding artifacts (2.9-3.0) but were limited in co-registration (2.0) due to reliance on adjacent sections. Sublimation methods generally produced greater lipid coverage with reduced lateral diffusion, while automated sprayer methods scored higher in signal intensity/sensitivity (3.0) but had increased lipid delocalisation, particularly for highly hydrophobic species such as triacylglycerols and sterols. The results highlight clear trade-offs between tissue structural preservation, lipid detection sensitivity, and spatial integrity in MALDI-MSI. Because spatial integrity cannot be compromised for imaging lipids in carotid atherosclerotic plaques, Cryofilm combined with sublimation offers a clear advantage. This work strengthens MALDI-MSI workflows enabling more precise spatial mapping and deeper biological interpretation of atherosclerotic lipid distributions.