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Zhang J, Li S, Wu L, Wang H, Wang C, Zhou Y, Sui B, Zhao X. Application of Dual-Layer Spectral-Detector Computed Tomography Angiography in Identifying Symptomatic Carotid Atherosclerosis: A Prospective Observational Study. J Am Heart Assoc 2024; 13:e032665. [PMID: 38497470 PMCID: PMC11010034 DOI: 10.1161/jaha.123.032665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Dual-layer spectral-detector dual-energy computed tomography angiography (DLCTA) can distinguish components of carotid plaques. Data on identifying symptomatic carotid plaques in patients using DLCTA are not available. METHODS AND RESULTS In this prospective observational study, patients with carotid plaques were enrolled and received DLCTA. The attenuation for both polyenergetic image and virtual monoenergetic images (40, 70, 100, and 140 keV), as well as Z-effective value, were recorded in the noncalcified regions of plaques. Logistic regression models were used to assess the association between attenuations of DLCTA and the presence of symptomatic carotid plaques. In total, 100 participants (mean±SD age, 64.37±8.31 years; 82.0% were men) were included, and 36% of the cases were identified with the symptomatic group. DLCTA parameters were different between 2 groups (symptomatic versus asymptomatic: computed tomography [CT] 40 keV, 152.63 [interquartile range (IQR), 70.22-259.78] versus 256.78 [IQR, 150.34-408.13]; CT 70 keV, 81.28 [IQR, 50.13-119.33] versus 108.87 [IQR, 77.01-165.88]; slope40-140 keV, 0.91 [IQR, 0.35-1.87] versus 1.92 [IQR, 0.96-3.00]; Z-effective value, 7.92 [IQR, 7.53-8.46] versus 8.41 [IQR, 7.94-8.92]), whereas no difference was found in conventional polyenergetic images. The risk of symptomatic plaque was lower in the highest tertiles of attenuations in CT 40 keV (adjusted odds ratio [OR], 0.243 [95% CI, 0.078-0.754]), CT 70 keV (adjusted OR, 0.313 [95% CI, 0.104-0.940]), Z-effective values (adjusted OR, 0.138 [95% CI, 0.039-0.490]), and slope40-140 keV (adjusted OR, 0.157 [95% CI, 0.046-0.539]), with all P values and P trends <0.05. The areas under the curve for CT 40 keV, CT 70 keV, slope 40 to 140 keV, and Z-effective values were 0.64, 0.61, 0.64, and 0.63, respectively. CONCLUSIONS Parameters of DLCTA might help assist in distinguishing symptomatic carotid plaques. Further studies with a larger sample size may address the overlap and improve the diagnostic accuracy.
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Affiliation(s)
- Jia Zhang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Sijia Li
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Lei Wu
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Haoyuan Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Chuanying Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yinan Zhou
- CT Clinical SpecialistPhilips HealthcareBeijingChina
| | - Binbin Sui
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Tiantan Neuroimaging Center of ExcellenceChina National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xingquan Zhao
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular DiseaseChinese Academy of Medical SciencesBeijingChina
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Jiang C, Zhang J, Li W, Li Y, Ni M, Jin D, Zhang Y, Jiang L, Yuan H. Deep Learning Imaging Reconstruction Algorithm for Carotid Dual Energy CT Angiography: Opportunistic Evaluation of Cervical Intervertebral Discs-A Preliminary Study. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01016-x. [PMID: 38429560 DOI: 10.1007/s10278-024-01016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 03/03/2024]
Abstract
Thus, the aim of this study is to evaluate the performance of deep learning imaging reconstruction (DLIR) algorithm in different image sets derived from carotid dual-energy computed tomography angiography (DECTA) for evaluating cervical intervertebral discs (IVDs) and compare them with those reconstructed using adaptive statistical iterative reconstruction-Veo (ASiR-V). Forty-two patients who underwent carotid DECTA were included in this retrospective analysis. Three types of image sets (70 keV, water-iodine, and water-calcium) were reconstructed using 50% ASiR-V and DLIR at medium and high levels (DLIR-M and DLIR-H). The diagnostic acceptability and conspicuity of IVDs were assessed using a 5-point scale. Hounsfield Units (HU) and water concentration (WC) values of the IVDs; standard deviation (SD); and coefficient of variation (CV) were calculated. Measurement parameters of the 50% ASIR-V, DLIR-M, and DLIR-H groups were compared. The DLIR-H group showed higher scores for diagnostic acceptability and conspicuity, as well as lower SD values for HU and WC than the ASiR-V and DLIR-M groups for the 70 keV and water-iodine image sets (all p < .001). However, there was no significant difference in scores and SD among the three groups for the water-calcium image set (all p > .005). The water-calcium image set showed better diagnostic accuracy for evaluating IVDs compared to the other image sets. The inter-rater agreement using ASiR-V, DLIR-M, and DLIR-H was good for the 70 keV image set, excellent for the water-iodine and water-calcium image sets. DLIR improved the visualization of IVDs in the 70 keV and water-iodine image sets. However, its improvement on color-coded water-calcium image set was limited.
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Affiliation(s)
- Chenyu Jiang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Jingxin Zhang
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijin, China
| | - Wenhuan Li
- CT Research Center, GE Healthcare China, 1 South Tongji Road, Beijing, China
| | - Yali Li
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ming Ni
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Dan Jin
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yan Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China.
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Gao Y, Liu X, Xu B, Zhang X, Wang Y, Ni J, Yang Y. Effect of collateral circulation in patients with multiple craniocervical artery stenoses. Clin Transl Sci 2023; 16:2779-2790. [PMID: 37932924 PMCID: PMC10719488 DOI: 10.1111/cts.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/08/2023] Open
Abstract
Based on previous findings, collateral circulation in the brain is vital in mitigating cerebral ischemia's effects and influencing stroke risk. This retrospective study examined collateral circulation, admission ischemic stroke status, and long-term recurrence in patients with multiple craniocervical artery stenoses. Consecutive symptomatic internal carotid artery (ICA) stenosis patients from the First Affiliated Hospital of Soochow University were recruited. Baseline data including medical histories and neurological function at admission were collected. Imaging techniques assessed collateral compensative capacity. Multivariate logistic regression analysis was used to investigate the association between collateral circulation and case status. A total of 559 patients with symptomatic ICA stenosis were included, among whom 153 (27.4%) had concurrent moderate to severe vertebro-basilar artery (VBA) stenosis. Dizziness, weakness/numbness, and slurring of speech were the primary symptoms in all patients. Over 36 months, 71 (12.7%) patients experienced a recurrence of acute ischemic stroke (AIS). In multivariate analysis, collateral circulation was found to be negatively associated with AIS (regional leptomeningeal collateral [rLMC] scores: OR: 0.798, 95% CI: 0.743-0.857, p < 0.001; Tan scores: OR: 0.478, 95% CI: 0.336-0.679, p < 0.001). Meanwhile, the collateral circulation scores were significantly associated with the recurrence of AIS within 3 years (rLMC scores: OR: 0.926, 95% CI: 0.860-0.997, p = 0.042; Tan scores: OR: 0.467, 95% CI: 0.306-0.712, p < 0.001). Most associations remained significant in the subgroup of patients with VBA stenosis. Favorable collateral circulation in multiple craniocervical artery stenosis patients reduced long-term ischemic event recurrence. Stratifying treatment risks is essential for optimizing outcomes.
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Affiliation(s)
- Ya Gao
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhou, JiangsuChina
- Departments of NeurologySuzhou Guangci Cancer HospitalSuzhou, JiangsuChina
| | - Xuan Liu
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhou, JiangsuChina
| | - Beibei Xu
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhou, JiangsuChina
| | - Ximeng Zhang
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhou, JiangsuChina
| | - Yiqing Wang
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhou, JiangsuChina
| | - Jianqiang Ni
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhou, JiangsuChina
| | - Yi Yang
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhou, JiangsuChina
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Jiang C, Jin D, Liu Z, Zhang Y, Ni M, Yuan H. Deep learning image reconstruction algorithm for carotid dual-energy computed tomography angiography: evaluation of image quality and diagnostic performance. Insights Imaging 2022; 13:182. [DOI: 10.1186/s13244-022-01308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/24/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Objectives
To evaluate image quality and diagnostic performance of carotid dual-energy computed tomography angiography (DECTA) using deep learning image reconstruction (DLIR) compared with images using adaptive statistical iterative reconstruction-Veo (ASIR-V).
Methods
Carotid DECTA datasets of 28 consecutive patients were reconstructed at 50 keV using DLIR at low, medium, and high levels (DLIR-L, DLIR-M, and DLIR-H) and 80% ASIR-V algorithms. Mean attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) at different levels of arteries were measured and calculated. Image quality for noise and texture, depiction of arteries, and diagnostic performance toward carotid plaques were assessed subjectively by two radiologists. Quantitative and qualitative parameters were compared between the ASIR-V, DLIR-L, DLIR-M, and DLIR-H groups.
Results
The image noise at aorta and common carotid artery, SNR, and CNR at all level arteries of DLIR-H images were significantly higher than those of ASIR-V images (p = 0.000–0.040). The quantitative analysis of DLIR-L and DLIR-M showed comparable denoise capability with ASIR-V. The overall image quality (p = 0.000) and image noise (p = 0.000–0.014) were significantly better in the DLIR-M and DLIR-H images. The image texture was improved by DLR at all level compared to ASIR-V images (p = 0.000–0.008). Depictions of head and neck arteries and diagnostic performance were comparable between four groups (p > 0.05).
Conclusions
Compared with 80% ASIR-V, we recommend DLIR-H for clinical carotid DECTA reconstruction, which can significantly improve the image quality of carotid DECTA at 50 keV but maintain a desirable diagnostic performance and arterial depiction.
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Liang H, Zhou Y, Xiong W, Zheng S. Impact of radiotherapy for nasopharyngeal carcinoma on carotid stenosis risk: a meta-analysis. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S98-S107. [PMID: 36127266 DOI: 10.1016/j.bjorl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/05/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTS Radiotherapy (RT) serves as the most effective treatment for Nasopharyngeal Carcinoma (NPC) and can cause carotid stenosis. The aim of this study is to assess the impact of RT on carotid stenosis in NPC patients, as well as to explore the risk factors for significant carotid stenosis. METHODS Studies reporting the carotid stenosis in NPC patients who underwent RT were found on PubMed, Embase and Web of Science. Outcomes of our interest included incidence of overall/significant stenosis, Common Carotid Artery (CCA) stenosis, External Carotid Artery (ECA) stenosis, Internal Carotid Artery (ICA) stenosis, and risk factors for significant carotid stenosis. RESULTS Sixteen studies met the inclusion criteria and were included in this meta-analysis. Pooled estimate showed that RT was associated with a significantly higher incidence of overall stenosis (Risk Ratio [RR = 3.53], 95% CI: 2.32‒5.37; p < 0.001) and significant stenosis (RR = 7.06, 95% CI: 3.61‒13.79; p < 0.001) as compared with controls. Moreover, patients treated with RT had a significantly higher risk of stenosis in CCA (RR = 6.87, 95% CI: 4.08‒11.58; p < 0.001), ICA (RR = 3.43, 95% CI: 1.35‒8.73; p = 0.010), ECA (RR = 9.37, 95% CI: 2.06‒42.68; p = 0.004), and ECA/ICA (RR = 2.18, 95% CI: 1.52‒3.13; p < 0.001). Meta-analysis indicated that age (RR = 1.46, 95% CI: 1.05‒2.04; p = 0.024), smoking habit (RR = 1.20, 95% CI: 1.02‒2.78; p = 0.045) and time interval from radiotherapy (RR = 1.56, 95% CI: 1.07‒2.28; p = 0.02) were independent predictors of significant carotid stenosis. CONCLUSION Our results suggested that RT increased the risk of carotid stenosis in patients with NPC. Prevention and control measurements should be made for older NPC patients with longer interval from RT, especially those with smoking habit. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Huiqing Liang
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China.
| | - Yuanyong Zhou
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China
| | - Wei Xiong
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China
| | - Suimin Zheng
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China
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Cassola N, Baptista-Silva JC, Nakano LC, Flumignan CD, Sesso R, Vasconcelos V, Carvas Junior N, Flumignan RL. Duplex ultrasound for diagnosing symptomatic carotid stenosis in the extracranial segments. Cochrane Database Syst Rev 2022; 7:CD013172. [PMID: 35815652 PMCID: PMC9272405 DOI: 10.1002/14651858.cd013172.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Carotid artery stenosis is an important cause of stroke and transient ischemic attack. Correctly and rapidly identifying patients with symptomatic carotid artery stenosis is essential for adequate treatment with early cerebral revascularization. Doubts about the diagnostic value regarding the accuracy of duplex ultrasound (DUS) and the possibility of using DUS as the single diagnostic test before carotid revascularization are still debated. OBJECTIVES To estimate the accuracy of DUS in individuals with symptomatic carotid stenosis verified by either digital subtraction angiography (DSA), computed tomography angiography (CTA), or magnetic resonance angiography (MRA). SEARCH METHODS We searched CRDTAS, CENTRAL, MEDLINE (Ovid), Embase (Ovid), ISI Web of Science, HTA, DARE, and LILACS up to 15 February 2021. We handsearched the reference lists of all included studies and other relevant publications and contacted experts in the field to identify additional studies or unpublished data. SELECTION CRITERIA We included studies assessing DUS accuracy against an acceptable reference standard (DSA, MRA, or CTA) in symptomatic patients. We considered the classification of carotid stenosis with DUS defined with validated duplex velocity criteria, and the NASCET criteria for carotid stenosis measures on DSA, MRA, and CTA. We excluded studies that included < 70% of symptomatic patients; the time between the index test and the reference standard was longer than four weeks or not described, or that presented no objective criteria to estimate carotid stenosis. DATA COLLECTION AND ANALYSIS The review authors independently screened articles, extracted data, and assessed the risk of bias and applicability concerns using the QUADAS-2 domain list. We extracted data with an effort to complete a 2 × 2 table (true positives, true negatives, false positives, and false negatives) for each of the different categories of carotid stenosis and reference standards. We produced forest plots and summary receiver operating characteristic (ROC) plots to summarize the data. Where meta-analysis was possible, we used a bivariate meta-analysis model. MAIN RESULTS We identified 25,087 unique studies, of which 22 were deemed eligible for inclusion (4957 carotid arteries). The risk of bias varied considerably across the studies, and studies were generally of moderate to low quality. We narratively described the results without meta-analysis in seven studies in which the criteria used to determine stenosis were too different from the duplex velocity criteria proposed in our protocol or studies that provided insufficient data to complete a 2 × 2 table for at least in one category of stenosis. Nine studies (2770 carotid arteries) presented DUS versus DSA results for 70% to 99% carotid artery stenosis, and two (685 carotid arteries) presented results from DUS versus CTA in this category. Seven studies presented results for occlusion with DSA as the reference standard and three with CTA as the reference standard. Five studies compared DUS versus DSA for 50% to 99% carotid artery stenosis. Only one study presented results from 50% to 69% carotid artery stenosis. For DUS versus DSA, for < 50% carotid artery stenosis, the summary sensitivity was 0.63 (95% confidence interval [CI] 0.48 to 0.76) and the summary specificity was 0.99 (95% CI 0.96 to 0.99); for the 50% to 69% range, only one study was included and meta-analysis not performed; for the 50% to 99% range, the summary sensitivity was 0.97 (95% CI 0.95 to 0.98) and the summary specificity was 0.70 (95% CI 0.67 to 0.73); for the 70% to 99% range, the summary sensitivity was 0.85 (95% CI 0.77 to 0.91) and the summary specificity was 0.98 (95% CI 0.74 to 0.90); for occlusion, the summary sensitivity was 0.91 (95% CI 0.81 to 0.97) and the summary specificity was 0.95 (95% CI 0.76 to 0.99). For sensitivity analyses, excluding studies in which participants were selected based on the presence of occlusion on DUS had an impact on specificity: 0.98 (95% CI 0.97 to 0.99). For DUS versus CTA, we found two studies in the range of 70% to 99%; the sensitivity varied from 0.57 to 0.94 and the specificity varied from 0.87 to 0.98. For occlusion, the summary sensitivity was 0.95 (95% CI 0.80 to 0.99) and the summary specificity was 0.91 (95% CI 0.09 to 0.99). For DUS versus MRA, there was one study with results for 50% to 99% carotid artery stenosis, with a sensitivity of 0.88 (95% CI 0.70 to 0.98) and specificity of 0.60 (95% CI 0.15 to 0.95); in the 70% to 99% range, two studies were included, with sensitivity that varied from 0.54 to 0.99 and specificity that varied from 0.78 to 0.89. We could perform only a few of the proposed sensitivity analyses because of the small number of studies included. AUTHORS' CONCLUSIONS This review provides evidence that the diagnostic accuracy of DUS is high, especially at discriminating between the presence or absence of significant carotid artery stenosis (< 50% or 50% to 99%). This evidence, plus its less invasive nature, supports the early use of DUS for the detection of carotid artery stenosis. The accuracy for 70% to 99% carotid artery stenosis and occlusion is high. Clinicians should exercise caution when using DUS as the single preoperative diagnostic method, and the limitations should be considered. There was little evidence of the accuracy of DUS when compared with CTA or MRA. The results of this review should be interpreted with caution because they are based on studies of low methodological quality, mainly due to the patient selection method. Methodological problems in participant inclusion criteria from the studies discussed above apparently influenced an overestimated estimate of prevalence values. Most of the studies included failed to precisely describe inclusion criteria and previous testing. Future diagnostic accuracy studies should include direct comparisons of the various modalities of diagnostic tests (mainly DUS, CTA, and MRA) for carotid artery stenosis since DSA is no longer considered to be the best method for diagnosing carotid stenosis and less invasive tests are now used as reference standards in clinical practice. Also, for future studies, the participant inclusion criteria require careful attention.
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Affiliation(s)
- Nicolle Cassola
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose Cc Baptista-Silva
- Evidence Based Medicine, Cochrane Brazil, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis Cu Nakano
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina Dq Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ricardo Sesso
- Department of Medicine, Division of Nefrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vladimir Vasconcelos
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Nelson Carvas Junior
- Evidence-Based Health Post-Graduation Program, Universidade Federal de São Paulo; Cochrane Brazil; Department of Physiotherapy, Universidade Paulista, São Paulo, Brazil
| | - Ronald Lg Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
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Cheng X, Dong Z, Liu J, Li H, Zhou C, Zhang F, Wang C, Zhang Z, Lu G. Prediction of Carotid In-Stent Restenosis by Computed Tomography Angiography Carotid Plaque-Based Radiomics. J Clin Med 2022; 11:jcm11113234. [PMID: 35683623 PMCID: PMC9180993 DOI: 10.3390/jcm11113234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
In-stent restenosis (ISR) after carotid artery stenting (CAS) critically influences long-term CAS benefits and safety. The study was aimed at screening preoperative ISR-predictive features and developing predictive models. Thus, we retrospectively analyzed clinical and imaging data of 221 patients who underwent pre-CAS carotid computed tomography angiography (CTA) and whose digital subtraction angiography data for verifying ISR presence were available. Carotid plaque characteristics determined using CTA were used to build a traditional model. Backward elimination (likelihood ratio) was used for the radiomics model. Furthermore, a combined model was built using the traditional and radiomics features. Five-fold cross-validation was used to evaluate the accuracy of the trained classifier and stability of the selected features. Follow-up angiography showed ISR in 30 patients. Carotid plaque length and thickness were independently associated with ISR (multivariate analysis); regarding the conventional model, the area under the curve (AUC) was 0.84 and 0.82 in the training and validation cohorts, respectively. The corresponding AUC values for the radiomics-based model were 0.87 and 0.82, and those for the optimal combined model were 0.88 and 0.83. Plaque length and thickness could independently predict post-CAS ISR, and the combination of radiomics and plaque features afforded the best predictive performance.
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Affiliation(s)
- Xiaoqing Cheng
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210029, China; (X.C.); (J.L.); (C.Z.)
| | - Zheng Dong
- Department of Diagnostic Radiology, Xuzhou Medical University, Xuzhou 221004, China;
| | - Jia Liu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210029, China; (X.C.); (J.L.); (C.Z.)
| | - Hongxia Li
- Department of Diagnostic Radiology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing 210000, China;
| | - Changsheng Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210029, China; (X.C.); (J.L.); (C.Z.)
| | - Fandong Zhang
- DeepWise AI Lab, Beijing 100080, China; (F.Z.); (C.W.)
| | - Churan Wang
- DeepWise AI Lab, Beijing 100080, China; (F.Z.); (C.W.)
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210029, China; (X.C.); (J.L.); (C.Z.)
- Correspondence: (Z.Z.); (G.L.); Tel.: +86-139-1388-5490 (Z.Z.); +86-136-7514-5822 (G.L.)
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210029, China; (X.C.); (J.L.); (C.Z.)
- Correspondence: (Z.Z.); (G.L.); Tel.: +86-139-1388-5490 (Z.Z.); +86-136-7514-5822 (G.L.)
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Chen S, Liu C, Chen X, Liu WV, Ma L, Zha Y. A Radiomics Approach to Assess High Risk Carotid Plaques: A Non-invasive Imaging Biomarker, Retrospective Study. Front Neurol 2022; 13:788652. [PMID: 35350403 PMCID: PMC8957977 DOI: 10.3389/fneur.2022.788652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to construct a radiomics-based MRI sequence from high-resolution magnetic resonance imaging (HRMRI), combined with clinical high-risk factors for non-invasive differentiation of the plaque of symptomatic patients from asyptomatic patients. Methods A total of 115 patients were retrospectively recruited. HRMRI was performed, and patients were diagnosed with symptomatic plaques (SPs) and asymptomatic plaques (ASPs). Patients were randomly divided into training and test groups in the ratio of 7:3. T2WI was used for segmentation and extraction of the texture features. Max-Relevance and Min-Redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were employed for the optimized model. Radscore was applied to construct a diagnostic model considering the T2WI texture features and patient demography to assess the power in differentiating SPs and ASPs. Results SPs and ASPs were seen in 75 and 40 patients, respectively. Thirty texture features were selected by mRMR, and LASSO identified a radscore of 16 radiomics features as being related to plaque vulnerability. The radscore, consisting of eight texture features, showed a better diagnostic performance than clinical information, both in the training (area under the curve [AUC], 0.923 vs. 0.713) and test groups (AUC, 0.989 vs. 0.735). The combination model of texture and clinical information had the best performance in assessing lesion vulnerability in both the training (AUC, 0.926) and test groups (AUC, 0.898). Conclusion This study demonstrated that HRMRI texture features provide incremental value for carotid atherosclerotic risk assessment.
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Affiliation(s)
- Sihan Chen
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Changsheng Liu
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Xixiang Chen
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Weiyin Vivian Liu
- Advanced Application Team, MR Research, GE Healthcare, Beijing, China
| | - Ling Ma
- He Kang Corporate Management (SH) Co. Ltd, Shanghai, China
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
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Yue W, Yang W, peng H, Zhong Feng N, Hong Jie H. Comparative study of the image quality of twin beam dual energy and single energy carotid CT angiography. Eur J Radiol 2022; 148:110160. [DOI: 10.1016/j.ejrad.2022.110160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/18/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
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10
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Dilba K, van Dam-Nolen DHK, Korteland SA, van der Kolk AG, Kassem M, Bos D, Koudstaal PJ, Nederkoorn PJ, Hendrikse J, Kooi ME, Gijsen FJH, van der Steen AFW, van der Lugt A, Wentzel JJ. The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study. Front Cardiovasc Med 2021; 8:732646. [PMID: 34869634 PMCID: PMC8636734 DOI: 10.3389/fcvm.2021.732646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Shear stress (WSS) is involved in the pathophysiology of atherosclerotic disease and might affect plaque ulceration. In this case-control study, we compared carotid plaques that developed a new ulcer during follow-up and plaques that remained silent for their exposure to time-dependent oscillatory shear stress parameters at baseline. Materials and Methods: Eighteen patients who underwent CTA and MRI of their carotid arteries at baseline and 2 years follow-up were included. These 18 patients consisted of six patients who demonstrated a new ulcer and 12 control patients selected from a larger cohort with similar MRI-based plaque characteristics as the ulcer group. (Oscillatory) WSS parameters [time average WSS, oscillatory shear index (OSI), and relative residence time (RRT)] were calculated using computational fluid dynamics applying the MRI-based geometry of the carotid arteries and compared among plaques (wall thickness>2 mm) with and without ulceration (Mann–Whitney U test) and ulcer-site vs. non-ulcer-site within the plaque (Wilcoxon signed rank test). More detailed analysis on ulcer cases was performed and the predictive value of oscillatory WSS parameters was calculated using linear and logistic mixed-effect regression models. Results: The ulcer group demonstrated no difference in maximum WSS [9.9 (6.6–18.5) vs. 13.6 (9.7–17.7) Pa, p = 0.349], a lower maximum OSI [0.04 (0.01–0.10) vs. 0.12 (0.06–0.20) p = 0.019] and lower maximum RRT [1.25 (0.78–2.03) Pa−1 vs. 2.93 (2.03–5.28) Pa−1, p = 0.011] compared to controls. The location of the ulcer (ulcer-site) within the plaque was not always at the maximal WSS, but demonstrated higher average WSS, lower average RRT and OSI at the ulcer-site compared to the non-ulcer-sites. High WSS (WSS>4.3 Pa) and low RRT (RRT < 0.25 Pa) were associated with ulceration with an odds ratio of 3.6 [CI 2.1–6.3] and 2.6 [CI 1.54–4.44] respectively, which remained significant after adjustment for wall thickness. Conclusion: In this explorative study, ulcers were not exclusively located at plaque regions exposed to the highest WSS, OSI, or RRT, but high WSS and low RRT regions had a significantly higher odds to present ulceration within the plaque even after adjustment for wall thickness.
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Affiliation(s)
- Kristine Dilba
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dianne H K van Dam-Nolen
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anja G van der Kolk
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mohamed Kassem
- Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, University Medical Centers Amsterdam, Amsterdam, Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - M Eline Kooi
- Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Frank J H Gijsen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anton F W van der Steen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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11
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Thurgood H, Witte R, Laksari K. 4D Reconstruction and Identification of Carotid Artery Stenosis Utilizing a Novel Pulsatile Ultrasound Phantom. Curr Protoc 2021; 1:e264. [PMID: 34679245 DOI: 10.1002/cpz1.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
As a major application focus of vascular ultrasonography, the carotid artery has long been the subject of phantom design and procedure focus. It is therefore important to devise procedures that are minimally invasive and informative, initially using a physiologically accurate anthropomorphic phantom to validate the methodology. In this article, a novel phantom design protocol is presented that enables the efficient production of a pulsatile ultrasound phantom consisting of soft and vascular tissue mimics, as well as a blood surrogate fluid. These components when combined give the phantom high acoustic compatibility and lifelike mechanical properties. The phantom was developed using "at-home" purchasable components and 3D printing technology. The phantom was subsequently used to develop a 4D reconstruction algorithm of the pulsing vessel in MATLAB. In pattern with recent developments in medical imaging, the 4D reconstruction enables clinicians to view vessel wall motion in a 3D space without the need for manual intervention. The reconstruction algorithm also produces measured inner luminal areas and vessel wall thickness, providing further information relating to structural properties and stenosis, as well as elastic properties such as arterial stiffness, which could provide helpful markers for disease diagnosis. © 2021 Wiley Periodicals LLC. Basic Protocol 1: Constructing a pulsatile ultrasound phantom model Support Protocol: Creating a vascular mimic mold Basic Protocol 2: Creating a 4D reconstruction from ultrasound frames.
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Affiliation(s)
- Harrison Thurgood
- Deptartment of Aerospace and Mechanical Engineering, University of Arizona, Tucson, Arizona
| | - Russell Witte
- Deptartment of Biomedical Engineering, University of Arizona, Tucson, Arizona.,Deptartment of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Kaveh Laksari
- Deptartment of Aerospace and Mechanical Engineering, University of Arizona, Tucson, Arizona.,Deptartment of Biomedical Engineering, University of Arizona, Tucson, Arizona
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12
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Utility of Dual-Layer Spectral-Detector CTA to Characterize Carotid Atherosclerotic Plaque Components: An Imaging-Histopathology Comparison in Patients Undergoing Endarterectomy. AJR Am J Roentgenol 2021; 218:517-525. [PMID: 34549604 DOI: 10.2214/ajr.21.26540] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The composition of non-calcified portions of carotid atherosclerotic plaque represents an important marker of plaque vulnerability and ischemia risk. Objective: To assess the utility of dual-layer spectral-detector CTA (DLCTA) parameters for carotid plaque component characterization, using histologic results from carotid endarterectomy (CEA) as reference. Methods: Seven patients (5 male, 2 female; 61.6±8.5 years old) with carotid plaque awaiting CEA were prospectively enrolled and underwent preoperative supra-aortic DLCTA. A neuroradiologist and pathologist performed joint slice-by-slice review of histologic slices of resected plaques and CTA images. ROIs were placed on non-calcified components [lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), fibrous tissue, loose matrix (LM)] on CTA images in comparison with corresponding histologic slices using anatomic landmarks. For each ROI, attenuation was recorded for polyenergetic images (CTPI) and virtual monoenergetic images with keV ranging from 40-140 (CT40-140keV); attenuation spectrum curve slope was calculated; and Z-effective value (representing effective atomic number) was recorded. DLCTA parameters were compared among plaque components. Results: Seven plaques with a total of 65 slices and 364 ROIs (159 fibrous tissue, 96 LRNC, 86 loose matrix, 23 IPH) were analyzed. All parameters (CTPI, CT40-140keV, slope from 40 to 140 keV, Z-effective value) showed significant differences between LRNC and the other components (all p<.001). For example, mean CTPI was 37.1±15.1 HU for LRNC, 58.4±21.6 HU for IPH, 69.7±20.5 HU for fibrous tissue, and 69.6±19.6 HU for loose matrix; mean CT40keV was 28.1±36.7 HU for LRNC, 87.5±48.9 HU for IPH, 106.3±47.5 HU for fibrous tissue, and 102.6±48.0 HU for loose matrix. AUC for differentiating LRNC from other components was highest (0.945) for CT40kev and decreased with higher keV; AUC for CTPI was 0.908. CT40kev also had highest accuracy (90.4%); at cutoff of 55.7 HU, CT40kev had 88.5% sensitivity and 90.9% specificity. For differentiating IPH from fibrous tissue and loose matrix, AUC was highest at 0.652 for CTPI and 0.645 for CT40kev. Conclusion: DLCTA showed strong performance in differentiating LRNC from other non-calcified plaque components; CT40kev had highest accuracy, outperforming conventional polyenergetic images. Clinical Impact: DLCTA parameters may help characterize carotid plaque composition as a marker of vulnerable plaque and ischemia risk.
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13
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Fonseca AC, Merwick Á, Dennis M, Ferrari J, Ferro JM, Kelly P, Lal A, Ois A, Olivot JM, Purroy F. European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack. Eur Stroke J 2021; 6:CLXIII-CLXXXVI. [PMID: 34414299 PMCID: PMC8370080 DOI: 10.1177/2396987321992905] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/16/2021] [Indexed: 01/14/2023] Open
Abstract
The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.
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Affiliation(s)
- Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Áine Merwick
- Department of Neurology, Cork University Hospital & University College Cork, Cork, Ireland
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julia Ferrari
- Department of Neurology, St. John´s of God Hospital, Vienna, Austria
| | - José M Ferro
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Peter Kelly
- Stroke Service, Mater University Hospital and HRB Stroke Clinical Trials Network Ireland, University College Dublin, Ireland
| | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Angel Ois
- Department of Neurology, Hospital del Mar, IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jean Marc Olivot
- Acute Stroke Unit, Clinical Investigation Center and Toulouse Neuro Imaging Center, Toulouse University Medical Center, Toulouse, France
| | - Francisco Purroy
- Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomedica de Lleida (IRBLleida), Universitat de Lleida (UdL), Lleida, Spain
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14
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Abstract
Carotid atherosclerosis is an important contributor to ischemic stroke. When imaging carotid atherosclerosis, it is essential to describe both the degree of luminal stenosis and specific plaque characteristics because both are risk factors for cerebrovascular ischemia. Carotid atherosclerosis can be accurately assessed using multiple imaging techniques, including ultrasonography, computed tomography angiography, and magnetic resonance angiography. By understanding the underlying histopathology, the specific plaque characteristics on each of these imaging modalities can be appreciated. This article briefly describes some of the most commonly encountered plaque features, including plaque calcification, intraplaque hemorrhage, lipid-rich necrotic core, and plaque ulceration.
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Affiliation(s)
- Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, UT, USA.
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10021, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
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15
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Zaccagna F, Ganeshan B, Arca M, Rengo M, Napoli A, Rundo L, Groves AM, Laghi A, Carbone I, Menezes LJ. CT texture-based radiomics analysis of carotid arteries identifies vulnerable patients: a preliminary outcome study. Neuroradiology 2021; 63:1043-1052. [PMID: 33392734 DOI: 10.1007/s00234-020-02628-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the potential role of computed tomography (CT) texture analysis (CTTA) in identifying vulnerable patients with carotid artery atherosclerosis. METHODS In this case-control pilot study, 12 patients with carotid atherosclerosis and a subsequent history of transient ischemic attack or stroke were age and sex matched with 12 control cases with asymptomatic carotid atherosclerosis (follow-up time 103.58 ± 9.2 months). CTTA was performed using a commercially available research software package (TexRAD) by an operator blinded to clinical data. CTTA comprised a filtration-histogram technique to extract features at different scales corresponding to spatial scale filter (fine = 2 mm, medium = 3 mm, coarse = 4 mm), followed by quantification using histogram-based statistical parameters: mean, kurtosis, skewness, entropy, standard deviation, and mean value of positive pixels. A single axial slice was selected to best represent the largest cross-section of the carotid bifurcation or the greatest degree of stenosis, in presence of an atherosclerotic plaque, on each side. RESULTS CTTA revealed a statistically significant difference in skewness between symptomatic and asymptomatic patients at the medium (0.22 ± 0.35 vs - 0.18 ± 0.39, p < 0.001) and coarse (0.23 ± 0.22 vs 0.03 ± 0.29, p = 0.003) texture scales. At the fine-texture scale, skewness (0.20 ± 0.59 vs - 0.18 ± 0.58, p = 0.009) and standard deviation (366.11 ± 117.19 vs 300.37 ± 82.51, p = 0.03) were significant before correction. CONCLUSION Our pilot study highlights the potential of CTTA to identify vulnerable patients in stroke and TIA. CT texture may have the potential to act as a novel risk stratification tool in patients with carotid atherosclerosis.
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Affiliation(s)
- Fulvio Zaccagna
- Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
- Department of Radiological, Oncological and Pathological Sciences, University of Rome - Sapienza, Rome, Italy.
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Marcello Arca
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, University of Rome - Sapienza, Rome, Italy
| | - Marco Rengo
- Department of Radiological, Oncological and Pathological Sciences, University of Rome-Sapienza, Polo Pontino, I.C.O.T. Hospital, Latina, Italy
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, University of Rome - Sapienza, Rome, Italy
| | - Leonardo Rundo
- Department of Radiology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Andrea Laghi
- Department of Radiological, Oncological and Pathological Sciences, University of Rome-Sapienza, Polo Pontino, I.C.O.T. Hospital, Latina, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, University of Rome - Sapienza, Rome, Italy
| | - Leon J Menezes
- Institute of Nuclear Medicine, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
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16
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Dilba K, van Dam-Nolen DHK, van Dijk AC, Kassem M, van der Steen AFW, Koudstaal PJ, Nederkoorn PJ, Hendrikse J, Kooi ME, Wentzel JJ, van der Lugt A. Plaque Composition as a Predictor of Plaque Ulceration in Carotid Artery Atherosclerosis: The Plaque At RISK Study. AJNR Am J Neuroradiol 2021; 42:144-151. [PMID: 33214179 DOI: 10.3174/ajnr.a6868] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/09/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Plaque ulceration is a marker of previous plaque rupture. We studied the association between atherosclerotic plaque composition at baseline and plaque ulceration at baseline and follow-up. MATERIALS AND METHODS We included symptomatic patients with a carotid stenosis of <70% who underwent MDCTA and MR imaging at baseline (n = 180). MDCTA was repeated at 2 years (n = 73). We assessed the presence of ulceration using MDCTA. Baseline MR imaging was used to assess the vessel wall volume and the presence and volume of plaque components (intraplaque hemorrhage, lipid-rich necrotic core, and calcifications) and the fibrous cap status. Associations at baseline were evaluated with binary logistic regression and reported with an OR and its 95% CI. Simple statistical testing was performed in the follow-up analysis. RESULTS At baseline, the prevalence of plaque ulceration was 27% (49/180). Increased wall volume (OR = 12.1; 95% CI, 3.5-42.0), higher relative lipid-rich necrotic core (OR = 1.7; 95% CI, 1.3-2.2), higher relative intraplaque hemorrhage volume (OR = 1.7; 95% CI, 1.3-2.2), and a thin-or-ruptured fibrous cap (OR = 3.4; 95% CI, 1.7-6.7) were associated with the presence of ulcerations at baseline. In 8% (6/73) of the patients, a new ulcer developed. Plaques with a new ulceration at follow-up had at baseline a larger wall volume (1.04 cm3 [IQR, 0.97-1.16 cm3] versus 0.86 cm3 [IQR, 0.73-1.00 cm3]; P = .029), a larger relative lipid-rich necrotic core volume (23% [IQR, 13-31%] versus 2% [IQR, 0-14%]; P = .002), and a larger relative intraplaque hemorrhage volume (14% [IQR, 8-24%] versus 0% [IQR, 0-5%]; P < .001). CONCLUSIONS Large atherosclerotic plaques and plaques with intraplaque hemorrhage and lipid-rich necrotic cores were associated with plaque ulcerations at baseline and follow-up.
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Affiliation(s)
- K Dilba
- From the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
- Cardiology (K.D., A.F.W.v.d.S., J.J.W.)
| | - D H K van Dam-Nolen
- From the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
| | - A C van Dijk
- From the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
- Neurology (A.C.v.D., P.J.K.), Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Kassem
- Department of Radiology and Nuclear Medicine (M.K., M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - P J Koudstaal
- Neurology (A.C.v.D., P.J.K.), Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P J Nederkoorn
- Department of Neurology (P.J.N.), University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - J Hendrikse
- Department of Radiology (J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - M E Kooi
- Department of Radiology and Nuclear Medicine (M.K., M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - A van der Lugt
- From the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
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17
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Zhou T, Tan T, Pan X, Tang H, Li J. Fully automatic deep learning trained on limited data for carotid artery segmentation from large image volumes. Quant Imaging Med Surg 2021; 11:67-83. [PMID: 33392012 PMCID: PMC7719941 DOI: 10.21037/qims-20-286] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objectives of this study were to develop a 3D convolutional deep learning framework (CarotidNet) for fully automatic segmentation of carotid bifurcations in computed tomography angiography (CTA) images and to facilitate the quantification of carotid stenosis and risk assessment of stroke. METHODS Our pipeline was a two-stage cascade network that included a localization phase and a segmentation phase. The network framework was based on the 3D version of U-Net, but was refined in three ways: (I) by adding residual connections and a deep supervision strategy to cope with the vanishing problem in back-propagation; (II) by adopting dilated convolution in order to strengthen the capacity to capture contextual information; and (III) by establishing a hybrid objective function to address the extreme imbalance between foreground and background voxels. RESULTS We trained our networks on 15 cases and evaluated their performance based on 41 cases from the MICCAI Challenge 2009 dataset. A Dice similarity coefficient of 82.3% was achieved for the test cases. CONCLUSIONS We developed a carotid segmentation method based on U-Net that can segment tiny carotid bifurcation lumens from very large backgrounds with no manual intervention. This was the first attempt to use deep learning to achieve carotid bifurcation segmentation in 3D CTA images. Our results indicate that deep learning is a promising method for automatically extracting carotid bifurcation lumens.
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Affiliation(s)
- Tianshu Zhou
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Tao Tan
- Department of Mathematics and Computer Science, Eindhoven University of Technology and Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Xiaoyan Pan
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Hui Tang
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, 3000 CA Rotterdam, the Netherlands
| | - Jingsong Li
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
- Research Center for Healthcare Data Science, Zhejiang Lab, Hangzhou, China
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18
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Pala AA, Urcun YS. Effect of calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities. Vascular 2020; 29:527-534. [PMID: 33245024 DOI: 10.1177/1708538120963922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The increase in carotid artery blood flow velocity is a measure of the severity of the carotid artery stenosis caused by atherosclerosis. Carotid artery stenosis is progressive and is of great importance due to the risk of stroke it creates. As an alternative to radiological examinations in these patients, patient follow-up can be facilitated by associating novel laboratory parameters with the severity of stenosis. In this study, we aimed to investigate the effect of the calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities in patients with carotid artery stenosis. METHODS A total of 161 patients diagnosed with carotid artery stenosis who admitted to our clinic between May 2018 and May 2020 were retrospectively analyzed. According to the carotid artery blood flow velocities measured with the Doppler ultrasonography, the patients were divided into two groups as "Normal flow velocity group" (n = 62) and "Increased flow velocity group" (n = 99). RESULTS The calculated plasma osmolality, atherogenic index of plasma, and mean platelet volume were significantly associated with increased carotid artery blood flow velocity (p < 0.001, p < 0.001, p = 0.006; respectively). Calculated plasma osmolality and atherogenic index of plasma were identified as independent predictors of increase in carotid artery blood flow velocity (p < 0.001, p < 0.001; respectively). In the Receiver Operating Characteristic curve analysis, the plasma osmolality cut-off value, which predicts the increase in carotid artery blood flow velocity was found to be 291.45 mOsm/kg (Area Under the Curve: 0.746, p < 0.001, 65.7% sensitivity, and 67.7% specificity), and atherogenic index of plasma cut-off value was 0.20 (Area Under the Curve: 0.735, p < 0.001, 65.7% sensitivity, and 66.1% specificity). CONCLUSION There was a significant relationship between the increase in carotid artery blood flow velocity and the increase in plasma osmolality and atherogenic index of plasma values. As a result, we can predict the increase in carotid artery blood flow velocity, that is, the increase in the severity of the carotid artery stenosis, with plasma osmolality and atherogenic index of plasma values that can be calculated simply from routine biochemical tests.
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Affiliation(s)
- Arda Aybars Pala
- Department of Cardiovascular Surgery, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Yusuf Salim Urcun
- Department of Cardiovascular Surgery, Adiyaman Training and Research Hospital, Adiyaman, Turkey
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19
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Sun Y, Xu L, Jiang Y, Ma M, Wang XY, Xing Y. Significance of high resolution MRI in the identification of carotid plaque. Exp Ther Med 2020; 20:3653-3660. [PMID: 32855717 PMCID: PMC7444342 DOI: 10.3892/etm.2020.9091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
The stability of carotid artery plaque serves a key role in the occurrence of stroke. The present study was based on the recruitment of patients with acute ischemic cerebrovascular disease. High-resolution magnetic resonance imaging (HR-MRI) was used to identify the nature of carotid artery plaque, and the results were then used to manage the high-risk group of stroke. The patients were divided equally into a symptomatic group (36 cases) and an asymptomatic group (36 cases). According to the degree of carotid artery stenosis, the patients were divided into mild, moderate and severe stenosis groups, each group comprising 12 patients, and HR-MRI was performed. The proportion of patients with vulnerable plaque in the symptomatic group was higher compared with that in the asymptomatic group (P<0.05). The more severe the stenosis, the higher the proportion of vulnerable plaque that was identified (P<0.05). Compared with carotid ultrasound, HR-MRI was indicated to have the capability to both identify and quantify the different components in the plaque, allowing an assessment of its properties. In conclusion, the present study demonstrated that carotid HR-MRI is able to distinguish and quantify the different components of plaque, which may prove to be helpful for the hierarchical management of a population at high risk of stroke.
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Affiliation(s)
- Yong Sun
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Lei Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Yan Jiang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Ming Ma
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xin-Yi Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Ying Xing
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Bai X, Gao P, Zhang D, Zhang S, Liang J, Lu X, Sui B. Plaque burden assessment and attenuation measurement of carotid atherosclerotic plaque using virtual monoenergetic images in comparison to conventional polyenergetic images from dual-layer spectral detector CT. Eur J Radiol 2020; 132:109302. [PMID: 33007518 DOI: 10.1016/j.ejrad.2020.109302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare virtual monoenergetic images (VMIs) with conventional polyenergetic images (PI) of Dual-layer spectral detector CT angiography (DLCTA) in plaque burden assessment and attenuation measurement of carotid atherosclerotic plaques. METHODS Supra-aortic DLCTA imaging of thirty patients (8 female, mean ages 63.1 ± 7.5 years) were respectively reviewed. Lumen area, wall area, and calcified area of plaques were outlined and recorded. Normalized wall index (NWI) was calculated for plaque burden and compared between PI and different VMIs. The attenuation of the non-calcified, calcified area of the plaques, sternocleidomastoid muscle (SCM), as well as Z effective values were measured and compared. RESULTS Fifty carotid plaques (27 left, 23 right) of thirty patients were analyzed. The average values of lumen, wall, calcified areas and NWI on PI were 34.50 ± 20.57mm2, 47.61 ± 19.94 mm2, 5.25 mm2 (1.35- 51.86 mm2), and 0.59 ± 0.16 respectively. No significant difference was found in the lumen area (p = 0.314), wall area (p = 0.600), and NWI (p = 0.980) between different VMIs and PI. A significant difference was found in the calcified area between VMIs and PI (p = 0.009). Attenuations of non-calcified and calcified components in carotid plaques were comparable to PI for 50-120 keV (all: p > 0.05) and 60-120 keVs (all p > 0.05), respectively. Z Effective values for non-calcified, calcified and SCM were 7.67 ± 0.42, 11.70 ± 1.22, and 7.45 ± 0.12, respectively. CONCLUSIONS Carotid plaque burden assessment was comparable between PI and VMIs at 40-120 keVs. Attenuations of non-calcified components in carotid plaques were comparable to PI for 50-120 keV VMIs of DLCTA. VMIs might provide more information on carotid plaque features.
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Affiliation(s)
- Xiaoyan Bai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Shaosen Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiang Liang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang 110016, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
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Zhu G, Hom J, Li Y, Jiang B, Rodriguez F, Fleischmann D, Saloner D, Porcu M, Zhang Y, Saba L, Wintermark M. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020; 10:1048-1067. [PMID: 32968660 DOI: 10.21037/cdt.2020.03.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Carotid artery plaque is a measure of atherosclerosis and is associated with future risk of atherosclerotic cardiovascular disease (ASCVD), which encompasses coronary, cerebrovascular, and peripheral arterial diseases. With advanced imaging techniques, computerized tomography (CT) and magnetic resonance imaging (MRI) have shown their potential superiority to routine ultrasound to detect features of carotid plaque vulnerability, such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC), and calcification. The correlation between imaging features and histological changes of carotid plaques has been investigated. Imaging of carotid features has been used to predict the risk of cardiovascular events. Other techniques such as nuclear imaging and intra-vascular ultrasound (IVUS) have also been proposed to better understand the vulnerable carotid plaque features. In this article, we review the studies of imaging specific carotid plaque components and their correlation with risk scores.
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Affiliation(s)
- Guangming Zhu
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ying Li
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA.,Clinical Medical Research Center, Luye Pharma Group Ltd., Beijing 100000, China
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Dominik Fleischmann
- Department of Radiology, Cardiovascular Imaging Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Saloner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Michele Porcu
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Yanrong Zhang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
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Seyman EE, Bornstein N, Auriel E, Cohen O, Nissel T, Hallevi H. Assessment of carotid artery ultrasonography in the presence of an acoustic shadow artifact. BMC Neurol 2019; 19:178. [PMID: 31357950 PMCID: PMC6664737 DOI: 10.1186/s12883-019-1405-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background B-mode and Color Doppler ultrasonography (CDUS) are the methods of choice for screening and determining the degree of Carotid artery stenosis. The evaluation of stenosis with calcification may be hampered by a common CDUS artifact known as acoustic shadow (AS). Our objective was to assess the change in reliability of CDUS readings in the presence of an AS artifact. Methods Single center retrospective observational study. Included were patients with either an AS artifact or high-grade stenosis (defined by peak systolic velocity (PSV) > 240 cm/s) demonstrated in CDUS, and had a CT angiography (CTA) done within 6 months of the sonographic exam. All subjects were identified through the Tel-Aviv Sorasky medical center (TASMC) CDUS unit registry from which clinical information was extracted. CDUS images were manually reviewed grading AS magnitude. All CTAs were reviewed and reconstructed for accurate assessment of percent stenosis and were used as gold standard. Results The study cohort included 227 consecutive patients (corresponding with 454 internal carotid arteries) meeting inclusion criteria. 43.2% of the arteries (n = 195) had an AS artifact present on CDUS, regardless of percent stenosis, with a large artifact present in 6.7% arteries (n = 30). Older age was significantly related to the presence of AS artifact (p < 0.001). In the study cohort as a whole there was a strong correlation between percent stenosis on CTA and PSV values (Pearson’s r 0.672, p < 0.001) regardless of AS existence. The CDUS sensitivity and specificity for predicting severe stenosis were 82 and 73% respectively. The presence of a small AS slightly diminished the correlation between CDUS and CTA results without compromising CDUS reliability. A large AS severely affected the correlation between CDUS and CTA exams (Pearson’s r = 0.24, p = 0.27) and reduced CDUS reliability with a sensitivity and specificity of 62%. Conclusion The presence of a large AS severely degrades the accuracy of the routine CDUS measurements. In these cases, the patient should be referred to a CDUS exam including doppler-measurement of periorbital arteries and intracranial arteries in addition to other imaging modalities such as CTA or MRA in order to assess future stroke risk.
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Affiliation(s)
- Estelle E Seyman
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel.
| | - Natan Bornstein
- Department of Neurology Shaarey-Tzedek Medical Center, 12 Shmuel Bait Street, Jerusalem, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
| | - Oren Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
| | - Tania Nissel
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel
| | - Hen Hallevi
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
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de la Cruz Cosme C, Dawid Milner M, Ojeda Burgos G, Gallardo Tur A, Márquez Martínez M, Segura T. Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis. Neurologia 2019; 34:367-375. [PMID: 28347575 DOI: 10.1016/j.nrl.2017.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/31/2016] [Accepted: 01/12/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Most of the cases of ischaemic stroke in our setting are of atherothrombotic origin. Detecting intracranial and cervical carotid artery stenosis in patients with ischaemic stroke is therefore essential. Ultrasonography has become the tool of choice for diagnosing carotid artery stenosis because it is both readily accessibility and reliable. However, use of this technique must be validated in each laboratory. The purpose of this study is to validate Doppler ultrasound in our laboratory as a means of detecting severe carotid artery stenosis. PATIENTS AND METHODS We conducted an observational descriptive study to evaluate diagnostic tests. The results from transcranial and cervical carotid Doppler ultrasound scans conducted by neurologists were compared to those from carotid duplex scans performed by radiologists in patients diagnosed with stroke. Arteriography was considered the gold standard (MR angiography, CT angiography, or conventional arteriography). RESULTS Our sample included 228 patients. Transcranial and cervical carotid Doppler ultrasound showed a sensitivity of 95% and specificity of 100% for detection of carotid artery stenosis > 70%, whereas carotid duplex displayed a sensitivity of 87% and a specificity of 94%. Transcranial carotid Doppler ultrasound achieved a sensitivity of 78% and a specificity of 98% for detection of intracranial stenosis. CONCLUSIONS Doppler ultrasound in our neurosonology laboratory was found to be a useful diagnostic tool for detecting cervical carotid artery stenosis and demonstrated superiority to carotid duplex despite the lack of B-mode. Furthermore, this technique was found to be useful for detecting intracranial stenosis.
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Seo J, Kim GS, Lee HY, Byun YS, Jung IH, Rhee KJ, Kim BO. Prevalence and Clinical Outcomes of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Concurrent Coronary and Carotid Angiography. Yonsei Med J 2019; 60:542-546. [PMID: 31124337 PMCID: PMC6536396 DOI: 10.3349/ymj.2019.60.6.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The prevalence and clinical outcomes of asymptomatic carotid artery stenosis (CAS) in patients with coronary artery disease (CAD) have not been thoroughly studied. We examined the prevalence and predictors of asymptomatic CAS detected by carotid angiography and determined the impact of concomitant CAS on prognosis in patients undergoing coronary angiography (CAG) due to CAD. MATERIALS AND METHODS Between January 2013 and July 2015, 395 patients who underwent carotid digital subtraction angiography to screen for CAS during CAG were analyzed. The presence of CAS was defined as angiographically significant stenosis (≥50%). Major adverse cardiac and cerebrovascular event (MACCE) rates were compared between patients with and without CAS. MACCEs included a composite of cardiac death, cerebrovascular death, acute myocardial infarction, and stroke. RESULTS Of the 395 patients, 101 (25.5%) patients had significant CAS. The independent predictors of CAS were age, male sex, hypertension, diabetes, and multi-vessel disease. In patients with CAD, the presence of CAS was as an independent predictor for MACCEs after adjusting for confounding factors (hazard ratio 2.47, 95% confidence interval 1.16-5.24, p=0.018). CONCLUSION Asymptomatic CAS was documented in up to 25% of patients with CAD. The presence of CAS in patients with CAD was associated with a higher rate of MACCEs. Therefore, detection of CAS by carotid angiography during CAG may be important for risk stratification for CAD patients, particularly those with multi-vessel disease.
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Affiliation(s)
- Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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Forjoe T, Asad Rahi M. Systematic review of preoperative carotid duplex ultrasound compared with computed tomography carotid angiography for carotid endarterectomy. Ann R Coll Surg Engl 2019; 101:141-149. [PMID: 30767557 PMCID: PMC6400905 DOI: 10.1308/rcsann.2019.0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION We reviewed the literature for preoperative computed tomography carotid angiography and/or carotid duplex to determine their respective sensitivity and specificity in assessing the degree of carotid stenosis. We aimed to identify whether one imaging modality can accurately identify critical stenosis in patients presenting with transient ischaemic attack or symptoms of a cerebrovascular accident requiring carotid endarterectomy. METHODS Systematic search of MEDLINE, Embase, Cochrane database of systematic reviews, all Evidence-Based Medicine Reviews (Cochrane Database of Systematic Reviews, ACP Journal club, Database of Abstracts of Reviews of Effects, Cochrane Clinical Answers, Cochrane Controlled Trials Register, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database) for primary studies relating to computed tomography carotid angiography (CTA) and/or carotid duplex ultrasound (CDU). Studies included were published between 1990 and 2018 and focused on practice in the UK, Europe and North America. RESULTS The sensitivity and specificity of CTA and CDU are comparable. CDU is safe and readily available in the clinical environment hence its use in the initial preoperative assessment of carotid stenosis. CDU is an adequate imaging modality for determining stenosis greater than 70%; sensitivity and specificity are improved when the criteria for determining greater than 70% stenosis are adjusted. Vascular laboratories opting to use duplex as their sole imaging modality should assess the sensitivity and specificity of their own duplex procedure before altering practice to preoperative single imaging for patients. CONCLUSIONS The sensitivity and specificity of CTA (90.6% and 93%, respectively) and CDU (92.3% and 89%, respectively) are comparable. Both are dependent on criteria used in vascular laboratories. CDU sensitivity and specificity was improved to 98.7% and 94.1%, respectively, where peak systolic velocity and end diastolic velocity were assessed. Either modality can be used to determine greater than 70% stenosis, although a secondary imaging modality may be required for cases of greater than 50% stenosis.
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Affiliation(s)
- T Forjoe
- Manchester Medical School, Manchester, UK
| | - M Asad Rahi
- Regional Vascular Centre, Royal Preston Hospital, Preston, UK
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Rafailidis V, Chryssogonidis I, Xerras C, Nikolaou I, Tegos T, Kouskouras K, Rafailidis D, Charitanti-Kouridou A. A comparative study of color Doppler imaging and contrast-enhanced ultrasound for the detection of ulceration in patients with carotid atherosclerotic disease. Eur Radiol 2018; 29:2137-2145. [PMID: 30350162 DOI: 10.1007/s00330-018-5773-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/14/2018] [Accepted: 09/18/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of color Doppler imaging (CDI) and contrast-enhanced ultrasound (CEUS) for diagnosing carotid ulceration, having multi-detector computed tomography angiography (MDCTA) as the reference method. METHODS Patients with carotid disease referred for ultrasound (US), either due to the occurrence of neurovascular symptoms or for screening purposes, were included in this study if at least one plaque causing moderate (50-69%) or severe (70-99%) internal carotid artery stenosis was detected. Carotid US with CDI technique, CEUS, and MDCTA were performed in all patients, investigating the presence of ulceration. The agreement between modalities was evaluated using kappa statistics. RESULTS The study population included 54 patients (median age 62 years, inter-quartile range 16.2) and 66 carotid arteries. The mean degree of stenosis was 68.5% (SD 12.2%) while 47.1% of plaques were symptomatic. MDCTA characterized 28.8% of plaques as smooth, 45.5% irregular, and 24.3% ulcerated. Flow reversal was detected with CDI in 65.5% of ulcerations, while swirling of the microbubbles and neovessels adjacent to the ulcer were detected with CEUS in 17.64%. The agreement for ulceration diagnosis was moderate between CDI and CEUS (kappa 0.473) and between CDI and MDCTA (kappa 0.473) and very good between CEUS and MDCTA (kappa 0.921). The sensitivity, specificity, and positive and negative predictive values of CDI for the diagnosis of ulceration were 41.2%, 97.95%, 87.5%, 82.8% respectively, while CEUS respective measures were 94.1%, 97.95%, 94.1%, and 97.95%. CONCLUSION CEUS outperformed CDI in terms of agreement with MDCTA and diagnostic accuracy for the diagnosis of ulcerated carotid plaque. KEY POINTS • Superficial ulceration is a significant feature of carotid plaque vulnerability. • Color Doppler imaging has the potential to demonstrate carotid plaque ulceration but is characterized by limited sensitivity and moderate agreement with the reference method of multi-detector computed tomography angiography. • Contrast-enhanced ultrasound outperforms color Doppler imaging in terms of sensitivity for the detection of carotid plaque ulceration and in agreement with the reference method of multi-detector computed tomography angiography.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysostomos Xerras
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irini Nikolaou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Rafailidis
- Department of Radiology, "G. Gennimatas" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Charitanti-Kouridou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Comparison of Measurement and Grading of Carotid Stenosis with Computed Tomography Angiography and Doppler Ultrasound. Ann Vasc Surg 2018. [PMID: 29522870 DOI: 10.1016/j.avsg.2018.01.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Doppler ultrasound (DUS) and computed tomography angiography (CTA) are the most commonly used imaging modalities for carotid disease. The aim of this study was to test the accuracy and reproducibility of CTA-derived measurements of carotid stenosis and compare them with those obtained by DUS. METHODS Images of 100 carotid arteries of patients who underwent carotid DUS at our unit and CTA of the carotids within a 28-day period were identified retrospectively from multidisciplinary team meeting records. CTAs were assessed by 2 investigators, each using a manual and a semi-automated method. With both methods, the degree of stenosis was calculated using the North American Symptomatic Carotid Endarterectomy Trial equation and graded as mild (0-49%), moderate (50-69%), or severe (70-99%). Cohen's kappa and specificity and sensitivity for ≥50% stenosis were calculated. RESULTS The interobserver agreement was moderate (κ 0.407, weighted-κ 0.517) for the manual method and good (κ 0.786, weighted-κ 0.842) for the semi-automated method. Using DUS as the gold standard, the semi-automated method had greater sensitivity (75%) and specificity (91%) in detecting clinically significant carotid artery stenosis (≥50%) than the manual one (63% and 86%, respectively). Agreement between DUS and the semi-automated method of CTA reporting was moderate (κ 0.453, 95% confidence interval [CI]: 0.320-0.586, weighted-κ 0.598, 95% CI: 0.486-0.710), whereas DUS and the manual method of CTA reporting had only fair agreement (κ 0.344, 95% CI: 0.209-0.478, weighted-κ 0.446, 95% CI: 0.315-0.577). CONCLUSIONS CTA tends to underestimate the degree of stenosis when compared with DUS. The semi-automated method of CTA reporting has greater reproducibility and greater agreement with DUS. These findings have practical implications when CTA is used to measure the degree of carotid stenosis in clinical practice.
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Zopfs D, Lennartz S, Laukamp K, Große Hokamp N, Mpotsaris A, Maintz D, Borggrefe J, Neuhaus V. Improved depiction of atherosclerotic carotid artery stenosis in virtual monoenergetic reconstructions of venous phase dual-layer computed tomography in comparison to polyenergetic reconstructions. Eur J Radiol 2018; 100:36-42. [DOI: 10.1016/j.ejrad.2018.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/24/2017] [Accepted: 01/06/2018] [Indexed: 11/27/2022]
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30
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Cui H, Yan R, Zhai Z, Ren J, Li Z, Li Q, Wang S. Comparative analysis of 3D time-resolved contrast-enhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis. Exp Ther Med 2018; 15:1654-1659. [PMID: 29434750 DOI: 10.3892/etm.2017.5548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to compare the diagnostic value of contrast-enhanced magnetic resonance angiography (CE MRA) with 3D time-resolved imaging of contrast kinetics, color Doppler ultrasound (CDUS) and digital subtraction angiography (DSA) in extracranial carotid stenosis (CS). A total of 54 patients with symptomatic CS were subjected to CDUS, CE MRA and DSA examination. Results of DSA were defined as the standard, and a total of 216 vessels were examined. In each patient four vessels were examined, namely the bilateral common carotid arteries and the bilateral internal carotid arteries. The sensitivities and specificities of CE MRA and CDUS for various degrees of CS were also determined. It was observed that the sensitivities to mild-level (1-49%), moderate-level (50-69%) and severe-level (70-99%) CS were 85.45, 100 and 100% for CE MRA, and 78.18, 50 and 100% for CDUS, respectively. The corresponding specificities were 95.27, 98.58 and 99.53% for CE MRA, and 79.05, 93.36 and 98.10% for CDUS, respectively. In addition, the carotid sinus plaque detection rate for CDUS was significantly higher than that of DSA and CE MRA (both P<0.001). Detection rates for common carotid artery plaques and internal carotid artery plaques did not significantly differ among the three examination methods (all P>0.05). These data demonstrate that CE MRA has higher sensitivity and specificity than CDUS for the diagnosis of CS, and that CDUS has a higher carotid sinus plaque detection rate than DSA and CE MRA. Therefore, the combination of MRI and CDUS may be a 'gold standard' diagnostic method for the detection of moderate and severe CS.
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Affiliation(s)
- Hongkai Cui
- Department of Interventional Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Ruifang Yan
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Zhansheng Zhai
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Jipeng Ren
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Zheng Li
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Qiang Li
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Shouying Wang
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan 453000, P.R. China
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Harifi G, Nour-Eldine W, Noureldine MHA, Berjaoui MB, Kallas R, Khoury R, Uthman I, Al-Saleh J, Khamashta MA. Arterial stenosis in antiphospholipid syndrome: Update on the unrevealed mechanisms of an endothelial disease. Autoimmun Rev 2018; 17:256-266. [PMID: 29339317 DOI: 10.1016/j.autrev.2017.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 12/20/2022]
Abstract
First described in 1983, antiphospholipid syndrome (APS) is an autoimmune condition characterized by the occurrence of recurrent arterial and/or venous thrombosis, and/or pregnancy morbidity, in the setting of persistent presence of antiphospholipid antibodies (aPL). While thrombosis is the most well-known pathogenic mechanism in this disorder, the relevance of some other mechanisms such as arterial stenosis is being increasingly recognized. Arterial stenosis has been first described in the renal arteries in patients with APS, however intracranial and coeliac arteries can also be involved with various and treatable clinical manifestations. The underlying pathophysiology of this stenotic arterial vasculopathy is not fully understood but some recent studies revealed new insights into the molecular mechanism behind this endothelial cell activation in APS. In this review, we discuss these newly discovered mechanisms and highlight the diagnostic and therapeutic modalities of the APS related arterial stenosis.
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Affiliation(s)
- Ghita Harifi
- Dr Humeira Badsha Rheumatology Center, Dubai, United Arab Emirates.
| | - Wared Nour-Eldine
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unit 970, Paris-Cardiovascular Research Center, Paris, France; Université Paris-Descartes, Paris, France
| | | | - Mohammad Baker Berjaoui
- Department of Internal Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Romy Kallas
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Rita Khoury
- Department of Internal Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jamal Al-Saleh
- Division of Rheumatology, Department of Internal Medicine, Dubai Hospital, United Arab Emirates
| | - Munther A Khamashta
- Division of Rheumatology, Department of Internal Medicine, Dubai Hospital, United Arab Emirates
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Saba L, Francone M, Bassareo PP, Lai L, Sanfilippo R, Montisci R, Suri JS, De Cecco CN, Faa G. CT Attenuation Analysis of Carotid Intraplaque Hemorrhage. AJNR Am J Neuroradiol 2017; 39:131-137. [PMID: 29191874 DOI: 10.3174/ajnr.a5461] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/20/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage. MATERIALS AND METHODS This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm2). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed. RESULTS A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively). CONCLUSIONS The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.
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Affiliation(s)
- L Saba
- From the Departments of Radiology (L.S.)
| | | | | | - L Lai
- Department of Radiological, Oncological, and Pathological Sciences (L.L.), Sapienza University of Rome, Rome, Italy
| | - R Sanfilippo
- Vascular Surgery (R.S., R.M.), Azienda Ospedaliero Universitaria of Cagliari - Polo di Monserrato, Cagliari, Italy
| | - R Montisci
- Vascular Surgery (R.S., R.M.), Azienda Ospedaliero Universitaria of Cagliari - Polo di Monserrato, Cagliari, Italy
| | - J S Suri
- Point of Care Devices (J.S.S.), Global Biomedical Technologies, Roseville, California.,AtheroPoint (J.S.S.), Roseville, California.,Department of Electrical Engineering (J.S.S.), Idaho State University, Pocatello, Idaho
| | - C N De Cecco
- Department of Radiology and Radiological Science (C.N.D.C.), Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina
| | - G Faa
- Cardiology (M.F., P.P.B., G.F.)
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Malhotra K, Goyal N, Tsivgoulis G. Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management. Curr Atheroscler Rep 2017; 19:41. [PMID: 28861849 DOI: 10.1007/s11883-017-0677-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Acute internal carotid artery occlusion (ICAO) is associated with large infarcts and poor clinical outcomes and contributes to morbidity and mortality worldwide. In this review, we discuss various etiologies and pathophysiology of clinical presentations of ICAO, different radiographic patterns, and management of patients with ICAO. RECENT FINDINGS Recanalization rates remain suboptimal with systemic thrombolysis amongst patients with acute ICAO. Recent success of endovascular therapy for vessel occlusion in anterior circulation has expanded the horizons; however, few patients with cervical dissections and ICAO were included in these landmark trials. Acute ICAO responds poorly to intravenous thrombolysis and portends worse clinical outcomes. Extracranial and intracranial ICAOs have varied clinical course and imaging patterns, with discrete cervical ICAO usually associated with better clinical outcomes while tandem occlusions predispose poor outcomes. Diagnostic catheter-based angiogram is often required since appearances of ICAO using non-invasive neuroimaging modalities are often deceiving. Repeated vascular imaging in acute to subacute phase to determine recanalization of ICAO is critical for secondary prevention. Recent success of endovascular procedures will continue to expand the horizons to improve the management of ICAO.
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Affiliation(s)
- Konark Malhotra
- Department of Neurology, West Virginia University - Charleston Division, Charleston Area Medical Center, Charleston, WV, 25301, USA.
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.,Second Department of Neurology, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
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Zhao X, Hippe DS, Li R, Canton GM, Sui B, Song Y, Li F, Xue Y, Sun J, Yamada K, Hatsukami TS, Xu D, Wang M, Yuan C. Prevalence and Characteristics of Carotid Artery High-Risk Atherosclerotic Plaques in Chinese Patients With Cerebrovascular Symptoms: A Chinese Atherosclerosis Risk Evaluation II Study. J Am Heart Assoc 2017; 6:JAHA.117.005831. [PMID: 28862936 PMCID: PMC5586432 DOI: 10.1161/jaha.117.005831] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Carotid atherosclerotic plaque rupture is an important source of ischemic stroke. However, the prevalence of high‐risk plaque (HRP) defined as plaques with luminal surface disruption, a lipid‐rich necrotic core occupying >40% of the wall, or intraplaque hemorrhage in Chinese population remains unclear. This study uses carotid magnetic resonance imaging (CMRI) to investigate HRP prevalence in carotid arteries of Chinese patients with cerebrovascular symptoms. Methods and Results Patients with cerebral ischemic symptoms in the anterior circulation within 2 weeks and carotid plaque determined by ultrasound were recruited and underwent CMRI. The HRP features were identified and compared between symptomatic and asymptomatic arteries. Receiver‐operating‐characteristic analysis was used to calculate area‐under‐the‐curve (AUC) of stenosis and maximum wall thickness for discriminating presence of HRP. In 1047 recruited subjects, HRP detected by CMRI was nearly 1.5 times more prevalent than severe stenosis (≥50%) in this cohort (28% versus 19%, P<0.0001). Approximately two thirds of HRPs were found in arteries with <50% stenosis. The prevalence of HRP in symptomatic carotid arteries was significantly higher than that of the contralateral asymptomatic carotid arteries (23.0% versus 16.4%, P=0.001). Maximum wall thickness was found to be a stronger discriminator than stenosis for HRP (AUC: 0.93 versus 0.81, P<0.0001). Conclusions There are significantly more high‐risk carotid plaques than carotid arteries with ≥50% stenosis in symptomatic Chinese patients. A substantial number of HRPs were found in arteries with lower grade stenosis and maximum wall thickness was a stronger indicator for HRP than luminal stenosis. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02017756.
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Affiliation(s)
- Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Gador M Canton
- Department of Radiology, University of Washington, Seattle, WA
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Beijing, China
| | - Yan Song
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Feiyu Li
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yunjing Xue
- Department of Radiology, Fujian Union Hospital, Fuzhou, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, WA
| | | | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA
| | - Maoxue Wang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China .,Department of Radiology, University of Washington, Seattle, WA
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Raval SB, Britton CA, Zhao T, Krishnamurthy N, Santini T, Gorantla VS, Ibrahim TS. Ultra-high field upper extremity peripheral nerve and non-contrast enhanced vascular imaging. PLoS One 2017; 12:e0175629. [PMID: 28662061 PMCID: PMC5490941 DOI: 10.1371/journal.pone.0175629] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/29/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore the efficacy of Ultra-high field [UHF] 7 Tesla [T] MRI as compared to 3T MRI in non-contrast enhanced [nCE] imaging of structural anatomy in the elbow, forearm, and hand [upper extremity]. MATERIALS AND METHOD A wide range of sequences including T1 weighted [T1] volumetric interpolate breath-hold exam [VIBE], T2 weighted [T2] double-echo steady state [DESS], susceptibility weighted imaging [SWI], time-of-flight [TOF], diffusion tensor imaging [DTI], and diffusion spectrum imaging [DSI] were optimized and incorporated with a radiofrequency [RF] coil system composed of a transverse electromagnetic [TEM] transmit coil combined with an 8-channel receive-only array for 7T upper extremity [UE] imaging. In addition, Siemens optimized protocol/sequences were used on a 3T scanner and the resulting images from T1 VIBE and T2 DESS were compared to that obtained at 7T qualitatively and quantitatively [SWI was only qualitatively compared]. DSI studio was utilized to identify nerves based on analysis of diffusion weighted derived fractional anisotropy images. Images of forearm vasculature were extracted using a paint grow manual segmentation method based on MIPAV [Medical Image Processing, Analysis, and Visualization]. RESULTS High resolution and high quality signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]-images of the hand, forearm, and elbow were acquired with nearly homogeneous 7T excitation. Measured [performed on the T1 VIBE and T2 DESS sequences] SNR and CNR values were almost doubled at 7T vs. 3T. Cartilage, synovial fluid and tendon structures could be seen with higher clarity in the 7T T1 and T2 weighted images. SWI allowed high resolution and better quality imaging of large and medium sized arteries and veins, capillary networks and arteriovenous anastomoses at 7T when compared to 3T. 7T diffusion weighted sequence [not performed at 3T] demonstrates that the forearm nerves are clearly delineated by fiber tractography. The proper digital palmar arteries and superficial palmar arch could also be clearly visualized using TOF nCE 7T MRI. CONCLUSION Ultra-high resolution neurovascular imaging in upper extremities is possible at 7T without use of renal toxic intravenous contrast. 7T MRI can provide superior peripheral nerve [based on fiber anisotropy and diffusion coefficient parameters derived from diffusion tensor/spectrum imaging] and vascular [nCE MRA and vessel segmentation] imaging.
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Affiliation(s)
- Shailesh B. Raval
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Cynthia A. Britton
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Tiejun Zhao
- Siemens Medical Solutions, New York, United States of America
| | - Narayanan Krishnamurthy
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Tales Santini
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Vijay S. Gorantla
- Department of Plastic Surgery, Pittsburgh, Pittsburgh, United States of America
- * E-mail: (TSI); (VSG)
| | - Tamer S. Ibrahim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
- * E-mail: (TSI); (VSG)
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Computed Tomographic Angiography-Based Characterization of Source Blood Vessels for Nipple-Areola Complex Perfusion in Hypertrophic Breasts. Aesthetic Plast Surg 2017; 41:524-530. [PMID: 28233132 DOI: 10.1007/s00266-017-0791-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/05/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Current knowledge about the blood supply of the nipple-areola complex (NAC) has largely been derived from studies on cadavers or persons with breasts of normal size. The aim of this study was to identify and classify the NAC blood supply by computed tomographic angiography (CTA) examination in female volunteers with breast hypertrophy. METHODS CTA examination was performed on hypertrophic breasts of 23 female subjects. The main blood supplies were revealed through image data analyses. The dominant blood supply of the NAC and its vascular sources were identified and sorted. The detectable diameter threshold of blood vessels was set beyond 1.0 mm. RESULTS A total of 61 dominant blood vessels were identified. The source arteries were traced as the internal thoracic artery (ITA, 50.8%), lateral thoracic artery (LTA, 27.8%), thoracoacromial artery (TA, 14.8%), brachial artery (BA, 3.3%), and axillary artery (AA, 3.3%), and the corresponding reproducibility of these source vessels was 31, 37, 9, 4.3, and 4.3%, in all breasts. The intercostal artery (IA) was not identified as a dominant NAC supplying vessel in any CTA scan image. Twenty-six breasts had only one dominant artery, whereas 17 breasts showed multiple dominant blood supplies. Three breasts showed no dominant blood vessels of the NAC, with diameters greater than the detectable threshold of 1.0 mm, and 52.2% of the breasts demonstrated anatomically symmetrical patterns of blood supply for the NAC. CONCLUSIONS The ITA, LTA, and TA are likely to be the main vessel sources, whereas the IA is unlikely to be the dominant vessel for NAC perfusion, on the basis of the studied breasts. An asymmetrical pattern of bilateral breast blood supply was demonstrated in a considerable portion of the females with breast hypertrophy in this study. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Rai S, Thaler DE, Salehi P, Madan N, Leung LY. More to Atherosclerosis Than Stenosis. Stroke 2017; 48:e104-e107. [DOI: 10.1161/strokeaha.117.016923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Samhitha Rai
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.R., D.E.T., L.Y.L.), Division of Vascular Surgery, Department of Surgery (P.S.), and Division of Neuroradiology, Department of Radiology (N.M.), Tufts Medical Center, Boston, MA
| | - David E. Thaler
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.R., D.E.T., L.Y.L.), Division of Vascular Surgery, Department of Surgery (P.S.), and Division of Neuroradiology, Department of Radiology (N.M.), Tufts Medical Center, Boston, MA
| | - Payam Salehi
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.R., D.E.T., L.Y.L.), Division of Vascular Surgery, Department of Surgery (P.S.), and Division of Neuroradiology, Department of Radiology (N.M.), Tufts Medical Center, Boston, MA
| | - Neel Madan
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.R., D.E.T., L.Y.L.), Division of Vascular Surgery, Department of Surgery (P.S.), and Division of Neuroradiology, Department of Radiology (N.M.), Tufts Medical Center, Boston, MA
| | - Lester Y. Leung
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.R., D.E.T., L.Y.L.), Division of Vascular Surgery, Department of Surgery (P.S.), and Division of Neuroradiology, Department of Radiology (N.M.), Tufts Medical Center, Boston, MA
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Rafailidis V, Chryssogonidis I, Tegos T, Kouskouras K, Charitanti-Kouridou A. Imaging of the ulcerated carotid atherosclerotic plaque: a review of the literature. Insights Imaging 2017; 8:213-225. [PMID: 28160261 PMCID: PMC5359146 DOI: 10.1007/s13244-017-0543-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/02/2017] [Accepted: 01/09/2017] [Indexed: 02/01/2023] Open
Abstract
Abstract Carotid atherosclerotic disease constitutes a major modern health problem whose diagnosis primarily relies on imaging. Grading of stenosis has been long used as the main factor for risk stratification and guiding of management. Nevertheless, increasing evidence has shown that additional plaque characteristics such as plaque composition and surface morphology play an important role in the occurrence of symptoms, justifying the term “vulnerable plaque”. Carotid plaque surface characteristics either in the form of surface irregularities or ulceration represent an important factor of vulnerability and are associated with the occurrence of neurologic symptoms. The delineation of the carotid plaque surface can be performed with virtually all imaging modalities including ultrasound, contrast-enhanced ultrasound, multi-detector computed tomography angiography, magnetic resonance angiography and the traditional reference method of angiography. These techniques have shown varying levels of diagnostic accuracy for the identification of ulcerated carotid plaques or plaque surface irregularities. As a consequence and given its high clinical significance, radiologists should be familiar with the various aspects of this entity, including its definition, classification, imaging findings on different imaging modalities and associations. The purpose of this review is to present the current literature regarding carotid plaque ulcerations and present illustrative images of ulcerated carotid plaques. Teaching Points • Plaque surface and ulceration represent risk factors for stroke in carotid disease. • Characterisation of the plaque surface and ulcerations can be performed with every modality. • US is the first-line modality for carotid disease and identification of ulcerations. • The administration of microbubbles increases US accuracy for diagnosis of carotid ulceration. • MDCTA and MRA are valuable for diagnosing ulceration and evaluating plaque composition.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Charitanti-Kouridou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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İdil Soylu A, Arıkan Cortcu S, Uzunkaya F, Atalay YO, Bekçi T, Güngör L, Belet Ü. The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease. Vascular 2016; 25:299-306. [DOI: 10.1177/1708538116673770] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives Platelet-to-lymphocyte ratio is a novel biomarker, recently shown to be correlated with atherosclerotic inflammation. This study investigated the role of platelet-to-lymphocyte ratio in patients with carotid artery stenosis and stroke. Methods Patients, who underwent carotid angiography with Multiple Detector Computed Tomography Angiography at our hospital, were retrospectively screened. Patients enrolled were divided into three groups based on the platelet-to-lymphocyte ratio. Patients with a platelet-to-lymphocyte ratio value between 55.0 and 106.71 were assigned to Group I, patients with a platelet-to-lymphocyte ratio value between 106.79 and 160.61 were assigned to Group II and patients with a platelet-to-lymphocyte ratio value between 162.96 and 619.61 were assigned to Group III. The carotid arterial stenosis calculated was classified as per the criteria of North American Symptomatic Carotid Endarterectomy Trial. Results One hundred fifty patients were included in our trial (mean age 61.9 ± 13.1 with 104 males). The rate of carotid arterial stenosis was detected to be higher in patients with a high platelet-to-lymphocyte ratio value (p = 0.010). Additionally, the platelet-to-lymphocyte ratio was positively correlated with the carotid arterial stenosis percentage (r = 0.250, p = 0.002). In the multi-variate regression analysis, platelet-to-lymphocyte ratio was detected to be an independent variable with respect to stroke (odd’s ratio = 1.012, confidence interval = 1.001–1.024, p = 0.031). Conclusions Increased platelet-to-lymphocyte ratio could be a simple and practical marker of the clinical course in patients with carotid arterial stenosis.
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Affiliation(s)
| | | | - Fatih Uzunkaya
- Department of Radiology, Ondokuz Mayis University, Turkey
| | | | - Tumay Bekçi
- Department of Radiology, Ondokuz Mayis University, Turkey
| | - Levent Güngör
- Department of Neurology, Ondokuz Mayis University, Turkey
| | - Ümit Belet
- Department of Radiology, Ondokuz Mayis University, Turkey
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Low-Dose Carotid Computed Tomography Angiography Using Pure Iterative Reconstruction. J Comput Assist Tomogr 2016; 40:833-9. [PMID: 27331923 DOI: 10.1097/rct.0000000000000436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED The aim of this study was to assess if a low-dose carotid computed tomography angiography (CTA) performed with pure iterative reconstruction (IR) is comparable to a conventional dose CTA protocol. METHODS Twenty patients were included. Radiation dose was divided into a low-dose acquisition reconstructed with pure IR and a conventional dose acquisition reconstructed with 40% hybrid IR. Dose, image noise, contrast resolution, spatial resolution, and carotid artery stenosis were measured. RESULTS Mean effective dose was significantly lower for low-dose than conventional dose studies (1.84 versus 3.71 mSv; P < 0.001). Subjective image noise, contrast resolution, and spatial resolution were significantly higher for the low-dose studies. There was excellent agreement for stenosis grading accuracy between low- and conventional dose studies (Cohen κ = 0.806). CONCLUSIONS A low-dose carotid CTA protocol reconstructed with pure IR is comparable to a conventional dose CTA protocol in terms of image quality and diagnostic accuracy while enabling a dose reduction of 49.6%.
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MRI characteristics of carotid bulb atypical fibromuscular dysplasia in black stroke patients. J Neuroradiol 2016; 43:214-7. [DOI: 10.1016/j.neurad.2015.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
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Mukundan S, Steigner ML, Hsiao LL, Malek SK, Tullius SG, Chin MS, Siedlecki AM. Ferumoxytol-Enhanced Magnetic Resonance Imaging in Late-Stage CKD. Am J Kidney Dis 2016; 67:984-8. [PMID: 26786296 DOI: 10.1053/j.ajkd.2015.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/14/2015] [Indexed: 12/20/2022]
Abstract
Ferumoxytol is a superparamagnetic iron oxide particle encapsulated by a semisynthetic carbohydrate with properties that can be used by the nephrologist for diagnosis and therapy. Ferumoxytol is approved by the US Food and Drug Administration for treating iron deficiency anemia in the setting of chronic kidney disease, but not for clinical diagnostic imaging. It has gained appeal as a magnetic resonance imaging contrast agent in patients with estimated glomerular filtration rates < 30mL/min/1.73m(2) in whom gadolinium-based contrast magnetic resonance imaging agents are relatively contraindicated because of the association with gadolinium deposition and nephrogenic systemic fibrosis. Ferumoxytol metabolism is not dependent on kidney function, but rather is removed from the circulation by the reticuloendothelial system of the liver, spleen, and bone marrow. Additionally, the prolonged intravascular half-life (>14 hours) of ferumoxytol allows for longer image acquisition and repeat imaging, if necessary. In patients with contraindications for gadolinium contrast agents, ferumoxytol is an alternative agent for vascular assessment, including patency and course.
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Affiliation(s)
| | | | | | | | | | - Matthew S Chin
- Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
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McLaughlin MS, Hinckley PJ, Treiman SM, Kim SE, Stoddard GJ, Parker DL, Treiman GS, McNally JS. Optimal Prediction of Carotid Intraplaque Hemorrhage Using Clinical and Lumen Imaging Markers. AJNR Am J Neuroradiol 2015; 36:2360-6. [PMID: 26338923 DOI: 10.3174/ajnr.a4454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/03/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging detects intraplaque hemorrhage with high accuracy by using the magnetization-prepared rapid acquisition of gradient echo sequence. Still, MR imaging is not readily available for all patients, and many undergo CTA instead. Our goal was to determine essential clinical and lumen imaging predictors of intraplaque hemorrhage, as indicators of its presence and clues to its pathogenesis. MATERIALS AND METHODS In this retrospective cross-sectional study, patients undergoing stroke work-up with MR imaging/MRA underwent carotid intraplaque hemorrhage imaging. We analyzed 726 carotid plaques, excluding vessels with non-carotid stroke sources (n = 420), occlusions (n = 7), or near-occlusions (n = 3). Potential carotid imaging predictors of intraplaque hemorrhage included percentage diameter and millimeter stenosis, plaque thickness, ulceration, and intraluminal thrombus. Clinical predictors were recorded, and a multivariable logistic regression model was fitted. Backward elimination was used to determine essential intraplaque hemorrhage predictors with a thresholded 2-sided P < .10. Receiver operating characteristic analysis was also performed. RESULTS Predictors of carotid intraplaque hemorrhage included plaque thickness (OR = 2.20, P < .001), millimeter stenosis (OR = 0.46, P < .001), ulceration (OR = 4.25, P = .020), age (OR = 1.11, P = .001), and male sex (OR = 3.23, P = .077). The final model discriminatory value was excellent (area under the curve = 0.932). This was significantly higher than models using only plaque thickness (area under the curve = 0.881), millimeter stenosis (area under the curve = 0.830), or ulceration (area under the curve= 0.715, P < .001). CONCLUSIONS Optimal discrimination of carotid intraplaque hemorrhage requires information on plaque thickness, millimeter stenosis, ulceration, age, and male sex. These factors predict intraplaque hemorrhage with high discriminatory power and may provide clues to the pathogenesis of intraplaque hemorrhage. This model could be used to predict the presence of intraplaque hemorrhage when MR imaging is contraindicated.
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Affiliation(s)
- M S McLaughlin
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - P J Hinckley
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - S M Treiman
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - S-E Kim
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - G J Stoddard
- Department of Orthopedics (G.J.S.), Study Design and Biostatistics Center
| | - D L Parker
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - G S Treiman
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research Department of Surgery (G.S.T.), University of Utah, Salt Lake City, Utah Department of Surgery (G.S.T.), VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - J S McNally
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
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Singh N, Moody AR, Roifman I, Bluemke DA, Zavodni AEH. Advanced MRI for carotid plaque imaging. Int J Cardiovasc Imaging 2015; 32:83-9. [PMID: 26293362 PMCID: PMC4706840 DOI: 10.1007/s10554-015-0743-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 10/28/2022]
Abstract
Atherosclerosis is the ubiquitous underling pathological process that manifests in heart attack and stroke, cumulating in the death of one in three North American adults. High-resolution magnetic resonance imaging (MRI) is able to delineate atherosclerotic plaque components and total plaque burden within the carotid arteries. Using dedicated hardware, high resolution images can be obtained. Combining pre- and post-contrast T1, T2, proton-density, and magnetization-prepared rapid acquisition gradient echo weighted fat-saturation imaging, plaque components can be defined. Post-processing software allows for semi- and fully automated quantitative analysis. Imaging correlation with surgical specimens suggests that this technique accurately differentiates plaque features. Total plaque burden and specific plaque components such as a thin fibrous cap, large fatty or necrotic core and intraplaque hemorrhage are accepted markers of neuroischemic events. Given the systemic nature of atherosclerosis, emerging science suggests that the presence of carotid plaque is also an indicator of coronary artery plaque burden, although the preliminary data primarily involves patients with stable coronary disease. While the availability and cost-effectiveness of MRI will ultimately be important determinants of whether carotid MRI is adopted clinically in cardiovascular risk assessment, the high accuracy and reliability of this technique suggests that it has potential as an imaging biomarker of future risk.
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Affiliation(s)
- Navneet Singh
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Idan Roifman
- Division of Cardiology, Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - David A Bluemke
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Anna E H Zavodni
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada.
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Assessing internal carotid artery stenosis with a semiautomated computed tomography angiography tool and duplex ultrasound. J Vasc Surg 2015; 61:1449-56. [DOI: 10.1016/j.jvs.2015.01.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/13/2015] [Indexed: 11/22/2022]
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Treiman GS, McNally JS, Kim SE, Parker DL. Correlation of Carotid Intraplaque Hemorrhage and Stroke Using 1.5 T and 3 T MRI. MAGNETIC RESONANCE INSIGHTS 2015; 8:1-8. [PMID: 26056469 PMCID: PMC4454204 DOI: 10.4137/mri.s23560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 01/06/2023]
Abstract
Carotid therosclerotic disease causes approximately 25% of the nearly 690,000 ischemic strokes each year in the United States. Current risk stratification based on percent stenosis does not provide specific information on the actual risk of stroke for most individuals. Prospective randomized studies have found only 10 to 12% of asymptomatic patients will have a symptomatic stroke within 5 years. Measurements of percent stenosis do not determine plaque stability or composition. Reports have concluded that cerebral ischemic events associated with carotid plaque are intimately associated with plaque instability. Analysis of retrospective studies has found that plaque composition is important in risk stratification. Only MRI has the ability to identify and measure the detailed components and morphology of carotid plaque and provides more detailed information than other currently available techniques. MRI can accurately detect carotid hemorrhage, and MRI identified carotid hemorrhage correlates with acute stroke.
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Affiliation(s)
- Gerald S Treiman
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA ; Department of Surgery, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA ; Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Seong-Eun Kim
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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Zhou L, Xing P, Chen Y, Xu X, Shen J, Lu X. Carotid and vertebral artery stenosis evaluated by contrast-enhanced MR angiography in nasopharyngeal carcinoma patients after radiotherapy: a prospective cohort study. Br J Radiol 2015; 88:20150175. [PMID: 25875781 DOI: 10.1259/bjr.20150175] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the incidence of carotid artery (CA) and vertebral artery (VA) stenosis by contrast-enhanced MR angiography (CE-MRA) in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. METHODS 72 patients with NPC after radiotherapy more than 3 years ago were recruited as irradiation group to investigate the incidence and degree of CA and VA stenosis by CE-MRA. The results were compared with those of the control group, which comprised 50 newly diagnosed patients with NPC who had not received radiotherapy. RESULTS There was a higher incidence of CA and VA stenosis in the irradiation group than in the control group in terms of patient number as well as vessel involvement. The incidence of significant (>50%) CA and VA stenosis, except for the basilar artery, was also higher in the irradiation group than in the control group. The most commonly detected stenosis in the irradiation group was found in the internal CA (ICA) and VA, followed by the external CA and common CA (CCA). CCA and/or ICA (CCA/ICA) stenosis was present in 67 (93.1%) of 72 patients, with 27 (37.5%) patients having significant CCA/ICA stenosis. The statistical analysis demonstrated that age at receiving CE-MRA scanning and time interval from radiotherapy were the independent predictors of significant CCA/ICA stenosis. CONCLUSION The CE-MRA scanning results showed that the incidence of stenosis seems to exist in a wider range of CAs and VAs in the patients with NPC after radiotherapy than in the patients who had not received radiotherapy, and the incidence of significant CCA/ICA stenosis is higher in patients with older age and longer interval from radiotherapy. ADVANCES IN KNOWLEDGE Radiation-induced CA and VA stenosis exists widely in patients with NPC after radiotherapy, and its prevalence is more common in patients with older age and longer interval from radiotherapy.
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Affiliation(s)
- L Zhou
- 1 Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Parolini C, Busnelli M, Ganzetti GS, Dellera F, Manzini S, Scanziani E, Johnson JL, Sirtori CR, Chiesa G. Magnetic resonance imaging visualization of vulnerable atherosclerotic plaques at the brachiocephalic artery of apolipoprotein E knockout mice by the blood-pool contrast agent B22956/1. Mol Imaging 2015; 13. [PMID: 24825406 DOI: 10.2310/7290.2014.00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to identify, by magnetic resonance imaging (MRI), the ability of the blood-pool contrast agent B22956/1 to detect atherosclerotic plaques developing at the brachiocephalic artery of apolipoprotein E knockout (apoE-KO) mice and to possibly identify vulnerable atherosclerotic lesions. After high-fat feeding for 8 or 12 weeks, MRIs of brachiocephalic arteries were acquired before and after B22956/1 administration; then vessels were removed and analyzed by histology. B22956/1 injection caused a rapid increase in plaque signal enhancement and plaque to muscle contrast values, which remained stable up to 70 minutes. A linear correlation between signal enhancement and macrophage content was found 10 minutes after B22956/1 injection (p < .01). Signal enhancement and plaque to muscle contrast values correlated with macrophage content 40 minutes after contrast agent administration (p < .01). Finally, 70 minutes after B22956/1 infusion, plaque to muscle contrast significantly correlated with the percentage of stenosis (p < .005). B22956/1 administration to high fat-fed apoE-KO mice resulted in a rapid enhancement of atherosclerotic plaques and in a great ability to rapidly visualize vulnerable plaques, characterized by a high macrophage content. These results suggest that B22956/1 could represent an interesting tool for the identification of atherosclerotic plaques potentially leading to acute cardiovascular events.
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Lucatelli P, Fanelli F, Cirelli C, Sacconi B, Anzidei M, Montisci R, Sanfilippo R, Tamponi E, Catalano C, Saba L. Carotid endarterectomy versus stenting: Does the flow really change? An Echo-Color-Doppler analysis. Int J Cardiovasc Imaging 2015; 31:773-81. [PMID: 25697722 DOI: 10.1007/s10554-015-0623-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/16/2015] [Indexed: 11/26/2022]
Abstract
To assess potential hemodynamic differences after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and their eventual impact on clinical management. Between July 2012 and October 2013 two groups of 30 patients each referred for CEA or CAS were prospectively enrolled in two tertiary hospital care centers. Pre-procedural imaging assessment of carotid artery disease was performed with Echo-Color-Doppler (ECD) and computed tomography angiography (CTA). ECD was repeated within 24 h and 1, 6 and 12 months after surgical/endovascular procedures. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were assessed at two standard sites: common carotid artery (CCA) and distal internal carotid artery (ICA). Twenty-four hours ECD findings highly differ between the two populations. CCA PSV in the CEA and CAS groups was respectively 44.88 ± 9.16 and 69.20 ± 20.04 cm/s (p = 0.002); CCA EDV was 16.11 ± 2.29 and 19.13 ± 6.42 cm/s (p = 0.065); ICA PSV was 46.11 ± 7.9 and 94.02 ± 57.7 cm/s (p = 0.0012); ICA EDV was 20.22 ± 4.33 and 30.47 ± 18.33 cm/s (p = 0.025). One month, 6 months and 1 year findings confirmed the different trend in the two cohorts; in particular, at 1 year: CCA PSV was 50.94 ± 12.44 and 60.59 ± 26.84 cm/s (p = 0.181); CCA EDV was 17.11 ± 3.46 and 19 ± 16.35 cm/s (p = 0.634); ICA PSV was 51.66 ± 10.1 and 70.86 ± 20.64 cm/s (p = 0.014); ICA EDV was 25.05 ± 8.65 and 32.66 ± 13 cm/s (p = 0.0609). ECD follow-up of patients undergone CEA or CAS may play a critical role in the clinical management. Strict surveillance of blood flow velocities allows reducing false positive re-stenosis diagnosis and choosing the best anti-aggregation therapies. Within the first month CEA patients benefit from a lower risk condition in comparison with CAS patients, due to a significantly faster PSV drop; moreover, long-term CCA PSV after CEA could be used as a surrogate marker of neointima formation.
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MESH Headings
- Aged
- Angioplasty/adverse effects
- Angioplasty/instrumentation
- Blood Flow Velocity
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Common/physiopathology
- Carotid Artery, Common/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/physiopathology
- Carotid Artery, Internal/surgery
- Carotid Stenosis/diagnostic imaging
- Carotid Stenosis/physiopathology
- Carotid Stenosis/surgery
- Carotid Stenosis/therapy
- Endarterectomy, Carotid/adverse effects
- Female
- Humans
- Italy
- Male
- Middle Aged
- Predictive Value of Tests
- Prospective Studies
- Recurrence
- Regional Blood Flow
- Severity of Illness Index
- Stents
- Tertiary Care Centers
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography, Doppler, Color
- Vascular Patency
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy,
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