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Identification of carotid lipid-rich necrotic core and calcification by 3D magnetization-prepared rapid acquisition gradient-echo imaging. Magn Reson Imaging 2018; 53:71-76. [PMID: 30021124 DOI: 10.1016/j.mri.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE This study sought to investigate the feasibility of three-dimensional MPRAGE in identifying the lipid-rich necrotic core (LRNC) and calcification (CA) of carotid atherosclerotic plaques. MATERIALS AND METHODS Twelve patients (mean age 68.4 ± 11.8 years; 7 males) with carotid atherosclerotic plaques on ultrasound were included and underwent multicontrast magnetic resonance (MR) vessel wall imaging. The contrast enhanced T1W (CE-T1W) images were considered as reference for identifying LRNC. The signal intensity of LRNC, CA, sterno-cleidomastoid muscle and fibrous tissue (FT) was measured on CE-T1W, T1W, T2W, and MPRAGE images, respectively. The relative signal intensity (rSI) of LRNC and CA against muscle or FT was compared among four sequences. Area under the curve (AUC) of rSIs of LRNC, CA and FT against muscle on MPRAGE, T1W and T2W images in discriminating the LRNC or CA from FT and the other plaque component was calculated. RESULTS Of 352 slices, 88 (25.0%) had LRNC, 31 (8.8%) had CA, 14 (4.0%) had both LRNC and CA, and 247 (70.2%) had no components. Among four imaging sequences, MPRAGE images showed the lowest rSI of LRNC (0.34 ± 0.18) and CA (0.20 ± 0.16) against muscle, followed by T1W (0.48 ± 0.18 and 0.33 ± 0.21), CE-T1W (0.58 ± 0.23 and 0.40 ± 0.21) and T2W (0.71 ± 0.47 and 0.43 ± 0.40) images. In addition, the MPRAGE images showed the lowest rSI of LRNC (0.57 ± 0.26) and CA (0.33 ± 0.23) against FT. MPRAGE showed greater AUC than T2W and T1W in discriminating the LRNC (0.827 vs. 0.703 vs. 0.635) and CA (0.917 vs. 0.838 vs. 0.825). CONCLUSION MPRAGE sequence might be a potential non-contrast enhanced imaging tool for identification of carotid LRNC and CA.
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Watase H, Sun J, Hippe DS, Balu N, Li F, Zhao X, Mani V, Fayad ZA, Fuster V, Hatsukami TS, Yuan C. Carotid Artery Remodeling Is Segment Specific: An In Vivo Study by Vessel Wall Magnetic Resonance Imaging. Arterioscler Thromb Vasc Biol 2018; 38:927-934. [PMID: 29472231 DOI: 10.1161/atvbaha.117.310296] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/07/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Early atherosclerosis is often undetected due in part to compensatory enlargement of the outer wall, termed positive remodeling. Variations in hemodynamic conditions and clinical factors influence the patterns of remodeling. The carotid artery provides an opportunity to examine these variations because of the unique geometry of the carotid bulb. This study aimed to determine differences in remodeling of the common, internal, and bifurcation segments of the carotid using magnetic resonance imaging. APPROACH AND RESULTS Carotid arteries of 525 subjects without history of cardiovascular disease were imaged by magnetic resonance imaging. The carotid artery was divided into 3 segments: common carotid artery; bifurcation; and internal carotid artery. Remodeling patterns were characterized using linear regression analysis of lumen and total vessel areas (dependent variables) compared with maximum wall thickness (independent variable) for each segment, adjusted for age, sex, and height. The common carotid artery demonstrated a pattern consistent with positive remodeling, whereas the bifurcation demonstrated negative remodeling. The internal carotid artery demonstrated a mixed pattern of outer wall expansion and lumen constriction. Females and subjects with diabetes mellitus showed more positive remodeling, hypertension was associated with attenuated positive remodeling, and those with hypercholesterolemia showed more negative remodeling. CONCLUSIONS In this cohort of 55- to 80-year-old individuals without history of cardiovascular disease, the pattern of early carotid artery remodeling was segment specific and appeared to be associated with sex and clinical characteristics. These findings provide the groundwork for longitudinal studies to define local and systemic factors such as hemodynamic and clinical conditions on carotid artery remodeling.
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Affiliation(s)
- Hiroko Watase
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Jie Sun
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Daniel S Hippe
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Niranjan Balu
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Feiyu Li
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Xihai Zhao
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Venkatesh Mani
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Zahi A Fayad
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Valentin Fuster
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Thomas S Hatsukami
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Chun Yuan
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.).
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Lu M, Peng P, Cui Y, Qiao H, Li D, Cai J, Zhao X. Association of Progression of Carotid Artery Wall Volume and Recurrent Transient Ischemic Attack or Stroke: A Magnetic Resonance Imaging Study. Stroke 2018; 49:614-620. [PMID: 29382804 DOI: 10.1161/strokeaha.117.019422] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/18/2017] [Accepted: 12/15/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the association between carotid plaque progression and subsequent recurrent events using magnetic resonance imaging. METHODS Sixty-three symptomatic patients with ipsilateral carotid atherosclerotic stenosis (30%-69% stenosis) determined by ultrasound underwent first and second carotid artery magnetic resonance imaging for carotid artery at baseline and ≥6 months after the first scan, respectively. All the patients had clinical follow-up after the second magnetic resonance scan for ≤5 years until the onset of recurrent transient ischemic attack or stroke. Presence/absence of carotid plaque compositional features, particularly intraplaque hemorrhage and fibrous cap rupture was identified. The annual progression of carotid wall volume between 2 magnetic resonance scans was measured. Univariate and multivariate Cox regression was used to calculate the hazard ratio and corresponding 95% confidence interval of carotid plaque features in discriminating recurrent events. Receiver-operating-characteristic-curve analysis was conducted to determine the area-under-the-curve of carotid plaque features in predicting recurrent events. RESULTS Sixty-three patients (mean age: 66.5±10.0 years old; 54 males) were eligible for final statistics analysis. During a mean follow-up duration of 55.1±13.6 months, 14.3% of patients (n=9) experienced ipsilateral recurrent transient ischemic attack/stroke. The annual progression of carotid wall volume was significantly associated with recurrent events before (hazard ratio, 1.14 per 10 mm3; 95% confidence interval, 1.02-1.27; P=0.019) and after (hazard ratio, 1.19 per 10 mm3; 95% confidence interval, 1.03-1.37; P=0.022) adjusted for confounding factors. In discriminating the recurrence of transient ischemia attack/stroke, receiver-operator curve analysis indicated that combined with annual progression of wall volume, there was a significant incremental improvement in the area-under-the-curve of intraplaque hemorrhage (area-under-the-curve: 0.69-0.81) and fibrous cap rupture (area-under-the-curve: 0.73-0.84). CONCLUSIONS The annual progression of carotid wall volume is independently associated with recurrent ischemic cerebrovascular events, and this measurement has added value for intraplaque hemorrhage and fibrous cap rupture in predicting future events.
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Affiliation(s)
- Mingming Lu
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Peng Peng
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Yuanyuan Cui
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Huiyu Qiao
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Dongye Li
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Jianming Cai
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.).
| | - Xihai Zhao
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.).
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Qi H, Sun J, Qiao H, Chen S, Zhou Z, Pan X, Wang Y, Zhao X, Li R, Yuan C, Chen H. Carotid Intraplaque Hemorrhage Imaging with Quantitative Vessel Wall T1 Mapping: Technical Development and Initial Experience. Radiology 2017; 287:276-284. [PMID: 29117484 DOI: 10.1148/radiol.2017170526] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To develop a three-dimensional (3D) high-spatial-resolution time-efficient sequence for use in quantitative vessel wall T1 mapping. Materials and Methods A previously described sequence, simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging, was extended by introducing 3D golden angle radial k-space sampling (GOAL-SNAP). Sliding window reconstruction was adopted to reconstruct images at different inversion delay times (different T1 contrasts) for voxelwise T1 fitting. Phantom studies were performed to test the accuracy of T1 mapping with GOAL-SNAP against a two-dimensional inversion recovery (IR) spin-echo (SE) sequence. In vivo studies were performed in six healthy volunteers (mean age, 27.8 years ± 3.0 [standard deviation]; age range, 24-32 years; five male) and five patients with atherosclerosis (mean age, 66.4 years ± 5.5; range, 60-73 years; five male) to compare T1 measurements between vessel wall sections (five per artery) with and without intraplaque hemorrhage (IPH). Statistical analyses included Pearson correlation coefficient, Bland-Altman analysis, and Wilcoxon rank-sum test with data permutation by subject. Results Phantom T1 measurements with GOAL-SNAP and IR SE sequences showed excellent correlation (R2 = 0.99), with a mean bias of -25.8 msec ± 43.6 and a mean percentage error of 4.3% ± 2.5. Minimum T1 was significantly different between sections with IPH and those without it (mean, 371 msec ± 93 vs 944 msec ± 120; P = .01). Estimated T1 of normal vessel wall and muscle were 1195 msec ± 136 and 1117 msec ± 153, respectively. Conclusion High-spatial-resolution (0.8 mm isotropic) time-efficient (5 minutes) vessel wall T1 mapping is achieved by using the GOAL-SNAP sequence. This sequence may yield more quantitative reproducible biomarkers with which to characterize IPH and monitor its progression. © RSNA, 2017.
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Affiliation(s)
- Haikun Qi
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Jie Sun
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Huiyu Qiao
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Shuo Chen
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Zechen Zhou
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Xinlei Pan
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Yishi Wang
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Xihai Zhao
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Rui Li
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Chun Yuan
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Huijun Chen
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
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Li D, Zhao H, Chen X, Chen S, Qiao H, He L, Li R, Xu J, Yuan C, Zhao X. Identification of intraplaque haemorrhage in carotid artery by simultaneous non-contrast angiography and intraPlaque haemorrhage (SNAP) imaging: a magnetic resonance vessel wall imaging study. Eur Radiol 2017; 28:1681-1686. [PMID: 29098439 DOI: 10.1007/s00330-017-5096-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/05/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the usefulness of Simultaneous Non-contrast Angiography and intraPlaque haemorrhage (SNAP) imaging in characterising carotid intraplaque haemorrhage (IPH) compared with magnetisation-prepared rapid acquisition gradient-echo (MP-RAGE) sequence. METHODS Fifty-four symptomatic patients (mean age: 63.1 ± 5.7 years, 38 males) with carotid atherosclerosis were recruited and underwent carotid MR imaging. The presence and area of IPH on SNAP and MP-RAGE images were determined. The agreement in identifying IPH and its area between SNAP and MP-RAGE was analysed. RESULTS Of 1368 slices with acceptable image quality in 54 patients, 13% and 22.6% were found to have IPH on MP-RAGE and SNAP images, respectively. There was moderate agreement between MP-RAGE and SNAP sequences in identifying IPH (κ = 0.511, p = 0.029). The area of IPH on SNAP images was significantly larger than that on MP-RAGE images (17.9 ± 18.2 mm2 vs. 9.2 ± 10.5 mm2, p < 0.001). For IPHs detected by SNAP imaging, the area of IPHs also detected by the MP-RAGE sequence was significantly larger than that of IPHs not detected by the MP-RAGE sequence (17.9 ± 19.2 mm2 vs. 6.4 ± 6.2 mm2, p < 0.001). CONCLUSION Compared with the MP-RAGE sequence, SNAP imaging detects more IPHs, particularly for smaller IPHs, suggesting that SNAP imaging might be a more sensitive tool for identification of carotid haemorrhagic plaques. KEY POINTS • Moderate agreement was found between SNAP and MP-RAGE in identification of IPH • SNAP imaging might be a more sensitive tool to detect carotid IPHs • Compared with the MP-RAGE sequence, SNAP imaging can detect carotid IPHs with smaller size • SNAP imaging can help clinicians to optimise the treatment strategy.
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Affiliation(s)
- Dongye Li
- Centre for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyi Chen
- Centre for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Shuo Chen
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Huiyu Qiao
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Le He
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Rui Li
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chun Yuan
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Xihai Zhao
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China.
- Centre of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
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Sun J, Zhao XQ, Balu N, Neradilek MB, Isquith DA, Yamada K, Cantón G, Crouse JR, Anderson TJ, Huston J, O'Brien K, Hippe DS, Polissar NL, Yuan C, Hatsukami TS. Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes: The MRI Substudy in AIM-HIGH. JACC Cardiovasc Imaging 2017; 10:241-249. [PMID: 28279371 DOI: 10.1016/j.jcmg.2016.06.017] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. BACKGROUND Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. METHODS As part of the event-driven clinical trial AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes), subjects with clinically established atherosclerotic disease underwent multicontrast carotid magnetic resonance imaging (MRI) to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazards survival models. RESULTS Of the 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (82% male, mean age 61 ± 9 years, 94% statin use). During median follow-up of 35.1 months, 18 subjects (8.4%) reached the AIM-HIGH endpoint. High lipid content (hazard ratio [HR] per 1 SD increase in percent lipid core volume: 1.57; p = 0.002) and thin/ruptured fibrous cap (HR: 4.31; p = 0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (HR: 3.00; p = 0.053). High calcification content (HR per 1 SD increase in percent calcification volume: 0.66; p = 0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment. CONCLUSIONS Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Xue-Qiao Zhao
- Department of Medicine, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Daniel A Isquith
- Department of Medicine, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Gádor Cantón
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - John R Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J Anderson
- Libin Cardiovascular Institute of Alberta and Cumming School of Medicine, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin O'Brien
- Department of Medicine, University of Washington, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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Lorbeer R, Hetterich H, Strobl R, Schafnitzel A, Patscheider H, Schindler A, Müller-Peltzer K, Sommer W, Peters A, Meisinger C, Heier M, Rathmann W, Bamberg F, Grill E. Lack of association of MRI determined subclinical cardiovascular disease with dizziness and vertigo in a cross-sectional population-based study. PLoS One 2017; 12:e0184858. [PMID: 28910373 PMCID: PMC5599022 DOI: 10.1371/journal.pone.0184858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/03/2017] [Indexed: 12/01/2022] Open
Abstract
Objective We investigated the association between subclinical cardiovascular diseases assessed by MRI examination and symptoms of dizziness and vertigo in participants of a population-based sample. Methods Data from 400 participants (169 women) aged from 39 to 73 of a cross-sectional MRI sub-study of the “Kooperative Gesundheitsforschung in der Region Augsburg” (KORA) FF4 study from the south of Germany was used. MRI determined subclinical cardiovascular diseases include left and right ventricular structure and function as well as the presence of carotid plaque and carotid wall thickness. Cerebrum diseases include white matter lesions (WML) and cerebral microbleeds (CMB). The main outcomes of dizziness and vertigo were assessed by standardized interview. Logistic regression models were applied and adjusted odds ratios (OR) with 95% confidence intervals (CI) were provided. Results Lifetime and 12-month prevalence of dizziness and vertigo were 30% (95%CI 26% to 35%) and 21% (95%CI 17% to 26%) respectively in this sample. On multivariable analysis, cardiac and carotid measurements were not associated with dizziness and vertigo excluding orthostatic vertigo (20%, 95CI 16% to 24%). Only in male participants, there was a significant association between WML and the presence of dizziness and vertigo (OR = 2.95, 95%CI 1.08 to 8.07). There was no significant association of CMB with dizziness and vertigo. However, CMB and WML were tending to associate with a higher risk of dizziness and vertigo in the whole sample (CMB: OR = 1.48, 95%CI 0.70; 3.15; WML: OR = 1.71, 95%CI 0.80 to 3.67;), in persons with prediabetes and diabetes (WML: OR = 2.71, 95%CI 0.89 to 8.23) and in men with normal glucose metabolism (CMB: OR = 2.60, 95%CI 0.56 to 12.0; WML: OR = 3.08, 95%CI 0.58 to 16.5). Conclusions In this sample of participants without manifest cardiovascular diseases, subclinical left and right ventricular function and carotid structure were consistently not associated with dizziness and vertigo. Subclinical cerebrum measurements, however, tend to increase the risk for dizziness and vertigo, especially in men and in persons with prediabetes or diabetes.
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Affiliation(s)
- Roberto Lorbeer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- * E-mail:
| | - Holger Hetterich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Ralf Strobl
- Institute of Medical Information Processing, Biometrics and Epidemiology, LMU Munich, Munich, Germany
| | - Anina Schafnitzel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Hannah Patscheider
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Schindler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Wieland Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK e.V.), Munich, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Epidemiology, LMU Munich, UNIKA-T Augsburg, Augsburg, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Wolfgang Rathmann
- Department of Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
| | - Fabian Bamberg
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Eva Grill
- Institute of Medical Information Processing, Biometrics and Epidemiology, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU Munich, Munich, Germany
- Munich Center of Health Sciences (MC-Health), LMU Munich, Munich, Germany
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58
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Sun B, Li X, Liu X, Ge X, Lu Q, Zhao X, Pu J, Xu J, Zhao H. Association between carotid plaque characteristics and acute cerebral infarction determined by MRI in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2017; 16:111. [PMID: 28893252 PMCID: PMC5594451 DOI: 10.1186/s12933-017-0592-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) might aggravate the carotid plaque vulnerability, and increase the risk for ischemic stroke. Few studies reported the acute stroke subtype with carotid plaque characteristics in T2DM patients. This study aimed to investigate the association between carotid plaque characteristics and acute cerebral infarct (ACI) lesion features determined by MRI in T2DM patients. METHODS Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited. All patients were stratified into T2DM and non-T2DM groups and underwent both carotid and brain MRI scans. Ipsilateral carotid plaque morphological and compositional characteristics, intracranial and extracranial carotid artery stenosis were also determined. Stroke subtype based on the Trial of ORG 10172 in Acute Stroke Treatment classification and ACI lesion patterns were evaluated. RESULTS Of the recruited 140 patients, 68 (48.6%) patients had T2DM (mean age 64.16 ± 11.38 years, 40 males). T2DM patients exhibited higher prevalence of carotid type IV-VI lesions, larger plaque burden as well as larger lipid-rich necrotic core (LRNC) compared with non-T2DM patients. Among the patients with carotid LRNC on symptomatic side, more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in T2DM group than those in non-T2DM group. Carotid plaque with LRNC% > 22.0% was identified as an independent risk factor for the presence of ACI lesions confined to the carotid territory in T2DM patients, regardless of other risk factors. CONCLUSIONS This study shows that more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in the T2DM patients with ipsilateral carotid LRNC plaque than those in non-T2DM patients. Quantification of the carotid plaque characteristics, particularly the LRNC% by MRI has the potential usefulness for stroke risk stratification.
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Affiliation(s)
- Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
| | - Xiaoqian Ge
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
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Wang J, Chen H, Sun J, Hippe DS, Zhang H, Yu S, Cai J, Xie L, Cui B, Yuan C, Zhao X, Yuan W, Liu H. Dynamic contrast-enhanced MR imaging of carotid vasa vasorum in relation to coronary and cerebrovascular events. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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60
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Gao S, van 't Klooster R, Kitslaar PH, Coolen BF, van den Berg AM, Smits LP, Shahzad R, Shamonin DP, de Koning PJH, Nederveen AJ, van der Geest RJ. Learning-based automated segmentation of the carotid artery vessel wall in dual-sequence MRI using subdivision surface fitting. Med Phys 2017; 44:5244-5259. [PMID: 28715090 DOI: 10.1002/mp.12476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The quantification of vessel wall morphology and plaque burden requires vessel segmentation, which is generally performed by manual delineations. The purpose of our work is to develop and evaluate a new 3D model-based approach for carotid artery wall segmentation from dual-sequence MRI. METHODS The proposed method segments the lumen and outer wall surfaces including the bifurcation region by fitting a subdivision surface constructed hierarchical-tree model to the image data. In particular, a hybrid segmentation which combines deformable model fitting with boundary classification was applied to extract the lumen surface. The 3D model ensures the correct shape and topology of the carotid artery, while the boundary classification uses combined image information of 3D TOF-MRA and 3D BB-MRI to promote accurate delineation of the lumen boundaries. The proposed algorithm was validated on 25 subjects (48 arteries) including both healthy volunteers and atherosclerotic patients with 30% to 70% carotid stenosis. RESULTS For both lumen and outer wall border detection, our result shows good agreement between manually and automatically determined contours, with contour-to-contour distance less than 1 pixel as well as Dice overlap greater than 0.87 at all different carotid artery sections. CONCLUSIONS The presented 3D segmentation technique has demonstrated the capability of providing vessel wall delineation for 3D carotid MRI data with high accuracy and limited user interaction. This brings benefits to large-scale patient studies for assessing the effect of pharmacological treatment of atherosclerosis by reducing image analysis time and bias between human observers.
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Affiliation(s)
- Shan Gao
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Ronald van 't Klooster
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Pieter H Kitslaar
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Bram F Coolen
- Department of Radiology, Academic Medical Center, 1100 DD, Amsterdam, The Netherlands
| | | | - Loek P Smits
- Department of Radiology, Academic Medical Center, 1100 DD, Amsterdam, The Netherlands
| | - Rahil Shahzad
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Denis P Shamonin
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Patrick J H de Koning
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, 1100 DD, Amsterdam, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
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Qi H, Huang F, Zhou Z, Koken P, Balu N, Zhang B, Yuan C, Chen H. Large coverage black-bright blood interleaved imaging sequence (LaBBI) for 3D dynamic contrast-enhanced MRI of vessel wall. Magn Reson Med 2017. [PMID: 28626998 DOI: 10.1002/mrm.26786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To propose a large coverage black-bright blood interleaved imaging sequence (LaBBI) for 3D dynamic contrast-enhanced MRI (DCE-MRI) of the vessel wall. METHODS LaBBI consists of a 3D black-blood stack-of-stars golden angle radial acquisition with high spatial resolution for vessel wall imaging and a 2D bright-blood Cartesian acquisition with high temporal resolution for arterial input function estimation. The two acquisitions were performed in an interleaved fashion within a single scan. Simulations, phantom experiments, and in vivo tests in three patients were performed to investigate the feasibility and performance of the proposed LaBBI. RESULTS In simulation tests, the estimated Ktrans and vp by LaBBI were more accurate than conventional bright-blood DCE-MRI with lower root mean square error in all the tested conditions. In phantom test, no signal interference was found on the 2D scan in LaBBI. Pharmacokinetic analysis of the patients' data acquired by LaBBI showed that Ktrans was higher in fibrous tissue (0.0717 ± 0.0279 min-1 ), while lower in necrotic core (0.0206 ± 0.0040 min-1 ) and intraplaque hemorrhage (0.0078 ± 0.0007 min-1 ), compared with normal vessel wall (0.0273 ± 0.0052 min-1 ). CONCLUSION The proposed LaBBI sequence, with high spatial and temporal resolution, and large coverage blood suppression, was promising to probe the perfusion properties of vessel wall lesions. Magn Reson Med 79:1334-1344, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Haikun Qi
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | | | | | | | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Kerwin WS, Miller Z, Yuan C. Imaging of the high-risk carotid plaque: magnetic resonance imaging. Semin Vasc Surg 2017; 30:54-61. [PMID: 28818259 DOI: 10.1053/j.semvascsurg.2017.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The emergence of the concept of high-risk atherosclerotic plaque has led to considerable interest in noninvasive imaging techniques to identify high-risk features before clinical sequelae. For plaques in the carotid arteries, magnetic resonance imaging has undergone considerable histologic validation to link imaging features to indicators of plaque instability, including plaque burden, intraplaque hemorrhage, fibrous cap disruption, lipid rich necrotic core, and calcification. Recently introduced imaging technologies, especially those focused on three-dimensional imaging sequences, are now poised for integration into the clinical workup of patients with suspected carotid atherosclerosis. The purpose of this article is to review the carotid plaque magnetic resonance imaging techniques that are most ready for integration into the clinic.
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Affiliation(s)
- William S Kerwin
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Zach Miller
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Chun Yuan
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109.
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Relationship between Framingham risk score and subclinical atherosclerosis in carotid plaques: an in vivo study using multi-contrast MRI. SCIENCE CHINA-LIFE SCIENCES 2017; 60:23-27. [PMID: 28078510 DOI: 10.1007/s11427-016-0385-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/09/2016] [Indexed: 02/04/2023]
Abstract
The assessment and management of early-stage atherosclerosis are important for the prevention of cardiovascular disease (CVD). In this study, we used multi-contrast magnetic resonance imaging (MRI) to investigate the carotid plaque feature in asymptomatic, at-risk subjects; we also evaluated the correlation between MRI findings and Framingham risk score (FRS). One hundred sixty-six asymptomatic individuals with risk factors for CVD underwent multi-contrast MRI. After the arterial morphology and plaque components were outlined, the differences in carotid plaque burden among the various risk categories were analyzed. The FRS analysis showed that high-risk individuals had thicker vessel wall and higher plaque lipid content than did low risk participants. A substantial proportion of advanced carotid plaques occurred in low and intermediate-risk groups. Multi-contrast MRI may provide incremental value to the FRS in managing asymptomatic at-risk population.
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Mutharasan RK, Thaxton CS, Berry J, Daviglus ML, Yuan C, Sun J, Ayers C, Lloyd-Jones DM, Wilkins JT. HDL efflux capacity, HDL particle size, and high-risk carotid atherosclerosis in a cohort of asymptomatic older adults: the Chicago Healthy Aging Study. J Lipid Res 2017; 58:600-606. [PMID: 28049656 DOI: 10.1194/jlr.p069039] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 12/30/2016] [Indexed: 11/20/2022] Open
Abstract
HDL efflux capacity and HDL particle size are associated with atherosclerotic CVD (ASCVD) events in middle-aged individuals; however, it is unclear whether these associations are present in older adults. We sampled 402 Chicago Healthy Aging Study participants who underwent a dedicated carotid MRI assessment for lipid-rich necrotic core (LRNC) plaque. We measured HDL particle size, HDL particle number, and LDL particle number with NMR spectroscopy, as well as HDL efflux capacity. We quantified the associations between HDL particle size and HDL efflux using adjusted linear regression models. We quantified associations between the presence of LRNC and HDL and LDL particle number, HDL particle size, and HDL efflux capacity using adjusted logistic regression models. HDL efflux capacity was directly associated with large (β = 0.037, P < 0.001) and medium (β = 0.0065, P = 0.002) HDL particle concentration and inversely associated with small (β = -0.0049, P = 0.018) HDL particle concentration in multivariable adjusted models. HDL efflux capacity and HDL particle number were inversely associated with prevalent LRNC plaque in unadjusted models (odds ratio: 0.5; 95% confidence interval: 0.26, 0.96), but not after multivariable adjustment. HDL particle size was not associated with prevalent LRNC. HDL particle size was significantly associated with HDL efflux capacity, suggesting that differences in HDL efflux capacity may be due to structural differences in HDL particles. Future research is needed to determine whether HDL efflux is a marker of ASCVD risk in older populations.
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Affiliation(s)
- R Kannan Mutharasan
- Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - C Shad Thaxton
- Department of Urology and Institute of BioNanotechnology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - Jarett Berry
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago, IL 60612
| | - Chun Yuan
- University of Washington College of Engineering and University of Washington School of Medicine, University of Washington, Seattle, WA 98195
| | - Jie Sun
- University of Washington College of Engineering and University of Washington School of Medicine, University of Washington, Seattle, WA 98195
| | - Colby Ayers
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - John T Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
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Bamberg F, Hetterich H, Rospleszcz S, Lorbeer R, Auweter SD, Schlett CL, Schafnitzel A, Bayerl C, Schindler A, Saam T, Müller-Peltzer K, Sommer W, Zitzelsberger T, Machann J, Ingrisch M, Selder S, Rathmann W, Heier M, Linkohr B, Meisinger C, Weber C, Ertl-Wagner B, Massberg S, Reiser MF, Peters A. Subclinical Disease Burden as Assessed by Whole-Body MRI in Subjects With Prediabetes, Subjects With Diabetes, and Normal Control Subjects From the General Population: The KORA-MRI Study. Diabetes 2017; 66:158-169. [PMID: 27999110 DOI: 10.2337/db16-0630] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022]
Abstract
Detailed pathophysiological manifestations of early disease in the context of prediabetes are poorly understood. This study aimed to evaluate the extent of early signs of metabolic and cardio-cerebrovascular complications affecting multiple organs in individuals with prediabetes. Subjects without a history of stroke, coronary artery disease, or peripheral artery disease were enrolled in a case-control study nested within the Cooperative Health Research in the Region of Augsburg (KORA) FF4 cohort and underwent comprehensive MRI assessment to characterize cerebral parameters (white matter lesions, microbleeds), cardiovascular parameters (carotid plaque, left ventricular function, and myocardial late gadolinium enhancement [LGE]), and metabolic parameters (hepatic proton-density fat fraction [PDFF] and subcutaneous and visceral abdominal fat). Among 400 subjects who underwent MRI, 103 subjects had prediabetes and 54 had established diabetes. Subjects with prediabetes had an increased risk for carotid plaque and adverse functional cardiac parameters, including reduced early diastolic filling rates as well as a higher prevalence of LGE compared with healthy control subjects. In addition, people with prediabetes had significantly elevated levels of PDFF and total and visceral fat. Thus, subjects with prediabetes show early signs of subclinical disease that include vascular, cardiac, and metabolic changes, as measured by whole-body MRI after adjusting for cardiometabolic risk factors.
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Affiliation(s)
- Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
- German Center for Cardiovascular Disease Research, Munich, Germany
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
- German Center for Cardiovascular Disease Research, Munich, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Roberto Lorbeer
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
- German Center for Cardiovascular Disease Research, Munich, Germany
| | - Sigrid D Auweter
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anina Schafnitzel
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christian Bayerl
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Andreas Schindler
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | | | - Wieland Sommer
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Jürgen Machann
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Tübingen, Tübingen, Germany
- German Centre for Diabetes Research, Tübingen, Germany
| | - Michael Ingrisch
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Sonja Selder
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Christian Weber
- German Center for Cardiovascular Disease Research, Munich, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Maximilian F Reiser
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Annette Peters
- German Center for Cardiovascular Disease Research, Munich, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
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66
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Li B, Jiao Y, Fu C, Xie B, Ma G, Teng G, Yao Y. Contralateral artery enlargement predicts carotid plaque progression based on machine learning algorithm models in apoE -/- mice. Biomed Eng Online 2016; 15:146. [PMID: 28155719 PMCID: PMC5259854 DOI: 10.1186/s12938-016-0265-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study specifically focused on anatomical MRI characterization of the low shear stress-induced atherosclerotic plaque in mice. We used machine learning algorithms to analyze multiple correlation factors of plaque to generate predictive models and to find the predictive factor for vulnerable plaque. METHODS Branches of the left carotid artery in apoE-/- and C57BL/6J mice were ligated to produce the partial left carotid artery model. Before surgery, and 7, 14, and 28 days after surgery, in vivo serial MRI measurements of carotid artery diameter were obtained. Meanwhile, proximal blood flow was evaluated. After image acquisition and animal sacrifice, carotid arteries were harvested for histological analysis. Support vector machine (SVM) and decision tree (DT) were used to select features and generate predictive models of vulnerable plaque progression. RESULT Seven days after surgery, neointima formation was visualized on micro-MRI in both apoE-/- and C57BL/6J mice. Ultrasonography showed that blood flow had significantly decreased compared to that in the contralateral artery. Partial ligation of the carotid artery for 4 weeks in apoE-/- mice induced vulnerable plaque; however, in C57BL/6J mice this same technique performed for 4 weeks induced arterial stenosis. Contralateral carotid artery diameter at 7 days after surgery was the most reliable predictive factor in plaque progression. We achieved over 87.5% accuracy, 80% sensitivity, and 95% specificity with SVM. The accuracy, sensitivity, and specificity for the DT classifier were 90, 90, and 90%, respectively. CONCLUSIONS This study is the first to demonstrate that SVM and DT methods could be suitable models for identifying vulnerable plaque progression in mice. And contralateral artery enlargement can predict the vulnerable plaque in carotid artery at the very early stage. It may be a valuable tool which helps to optimize the clinical work flow process by providing more decision in selecting patients for treatment.
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Affiliation(s)
- Bing Li
- Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Yun Jiao
- Jiangsu Key Lab of Molecular and Function Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Cong Fu
- Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Bo Xie
- Jiangsu Key Lab of Molecular and Function Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Gaojun Teng
- Jiangsu Key Lab of Molecular and Function Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Yuyu Yao
- Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China.
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67
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Manual versus Automated Carotid Artery Plaque Component Segmentation in High and Lower Quality 3.0 Tesla MRI Scans. PLoS One 2016; 11:e0164267. [PMID: 27930665 PMCID: PMC5145140 DOI: 10.1371/journal.pone.0164267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/22/2016] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To study the interscan reproducibility of manual versus automated segmentation of carotid artery plaque components, and the agreement between both methods, in high and lower quality MRI scans. METHODS 24 patients with 30-70% carotid artery stenosis were planned for 3T carotid MRI, followed by a rescan within 1 month. A multicontrast protocol (T1w,T2w, PDw and TOF sequences) was used. After co-registration and delineation of the lumen and outer wall, segmentation of plaque components (lipid-rich necrotic cores (LRNC) and calcifications) was performed both manually and automated. Scan quality was assessed using a visual quality scale. RESULTS Agreement for the detection of LRNC (Cohen's kappa (k) is 0.04) and calcification (k = 0.41) between both manual and automated segmentation methods was poor. In the high-quality scans (visual quality score ≥ 3), the agreement between manual and automated segmentation increased to k = 0.55 and k = 0.58 for, respectively, the detection of LRNC and calcification larger than 1 mm2. Both manual and automated analysis showed good interscan reproducibility for the quantification of LRNC (intraclass correlation coefficient (ICC) of 0.94 and 0.80 respectively) and calcified plaque area (ICC of 0.95 and 0.77, respectively). CONCLUSION Agreement between manual and automated segmentation of LRNC and calcifications was poor, despite a good interscan reproducibility of both methods. The agreement between both methods increased to moderate in high quality scans. These findings indicate that image quality is a critical determinant of the performance of both manual and automated segmentation of carotid artery plaque components.
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68
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Jodas DS, Pereira AS, R.S. Tavares JM. Lumen segmentation in magnetic resonance images of the carotid artery. Comput Biol Med 2016; 79:233-242. [DOI: 10.1016/j.compbiomed.2016.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022]
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69
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Quantification of Lipid-Rich Core in Carotid Atherosclerosis Using Magnetic Resonance T 2 Mapping: Relation to Clinical Presentation. JACC Cardiovasc Imaging 2016; 10:747-756. [PMID: 27743954 PMCID: PMC5502905 DOI: 10.1016/j.jcmg.2016.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 11/23/2022]
Abstract
Objectives The aim of this study was to: 1) provide tissue validation of quantitative T2 mapping to measure plaque lipid content; and 2) investigate whether this technique could discern differences in plaque characteristics between symptom-related and non–symptom-related carotid plaques. Background Noninvasive plaque lipid quantification is appealing both for stratification in treatment selection and as a possible predictor of future plaque rupture. However, current cardiovascular magnetic resonance (CMR) methods are insensitive, require a coalesced mass of lipid core, and rely on multicontrast acquisition with contrast media and extensive post-processing. Methods Patients scheduled for carotid endarterectomy were recruited for 3-T carotid CMR before surgery. Lipid area was derived from segmented T2 maps and compared directly to plaque lipid defined by histology. Results Lipid area (%) on T2 mapping and histology showed excellent correlation, both by individual slices (R = 0.85, p < 0.001) and plaque average (R = 0.83, p < 0.001). Lipid area (%) on T2 maps was significantly higher in symptomatic compared with asymptomatic plaques (31.5 ± 3.7% vs. 15.8 ± 3.1%; p = 0.005) despite similar degrees of carotid stenosis and only modest difference in plaque volume (128.0 ± 6.0 mm3 symptomatic vs. 105.6 ± 9.4 mm3 asymptomatic; p = 0.04). Receiver-operating characteristic analysis showed that T2 mapping has a good ability to discriminate between symptomatic and asymptomatic plaques with 67% sensitivity and 91% specificity (area under the curve: 0.79; p = 0.012). Conclusions CMR T2 mapping distinguishes different plaque components and accurately quantifies plaque lipid content noninvasively. Compared with asymptomatic plaques, greater lipid content was found in symptomatic plaques despite similar degree of luminal stenosis and only modest difference in plaque volumes. This new technique may find a role in determining optimum treatment (e.g., providing an indication for intensive lipid lowering or by informing decisions of stents vs. surgery).
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70
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Sun B, Zhao H, Liu X, Lu Q, Zhao X, Pu J, Xu J. Elevated hemoglobin A1c Is Associated with Carotid Plaque Vulnerability: Novel Findings from Magnetic Resonance Imaging Study in Hypertensive Stroke Patients. Sci Rep 2016; 6:33246. [PMID: 27629481 PMCID: PMC5024110 DOI: 10.1038/srep33246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/22/2016] [Indexed: 11/09/2022] Open
Abstract
The association between hemoglobin A1c (HbA1c) level and carotid plaque vulnerability has been rarely studied by magnetic resonance imaging (MRI). The present study of MRI-identified carotid atherosclerotic lesions in hypertensive patients with acute stroke therefore sought to determine the associations between HbA1c level and plaque morphological and compositional characteristics and acute cerebral infarction (ACI) severity. Eighty hypertensive patients with acute stroke were enrolled; stratified into high (≥6.5%) and low (<6.5%) HbA1c groups; and underwent carotid and brain MRI to assess carotid plaque features and ACI volume in the region supplied by the internal carotid artery (ICA) in the symptomatic side. Plaque burden [percent wall volume (PWV), max wall thickness (max-WT)] and lipid-rich necrotic core (LRNC) were larger in the high as compared to the low HbA1c group. High HbA1c was an independent risk factor for the presence of plaque (odds ratio [OR] = 3.71) and LRNC plaque (OR = 7.08). HbA1c independently correlated with ACI severity among patients with ICA region cerebral infarction and carotid plaque. Our study suggested that an elevated HbA1c may have an adverse effect on carotid plaque vulnerability especially those with larger LRNC volumes in hypertensive stroke patients, which might exacerbate the severity of ACIs.
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Affiliation(s)
- Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
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71
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Li F, Wang X. Bilateral symmetry of human carotid artery atherosclerosis: a multi-contrast weighted MR study. Int J Cardiovasc Imaging 2016; 32:1219-26. [DOI: 10.1007/s10554-016-0890-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/02/2016] [Indexed: 02/05/2023]
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72
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Du R, Zhao XQ, Cai J, Cui B, Wu HM, Ye P. Changes in carotid plaque tissue composition in subjects who continued and discontinued statin therapy. J Clin Lipidol 2016; 10:587-93. [DOI: 10.1016/j.jacl.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/13/2016] [Indexed: 12/13/2022]
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73
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Qiao H, He Q, Chen Z, Xu D, Huang L, He L, Jiang L, Li R, Luo J, Yuan C, Zhao X. Identification of early atherosclerotic lesions in carotid arteries with quantitative characteristics measured by 3D MRI. J Magn Reson Imaging 2016; 44:1270-1276. [PMID: 27079951 DOI: 10.1002/jmri.25264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the usefulness of quantitative characteristics of morphology and signal intensity of arterial wall measured by 3D multicontrast magnetic resonance vessel wall imaging (MRVWI) in identification of carotid early atherosclerosis (CEAS). MATERIALS AND METHODS In all, 61 older subjects (mean age 71.8 ± 5.6 years old; 25 males) without cardiovascular symptoms in the last 6 months were recruited. The carotid arteries without advanced plaque features on 3.0T MRI were included for analysis. Ultrasound imaging was used as a reference to identify CEAS. The morphological parameters including lumen area (LA), wall area (WA), wall thickness (WT), and normalized wall index (NWI = WA/[WA+LA] × 100%) and the signal intensity on 3.0T MR T2 -weighted images (T2 SI) of the carotid arterial wall were measured. Three regression models were built to identify CEAS with the following parameters: Model 1 with both morphological and T2 SI parameters; Model 2 with T2 SI parameters; and Model 3 with morphological parameters. All models were adjusted for age and sex. Area under the curve (AUC) was calculated to validate models. RESULTS Of the 86 carotid arteries without advanced plaques, 47 (54.7%) were found to have early plaques determined by ultrasound. Among three regression models, Model 1 showed the highest AUC values in identifying CEAS (left: AUC = 0.856, P < 0.001; right: AUC = 0.867, P < 0.001), followed by Model 2 (left: AUC = 0.843, P < 0.001; right: AUC = 0.798, P = 0.001), and Model 3 (left: AUC = 0.790, P = 0.002; right: AUC = 0.806, P < 0.001). CONCLUSION The combination of morphology and normalized T2 SI of arterial wall measured by MRVWI is more effective than each characteristic alone in identification of CEAS. J. Magn. Reson. Imaging 2016;44:1270-1276.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Qiong He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Zhensen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Lingyun Huang
- Clinical Sites Research Program, Philips Research China, Shanghai, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Li Jiang
- Philips Healthcare (Suzhou), Jiangsu, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jianwen Luo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
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74
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O'Brien KD, Hippe DS, Chen H, Neradilek MB, Probstfield JL, Peck S, Isquith DA, Canton G, Yuan C, Polissar NL, Zhao XQ, Kerwin WS. Longer duration of statin therapy is associated with decreased carotid plaque vascularity by magnetic resonance imaging. Atherosclerosis 2016; 245:74-81. [PMID: 26708287 PMCID: PMC8629315 DOI: 10.1016/j.atherosclerosis.2015.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/06/2015] [Accepted: 11/26/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Plaque neovasculature is a major route for lipoprotein and leukocyte ingress into plaques, and has been identified as a risk factor for carotid plaque disruption. Vp, a variable derived from pharmacokinetic modeling of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), correlates with plaque neovasculature density. Because lipid-lowering therapy has been associated with regression of neovasculature in animal models, we sought to determine clinical correlates of carotid plaque neovasculature (as assessed by Vp) in participants on statin therapy for established cardiovascular disease. METHODS 98 participants from an AIM-HIGH sub-study underwent DCE-MRI of their carotid arteries. Expert readers who were blinded to all clinical variables analyzed the MR images to measure carotid plaque Vp in all participants. Associations between Vp and duration of statin therapy and other clinical risk factors were analyzed. RESULTS Prior duration of statin treatment at enrollment ranged from <1 year (21%) 1-5 years (40%) and >5 years (39%). In univariate analyses, shorter duration of statin therapy (P = 0.01), the presence of metabolic syndrome (P = 0.02), and higher body mass index (P = 0.01) and lipoprotein(a) (P = 0.01) were all significantly associated with higher baseline Vp values. In multivariate analyses, significant associations remained between shorter duration of statin therapy (P = 0.004) and lipoprotein(a) (P = 0.04). CONCLUSIONS These are the first human, in vivo findings suggesting a relationship between duration of statin therapy and regression of carotid plaque neovasculature. Future longitudinal studies are warranted both to confirm this finding and to address whether changes in neovasculature may translate into change in risk for plaque disruption. CLINICALTRIALS. GOV IDENTIFIERS NCT00880178, NCT01178320 and NCT00120289.
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Affiliation(s)
- Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | | | - Jeffrey L Probstfield
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Suzanne Peck
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Daniel A Isquith
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Xue-Qiao Zhao
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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Abstract
Plaque imaging by MR imaging provides a wealth of information on the characteristics of individual plaque that may reveal vulnerability to rupture, likelihood of progression, or optimal treatment strategy. T1-weighted and T2-weighted images among other options reveal plaque morphology and composition. Dynamic contrast-enhanced-MR imaging reveals plaque activity. To extract this information, image processing tools are needed. Numerous approaches for analyzing such images have been developed, validated against histologic gold standards, and used in clinical studies. These efforts are summarized in this article.
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Affiliation(s)
- Huijun Chen
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Room No. 109, Haidian District, Beijing, China
| | - Qiang Zhang
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Room No. 120, Haidian District, Beijing, China
| | - William Kerwin
- Department of Radiology, School of Medicine, University of Washington, 850 Republican Street, Seattle, WA 98109, USA.
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76
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Chen Y, Canton G, Kerwin WS, Chiu B. Modeling hemodynamic forces in carotid artery based on local geometric features. Med Biol Eng Comput 2015; 54:1437-52. [DOI: 10.1007/s11517-015-1417-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
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77
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Hyafil F, Schindler A, Sepp D, Obenhuber T, Bayer-Karpinska A, Boeckh-Behrens T, Höhn S, Hacker M, Nekolla SG, Rominger A, Dichgans M, Schwaiger M, Saam T, Poppert H. High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined (18)F-FDG PET/MR imaging. Eur J Nucl Med Mol Imaging 2015; 43:270-279. [PMID: 26433367 DOI: 10.1007/s00259-015-3201-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/17/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to investigate in 18 patients with ischaemic stroke classified as cryptogenic and presenting non-stenotic carotid atherosclerotic plaques the morphological and biological aspects of these plaques with magnetic resonance imaging (MRI) and (18)F-fluoro-deoxyglucose positron emission tomography ((18)F-FDG PET) imaging. METHODS Carotid arteries were imaged 150 min after injection of (18)F-FDG with a combined PET/MRI system. American Heart Association (AHA) lesion type and plaque composition were determined on consecutive MRI axial sections (n = 460) in both carotid arteries. (18)F-FDG uptake in carotid arteries was quantified using tissue to background ratio (TBR) on corresponding PET sections. RESULTS The prevalence of complicated atherosclerotic plaques (AHA lesion type VI) detected with high-resolution MRI was significantly higher in the carotid artery ipsilateral to the ischaemic stroke as compared to the contralateral side (39 vs 0 %; p = 0.001). For all other AHA lesion types, no significant differences were found between ipsilateral and contralateral sides. In addition, atherosclerotic plaques classified as high-risk lesions with MRI (AHA lesion type VI) were associated with higher (18)F-FDG uptake in comparison with other AHA lesions (TBR = 3.43 ± 1.13 vs 2.41 ± 0.84, respectively; p < 0.001). Furthermore, patients presenting at least one complicated lesion (AHA lesion type VI) with MRI showed significantly higher (18)F-FDG uptake in both carotid arteries (ipsilateral and contralateral to the stroke) in comparison with carotid arteries of patients showing no complicated lesion with MRI (mean TBR = 3.18 ± 1.26 and 2.80 ± 0.94 vs 2.19 ± 0.57, respectively; p < 0.05) in favour of a diffuse inflammatory process along both carotid arteries associated with complicated plaques. CONCLUSION Morphological and biological features of high-risk plaques can be detected with (18)F-FDG PET/MRI in non-stenotic atherosclerotic plaques ipsilateral to the stroke, suggesting a causal role for these plaques in stroke. Combined (18)F-FDG PET/MRI systems might help in the evaluation of patients with ischaemic stroke classified as cryptogenic.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. .,Department of Nuclear Medicine, Bichat University Hospital, Inserm 1148, DHU FIRE, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Dominik Sepp
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tilman Obenhuber
- Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Sabine Höhn
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Martin Dichgans
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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78
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Ukwatta E, Yuan J, Qiu W, Rajchl M, Chiu B, Fenster A. Joint segmentation of lumen and outer wall from femoral artery MR images: Towards 3D imaging measurements of peripheral arterial disease. Med Image Anal 2015; 26:120-32. [PMID: 26387053 DOI: 10.1016/j.media.2015.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
Three-dimensional (3D) measurements of peripheral arterial disease (PAD) plaque burden extracted from fast black-blood magnetic resonance (MR) images have shown to be more predictive of clinical outcomes than PAD stenosis measurements. To this end, accurate segmentation of the femoral artery lumen and outer wall is required for generating volumetric measurements of PAD plaque burden. Here, we propose a semi-automated algorithm to jointly segment the femoral artery lumen and outer wall surfaces from 3D black-blood MR images, which are reoriented and reconstructed along the medial axis of the femoral artery to obtain improved spatial coherence between slices of the long, thin femoral artery and to reduce computation time. The developed segmentation algorithm enforces two priors in a global optimization manner: the spatial consistency between the adjacent 2D slices and the anatomical region order between the femoral artery lumen and outer wall surfaces. The formulated combinatorial optimization problem for segmentation is solved globally and exactly by means of convex relaxation using a coupled continuous max-flow (CCMF) model, which is a dual formulation to the convex relaxed optimization problem. In addition, the CCMF model directly derives an efficient duality-based algorithm based on the modern multiplier augmented optimization scheme, which has been implemented on a GPU for fast computation. The computed segmentations from the developed algorithm were compared to manual delineations from experts using 20 black-blood MR images. The developed algorithm yielded both high accuracy (Dice similarity coefficients ≥ 87% for both the lumen and outer wall surfaces) and high reproducibility (intra-class correlation coefficient of 0.95 for generating vessel wall area), while outperforming the state-of-the-art method in terms of computational time by a factor of ≈ 20.
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Affiliation(s)
- Eranga Ukwatta
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Jing Yuan
- Robarts Research Institute, Western University, London, ON, Canada; Biomedical Engineering Graduate Program, Western University, London, ON, Canada
| | - Wu Qiu
- Robarts Research Institute, Western University, London, ON, Canada; Biomedical Engineering Graduate Program, Western University, London, ON, Canada
| | - Martin Rajchl
- Department of Computing, Imperial College London, London, UK
| | - Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Hong Kong
| | - Aaron Fenster
- Robarts Research Institute, Western University, London, ON, Canada; Biomedical Engineering Graduate Program, Western University, London, ON, Canada
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In vivo semi-automatic segmentation of multicontrast cardiovascular magnetic resonance for prospective cohort studies on plaque tissue composition: initial experience. Int J Cardiovasc Imaging 2015; 32:73-81. [PMID: 26169389 DOI: 10.1007/s10554-015-0704-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
Automatic in vivo segmentation of multicontrast (multisequence) carotid magnetic resonance for plaque composition has been proposed as a substitute for manual review to save time and reduce inter-reader variability in large-scale or multicenter studies. Using serial images from a prospective longitudinal study, we sought to compare a semi-automatic approach versus expert human reading in analyzing carotid atherosclerosis progression. Baseline and 6-month follow-up multicontrast carotid images from 59 asymptomatic subjects with 16-79 % carotid stenosis were reviewed by both trained radiologists with 2-4 years of specialized experience in carotid plaque characterization with MRI and a previously reported automatic atherosclerotic plaque segmentation algorithm, referred to as morphology-enhanced probabilistic plaque segmentation (MEPPS). Agreement on measurements from individual time points, as well as on compositional changes, was assessed using the intraclass correlation coefficient (ICC). There was good agreement between manual and MEPPS reviews on individual time points for calcification (CA) (area: ICC; 0.85-0.91; volume: ICC; 0.92-0.95) and lipid-rich necrotic core (LRNC) (area: ICC; 0.78-0.82; volume: ICC; 0.84-0.86). For compositional changes, agreement was good for CA volume change (ICC; 0.78) and moderate for LRNC volume change (ICC; 0.49). Factors associated with LRNC progression as detected by MEPPS review included intraplaque hemorrhage (positive association) and reduction in low-density lipoprotein cholesterol (negative association), which were consistent with previous findings from manual review. Automatic classifier for plaque composition produced results similar to expert manual review in a prospective serial MRI study of carotid atherosclerosis progression. Such automatic classification tools may be beneficial in large-scale multicenter studies by reducing image analysis time and avoiding bias between human reviewers.
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80
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Gao S, van 't Klooster R, van Wijk DF, Nederveen AJ, Lelieveldt BPF, van der Geest RJ. Repeatability of in vivo quantification of atherosclerotic carotid artery plaque components by supervised multispectral classification. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2015; 28:535-45. [PMID: 26162931 PMCID: PMC4651977 DOI: 10.1007/s10334-015-0495-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/24/2015] [Accepted: 06/29/2015] [Indexed: 12/17/2022]
Abstract
Objective
To evaluate the agreement and scan–rescan repeatability of automated and manual plaque segmentation for the quantification of in vivo carotid artery plaque components from multi-contrast MRI. Materials and methods Twenty-three patients with 30–70 % stenosis underwent two 3T MR carotid vessel wall exams within a 1 month interval. T1w, T2w, PDw and TOF images were acquired around the region of maximum vessel narrowing. Manual delineation of the vessel wall and plaque components (lipid, calcification, loose matrix) by an experienced observer provided the reference standard for training and evaluation of an automated plaque classifier. Areas of different plaque components and fibrous tissue were quantified and compared between segmentation methods and scan sessions. Results In total, 304 slices from 23 patients were included in the segmentation experiment, in which 144 aligned slice pairs were available for repeatability analysis. The correlation between manual and automated segmented areas was 0.35 for lipid, 0.66 for calcification, 0.50 for loose matrix and 0.82 for fibrous tissue. For the comparison between scan sessions, the coefficient of repeatability of area measurement obtained by automated segmentation was lower than by manual delineation for lipid (9.9 vs. 17.1 mm2), loose matrix (13.8 vs. 21.2 mm2) and fibrous tissue (24.6 vs. 35.0 mm2), and was similar for calcification (20.0 vs. 17.6 mm2). Conclusion Application of an automated classifier for segmentation of carotid vessel wall plaque components from in vivo MRI results in improved scan–rescan repeatability compared to manual analysis.
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Affiliation(s)
- Shan Gao
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Ronald van 't Klooster
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Diederik F van Wijk
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Boudewijn P F Lelieveldt
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rob J van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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81
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Rubinow KB, Wang S, den Hartigh LJ, Subramanian S, Morton GJ, Buaas FW, Lamont D, Gray N, Braun RE, Page ST. Hematopoietic androgen receptor deficiency promotes visceral fat deposition in male mice without impairing glucose homeostasis. Andrology 2015; 3:787-96. [PMID: 26097106 DOI: 10.1111/andr.12055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/27/2015] [Accepted: 05/02/2015] [Indexed: 12/12/2022]
Abstract
Androgen deficiency in men increases body fat, but the mechanisms by which testosterone suppresses fat deposition have not been elucidated fully. Adipose tissue macrophages express the androgen receptor (AR) and regulate adipose tissue remodeling. Thus, testosterone signaling in macrophages could alter the paracrine function of these cells and thereby contribute to the metabolic effects of androgens in men. A metabolic phenotyping study was performed to determine whether the loss of AR signaling in hematopoietic cells results in greater fat accumulation in male mice. C57BL/6J male mice (ages 12-14 weeks) underwent bone marrow transplant from either wild-type (WT) or AR knockout (ARKO) donors (n = 11-13 per group). Mice were fed a high-fat diet (60% fat) for 16 weeks. At baseline, 8 and 16 weeks, glucose and insulin tolerance tests were performed, and body composition was analyzed with fat-water imaging by MRI. No differences in body weight were observed between mice transplanted with WT bone marrow [WT(WTbm)] or ARKO bone marrow [WT(ARKObm)] prior to initiation of the high-fat diet. After 8 weeks of high-fat feeding, WT(ARKObm) mice exhibited significantly more visceral and total fat mass than WT(WTbm) animals. Despite this, no differences between groups were observed in glucose tolerance, insulin sensitivity, or plasma concentrations of insulin, glucose, leptin, or cholesterol, although WT(ARKObm) mice had higher plasma levels of adiponectin. Resultant data indicate that AR signaling in hematopoietic cells influences body fat distribution in male mice, and the absence of hematopoietic AR plays a permissive role in visceral fat accumulation. These findings demonstrate a metabolic role for AR signaling in marrow-derived cells and suggest a novel mechanism by which androgen deficiency in men might promote increased adiposity. The relative contributions of AR signaling in macrophages and other marrow-derived cells require further investigation.
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Affiliation(s)
- K B Rubinow
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - S Wang
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - L J den Hartigh
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - S Subramanian
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - G J Morton
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - F W Buaas
- Jackson Laboratory, Bar Harbor, ME, USA
| | - D Lamont
- Jackson Laboratory, Bar Harbor, ME, USA
| | - N Gray
- Jackson Laboratory, Bar Harbor, ME, USA
| | - R E Braun
- Jackson Laboratory, Bar Harbor, ME, USA
| | - S T Page
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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van Engelen A, van Dijk AC, Truijman MTB, Van't Klooster R, van Opbroek A, van der Lugt A, Niessen WJ, Kooi ME, de Bruijne M. Multi-Center MRI Carotid Plaque Component Segmentation Using Feature Normalization and Transfer Learning. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:1294-1305. [PMID: 25532205 DOI: 10.1109/tmi.2014.2384733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Automated segmentation of plaque components in carotid artery magnetic resonance imaging (MRI) is important to enable large studies on plaque vulnerability, and for incorporating plaque composition as an imaging biomarker in clinical practice. Especially supervised classification techniques, which learn from labeled examples, have shown good performance. However, a disadvantage of supervised methods is their reduced performance on data different from the training data, for example on images acquired with different scanners. Reducing the amount of manual annotations required for each new dataset will facilitate widespread implementation of supervised methods. In this paper we segment carotid plaque components of clinical interest (fibrous tissue, lipid tissue, calcification and intraplaque hemorrhage) in a multi-center MRI study. We perform voxelwise tissue classification by traditional same-center training, and compare results with two approaches that use little or no annotated same-center data. These approaches additionally use an annotated set of different-center data. We evaluate 1) a nonlinear feature normalization approach, and 2) two transfer-learning algorithms that use same and different-center data with different weights. Results showed that the best results were obtained for a combination of feature normalization and transfer learning. While for the other approaches significant differences in voxelwise or mean volume errors were found compared with the reference same-center training, the proposed approach did not yield significant differences from that reference. We conclude that both extensive feature normalization and transfer learning can be valuable for the development of supervised methods that perform well on different types of datasets.
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83
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Chen W, Xu J, Chiu B. Fast segmentation of the femoral arteries from 3D MR images: A tool for rapid assessment of peripheral arterial disease. Med Phys 2015; 42:2431-48. [DOI: 10.1118/1.4916803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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84
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Wang J, Helle M, Zhou Z, Börnert P, Hatsukami TS, Yuan C. Joint blood and cerebrospinal fluid suppression for intracranial vessel wall MRI. Magn Reson Med 2015; 75:831-8. [DOI: 10.1002/mrm.25667] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Jinnan Wang
- Philips Research North AmericaBriarcliff Manor New York USA
| | - Michael Helle
- Philips GmbH Innovative Technologies, Research LaboratoriesHamburg Germany
| | | | - Peter Börnert
- Philips GmbH Innovative Technologies, Research LaboratoriesHamburg Germany
| | | | - Chun Yuan
- CBIR, Tsinghua UniversityBeijing China
- Department of RadiologyUniversity of WashingtonSeattle Washington USA
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Markiewicz T, Dziekiewicz M, Osowski S, Boguslawska-Walecka R, Kozlowski W, Maruszynski M. Computerized System for Quantitative Assessment of Atherosclerotic Plaques in the Femoral and Iliac Arteries Visualized by Multislice Computed Tomography. IEEE Trans Biomed Eng 2015; 62:1490-502. [PMID: 25608298 DOI: 10.1109/tbme.2015.2392254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The investigation is aimed at the development of a semiautomatic method of examining the femoral and iliac arteries, and quantifying atherosclerotic plaques visible in the multislice computed tomography images. METHODS We have utilized the advanced morphology and segmentation methods for processing of a series of the images. In particular, a novel sorted pixel intensity approach to segment the artery into the lumen/plaque regions has been used, and effectively combined with the Gaussian mixture modeling to increase the accuracy of the segmentation. RESULTS Our numerical results are compared with those obtained manually by two experts. Statistics relevant to the progression of atherosclerosis have also been suggested. Results of the semiautomatic tracking of the femoral and iliac arteries and of the quantitative evaluation of atherosclerotic alterations therein have been shown to correspond well with the expert's results. CONCLUSION The developed system is likely to be valuable tool for supporting the quantitative evaluation of atherosclerotic changes in arteries. SIGNIFICANCE In its present form the system can be used for planning surgical treatment and/or predicting the course of the atherosclerotic alterations.
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86
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Mannelli L, MacDonald L, Mancini M, Ferguson M, Shuman WP, Ragucci M, Monti S, Xu D, Yuan C, Mitsumori LM. Dual energy computed tomography quantification of carotid plaques calcification: comparison between monochromatic and polychromatic energies with pathology correlation. Eur Radiol 2014; 25:1238-46. [PMID: 25537980 DOI: 10.1007/s00330-014-3523-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/30/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We compared carotid plaque calcification detection sensitivity and apparent cross-sectional area on CT as a function of CT beam energy using conventional CT techniques and virtual mono-energetic CT images generated from dual-energy acquisitions. METHODS & MATERIALS Five ex-vivo carotid endarterectomy (CEA) specimens were imaged with dual-energy computed tomography. Virtual monochromatic spectrum (VMS) CT images were reconstructed at energies between 40-140 keV. The same specimens were imaged using conventional polyenergetic spectrum (PS) CT with peak beam energies 80, 100, 120, and 140 kVp. The histological calcium areas on each corresponding CEA specimen were traced manually on digitized images of Toluidine-Blue/Basic-Fuchsin stained plastic sections. RESULTS 40 keV VMS CT images provided high detection sensitivity (97 %) similar to conventional PS CT images (~96 %). The calcification size measured on CT decreased systematically with increasing CT beam energy; the rate of change was larger for the VMS images than for PS images. CONCLUSION From a single dual-energy CT, multiple VMS-CT images can be generated, yielding equivalent detection sensitivity and size correlations as conventional PS-CT in CEA calcification imaging. VMS-CT at 80-100 keV provided the most accurate estimates of calcification size, as compared to histology, but detection sensitivity was reduced for smaller calcifications on these images. KEY POINTS • Calcifications depicted at 80-100 keV were most similar to the histology standard. • Conventional polychromatic images demonstrated excellent correlation with plaque size at pathology. • Conventional polychromatic images systematically overestimate plaque size. • Plaque calcifications can be missed on high energy monochromatic images.
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Affiliation(s)
- Lorenzo Mannelli
- Departments of Radiology, University of Washington, Seattle, WA, USA,
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87
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Sun J, Zhao XQ, Balu N, Hippe DS, Hatsukami TS, Isquith DA, Yamada K, Neradilek MB, Cantón G, Xue Y, Fleg JL, Desvigne-Nickens P, Klimas MT, Padley RJ, Vassileva MT, Wyman BT, Yuan C. Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study. Int J Cardiovasc Imaging 2014; 31:95-103. [PMID: 25216871 DOI: 10.1007/s10554-014-0532-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98-0.99) and compositional (ICC range 0.88-0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5-4.9 % for morphology, 36-44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican St Brotman 127, Seattle, WA, 98109, USA,
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Chen H, Sun J, Kerwin WS, Balu N, Neradilek MB, Hippe DS, Isquith D, Xue Y, Yamada K, Peck S, Yuan C, O’Brien KD, Zhao XQ. Scan-rescan reproducibility of quantitative assessment of inflammatory carotid atherosclerotic plaque using dynamic contrast-enhanced 3T CMR in a multi-center study. J Cardiovasc Magn Reson 2014; 16:51. [PMID: 25084698 PMCID: PMC4237824 DOI: 10.1186/s12968-014-0051-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/30/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study is to investigate the inter-scan reproducibility of kinetic parameters in atherosclerotic plaque using dynamic contrast-enhanced (DCE) cardiovascular magnetic resonance (CMR) in a multi-center setting at 3T. METHODS Carotid arteries of 51 subjects from 15 sites were scanned twice within two weeks on 3T scanners using a previously described DCE-CMR protocol. Imaging data with protocol compliance and sufficient image quality were analyzed to generate kinetic parameters of vessel wall, expressed as transfer constant (K trans ) and plasma volume (v p ). The inter-scan reproducibility was evaluated using intra-class correlation coefficient (ICC) and coefficient of variation (CV). Power analysis was carried out to provide sample size estimations for future prospective study. RESULTS Ten (19.6%) subjects were found to suffer from protocol violation, and another 6 (11.8%) had poor image quality (n=6) in at least one scan. In the 35 (68.6%) subjects with complete data, the ICCs of K trans and v p were 0.65 and 0.28, respectively. The CVs were 25% and 62%, respectively. The ICC and CV for v p improved to 0.73 and 28% in larger lesions with analyzed area larger than 25 mm2. Power analysis based on the measured CV showed that 50 subjects per arm are sufficient to detect a 20% difference in change of K trans over time between treatment arms with 80% power without consideration of the dropout rate. CONCLUSION The result of this study indicates that quantitative measurement from DCE-CMR is feasible to detect changes with a relatively modest sample size in a prospective multi-center study despite the limitations. The relative high dropout rate suggested the critical needs for intensive operator training, optimized imaging protocol, and strict quality control in future studies.
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Affiliation(s)
- Huijun Chen
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Beijing 100084, China
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Jie Sun
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - William S Kerwin
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Moni B Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle 98112, WA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Daniel Isquith
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
| | - Yunjing Xue
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Suzanne Peck
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
| | - Chun Yuan
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Beijing 100084, China
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Kevin D O’Brien
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
| | - Xue-Qiao Zhao
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
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Du R, Cai J, Zhao XQ, Wang QJ, Liu DQ, Leng WX, Gao P, Wu HM, Ma L, Ye P. Early decrease in carotid plaque lipid content as assessed by magnetic resonance imaging during treatment of rosuvastatin. BMC Cardiovasc Disord 2014; 14:83. [PMID: 25022285 PMCID: PMC4107586 DOI: 10.1186/1471-2261-14-83] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 06/26/2014] [Indexed: 12/05/2022] Open
Abstract
Background Statin therapy has shown to deplete atherosclerotic plaque lipid content and induce plaque regression. However, how early the plaque lipid depletion can occur with low-density lipoprotein cholesterol (LDL-C) lowering in humans in vivo has not been fully described. Methods We enrolled 43 lipid treatment naïve subjects with asymptomatic carotid atherosclerosis and LDL-C ≥ 100 and ≤ 250 mg/dl. Rosuvastatin 5–20 mg/day was used to lower LDL-C levels to < 80 mg/dl. Lipid profile and carotid MRI scans were obtained at baseline, 3, 12, and 24 months. Carotid plaque lipid-rich necrotic core (LRNC) and plaque burden were measured and compared between baseline and during treatment. Results Among the 32 subjects who completed the study, at 3 months, an average dose of rosuvastatin of 11 mg/day lowered LDL-C levels by 47% (125.2 ± 24.4 mg/dl vs. 66.7 ± 17.3 mg/dl, p < 0.001). There were no statistically significant changes in total wall volume, percent wall volume or lumen volume. However, LRNC volume was significantly decreased by 7.9 mm3, a reduction of 7.3% (111.5 ± 104.2 mm3 vs. 103.6 ± 95.8 mm3, p = 0.044). Similarly, % LRNC was also significantly decreased from 18.9 ± 11.9% to 17.9 ± 11.5% (p = 0.02) at 3 months. Both LRNC volume and % LRNC continued to decrease moderately at 12 and 24 months, although this trend was not significant. Conclusions Among a small number of lipid treatment naïve subjects, rosuvastatin therapy may induce a rapid and lasting decrease in carotid plaque lipid content as assessed by MRI. Trial registration ClinicalTrials.Gov numbers NCT00885872
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lin Ma
- Department of Geriatric Cardiology, Chinese PLA General Hospital, No, 28, Fuxing Road, Beijing 100853, China.
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Wu T, Wang J, Song Y, Deng X, Li A, Wei J, He L, Zhao X, Li R, Zhou Z, Wu W, Huang J, Jiao S, Yuan C, Chen H. Homologous HOmologous Black-Bright-blood and flexible Interleaved imaging sequence (HOBBI) for dynamic contrast-enhanced MRI of the vessel wall. Magn Reson Med 2014; 73:1754-63. [PMID: 24805922 DOI: 10.1002/mrm.25287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/27/2014] [Accepted: 04/16/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE To present a HOmologous Black-Bright-blood and flexible Interleaved imaging (HOBBI) sequence for dynamic contrast-enhanced magnetic resonance imaging (MRI) of the vessel wall. THEORY AND METHODS A HOBBI sequence is proposed to acquire high-spatial-resolution black-blood and high-temporal-resolution bright-blood dynamic contrast-enhanced images in an interleaved fashion. Black-blood imaging allows for thin vessel wall evaluation, whereas bright-blood imaging obtains the arterial input function accurately. A simulation was performed to assess the accuracy of the pharmacokinetic parameters [transfer constant (K(trans) ) and fractional plasma volume (vp )] generated from HOBBI. In vivo evaluation was also used to validate HOBBI in an animal model of aortic atherosclerosis. RESULTS In the simulation test, the estimated K(trans) and vp measured by HOBBI were more accurate than those from black-blood dynamic contrast-enhanced-MRI. In the animal model testing, K(trans) and vp also demonstrated good interscan reproducibility (K(trans) : ICC = 0.77, vp : ICC = 0.72, respectively). Additionally, K(trans) showed a significant increase from 1 month (0.026 ± 0.013 min(-1) ) to 2 months (0.069 ± 0.018 min(-1) ) in animal model plaque progression after balloon injury. CONCLUSION The proposed HOBBI sequence was demonstrated to be feasible and accurate in estimating the pharmacokinetic parameters of the atherosclerotic vessel wall, and has potential to become an early screening tool for atherosclerosis disease.
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Affiliation(s)
- Tingting Wu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Zavodni AEH, Wasserman BA, McClelland RL, Gomes AS, Folsom AR, Polak JF, Lima JAC, Bluemke DA. Carotid artery plaque morphology and composition in relation to incident cardiovascular events: the Multi-Ethnic Study of Atherosclerosis (MESA). Radiology 2014; 271:381-9. [PMID: 24592924 PMCID: PMC4263652 DOI: 10.1148/radiol.14131020] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine if carotid plaque morphology and composition with magnetic resonance (MR) imaging can be used to identify asymptomatic subjects at risk for cardiovascular events. MATERIALS AND METHODS Institutional review boards at each site approved the study, and all sites were Health Insurance Portability and Accountability Act (HIPAA) compliant. A total of 946 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) were evaluated with MR imaging and ultrasonography (US). MR imaging was used to define carotid plaque composition and remodeling index (wall area divided by the sum of wall area and lumen area), while US was used to assess carotid wall thickness. Incident cardiovascular events, including myocardial infarction, resuscitated cardiac arrest, angina, stroke, and death, were ascertained for an average of 5.5 years. Multivariable Cox proportional hazards models, C statistics, and net reclassification improvement (NRI) for event prediction were determined. RESULTS Cardiovascular events occurred in 59 (6%) of participants. Carotid IMT as well as MR imaging remodeling index, lipid core, and calcium in the internal carotid artery were significant predictors of events in univariate analysis (P < .001 for all). For traditional risk factors, the C statistic for event prediction was 0.696. For MR imaging remodeling index and lipid core, the C statistic was 0.734 and the NRI was 7.4% and 15.8% for participants with and those without cardiovascular events, respectively (P = .02). The NRI for US IMT in addition to traditional risk factors was not significant. CONCLUSION The identification of vulnerable plaque characteristics with MR imaging aids in cardiovascular disease prediction and improves the reclassification of baseline cardiovascular risk.
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Affiliation(s)
- Anna E. H. Zavodni
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
| | - Bruce A. Wasserman
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
| | - Robyn L. McClelland
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
| | - Antoinette S. Gomes
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
| | - Aaron R. Folsom
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
| | - Joseph F. Polak
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
| | - João A. C. Lima
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
| | - David A. Bluemke
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California–Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.)
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92
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van Engelen A, Niessen WJ, Klein S, Groen HC, Verhagen HJM, Wentzel JJ, van der Lugt A, de Bruijne M. Atherosclerotic plaque component segmentation in combined carotid MRI and CTA data incorporating class label uncertainty. PLoS One 2014; 9:e94840. [PMID: 24762678 PMCID: PMC3999092 DOI: 10.1371/journal.pone.0094840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/19/2014] [Indexed: 11/22/2022] Open
Abstract
Atherosclerotic plaque composition can indicate plaque vulnerability. We segment atherosclerotic plaque components from the carotid artery on a combination of in vivo MRI and CT-angiography (CTA) data using supervised voxelwise classification. In contrast to previous studies the ground truth for training is directly obtained from 3D registration with histology for fibrous and lipid-rich necrotic tissue, and with μCT for calcification. This registration does, however, not provide accurate voxelwise correspondence. We therefore evaluate three approaches that incorporate uncertainty in the ground truth used for training: I) soft labels are created by Gaussian blurring of the original binary histology segmentations to reduce weights at the boundaries between components, and are weighted by the estimated registration accuracy of the histology and in vivo imaging data (measured by overlap), II) samples are weighted by the local contour distance of the lumen and outer wall between histology and in vivo data, and III) 10% of each class is rejected by Gaussian outlier rejection. Classification was evaluated on the relative volumes (% of tissue type in the vessel wall) for calcified, fibrous and lipid-rich necrotic tissue, using linear discriminant (LDC) and support vector machine (SVM) classification. In addition, the combination of MRI and CTA data was compared to using only one imaging modality. Best results were obtained by LDC and outlier rejection: the volume error per vessel was 0.9±1.0% for calcification, 12.7±7.6% for fibrous and 12.1±8.1% for necrotic tissue, with Spearman rank correlation coefficients of 0.91 (calcification), 0.80 (fibrous) and 0.81 (necrotic). While segmentation using only MRI features yielded low accuracy for calcification, and segmentation using only CTA features yielded low accuracy for necrotic tissue, the combination of features from MRI and CTA gave good results for all studied components.
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Affiliation(s)
- Arna van Engelen
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Wiro J. Niessen
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Harald C. Groen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Jolanda J. Wentzel
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
| | | | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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93
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Jiang L, Chen H, Li R, Han X, Chen Z, He L, Yuan C, Zhao X. Associations of arterial distensibility between carotid arteries and abdominal aorta by MR. J Magn Reson Imaging 2014; 41:1138-42. [DOI: 10.1002/jmri.24631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/13/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Li Jiang
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
| | - Huijun Chen
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
| | - Rui Li
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
| | - Xu Han
- Department of Radiology; PLA General Hospital; Beijing China
| | - Zhensen Chen
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
| | - Le He
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
| | - Chun Yuan
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
- Department of Radiology; University of Washington; Seattle USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
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94
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Wan T, Madabhushi A, Phinikaridou A, Hamilton JA, Hua N, Pham T, Danagoulian J, Kleiman R, Buckler AJ. Spatio-temporal texture (SpTeT) for distinguishing vulnerable from stable atherosclerotic plaque on dynamic contrast enhancement (DCE) MRI in a rabbit model. Med Phys 2014; 41:042303. [PMID: 24694153 PMCID: PMC3987744 DOI: 10.1118/1.4867861] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To develop a new spatio-temporal texture (SpTeT) based method for distinguishing vulnerable versus stable atherosclerotic plaques on DCE-MRI using a rabbit model of atherothrombosis. METHODS Aortic atherosclerosis was induced in 20 New Zealand White rabbits by cholesterol diet and endothelial denudation. MRI was performed before (pretrigger) and after (posttrigger) inducing plaque disruption with Russell's-viper-venom and histamine. Of the 30 vascular targets (segments) under histology analysis, 16 contained thrombus (vulnerable) and 14 did not (stable). A total of 352 voxel-wise computerized SpTeT features, including 192 Gabor, 36 Kirsch, 12 Sobel, 52 Haralick, and 60 first-order textural features, were extracted on DCE-MRI to capture subtle texture changes in the plaques over the course of contrast uptake. Different combinations of SpTeT feature sets, in which the features were ranked by a minimum-redundancy-maximum-relevance feature selection technique, were evaluated via a random forest classifier. A 500 iterative 2-fold cross validation was performed for discriminating the vulnerable atherosclerotic plaque and stable atherosclerotic plaque on per voxel basis. Four quantitative metrics were utilized to measure the classification results in separating between vulnerable and stable plaques. RESULTS The quantitative results show that the combination of five classes of SpTeT features can distinguish between vulnerable (disrupted plaques with an overlying thrombus) and stable plaques with the best AUC values of 0.9631 ± 0.0088, accuracy of 89.98% ± 0.57%, sensitivity of 83.71% ± 1.71%, and specificity of 94.55% ± 0.48%. CONCLUSIONS Vulnerable and stable plaque can be distinguished by SpTeT based features. The SpTeT features, following validation on larger datasets, could be established as effective and reliable imaging biomarkers for noninvasively assessing atherosclerotic risk.
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Affiliation(s)
- Tao Wan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
| | - Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, United Kingdom
| | - James A Hamilton
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Ning Hua
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Tuan Pham
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts 02215
| | | | - Ross Kleiman
- Elucid Bioimaging Inc., Wenham, Massachusetts 01984
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95
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Xu D, Hippe DS, Underhill HR, Oikawa-Wakayama M, Dong L, Yamada K, Yuan C, Hatsukami TS. Prediction of high-risk plaque development and plaque progression with the carotid atherosclerosis score. JACC Cardiovasc Imaging 2014; 7:366-73. [PMID: 24631510 DOI: 10.1016/j.jcmg.2013.09.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/13/2013] [Accepted: 09/19/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The goal of this prospective study was to evaluate the carotid atherosclerosis score (CAS) for predicting the development of high-risk plaque features and plaque burden progression. BACKGROUND Previous studies have shown that carotid intraplaque hemorrhage (IPH) and a disrupted luminal surface (DLS), as identified by using magnetic resonance imaging, are associated with greater risk for cerebrovascular events. On the basis of data from a large cross-sectional study, a scoring system was developed to determine which plaque features are associated with the presence of IPH and DLS. However, the predictive value of CAS has not been previously tested in a prospective, longitudinal study. METHODS A total of 120 asymptomatic subjects with 50% to 79% carotid stenosis underwent carotid magnetic resonance imaging scans at baseline and 3 years thereafter. Presence of IPH and DLS, wall volume, maximum wall thickness, and maximum percent lipid-rich necrotic core area were measured at both time-points. Baseline CAS values were calculated on the basis of previously published criteria. RESULTS Of the 73 subjects without IPH or DLS at baseline, 9 (12%) developed 1 or both of these features during follow-up. There was a significant increasing trend between CAS and the development of new DLS (p < 0.001) and with plaque burden progression (p = 0.03) but not with the development of new IPH (p = 0.3). Percent carotid stenosis was not significantly associated with new DLS (p = 0.2), new IPH (p = 0.1), or plaque progression (p = 0.6). CONCLUSIONS CAS was found to have a significant increasing relationship with incident DLS and plaque progression in this prospective study. CAS can potentially provide improved risk stratification beyond luminal stenosis.
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Affiliation(s)
- Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington
| | - Hunter R Underhill
- Departments of Neurological Surgery and Medicine, University of Washington, Seattle, Washington
| | | | - Li Dong
- Department of Radiology, Anzhen Hospital, Beijing, China
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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96
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The carotid plaque imaging in acute stroke (CAPIAS) study: protocol and initial baseline data. BMC Neurol 2013; 13:201. [PMID: 24330333 PMCID: PMC3878777 DOI: 10.1186/1471-2377-13-201] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 12/09/2013] [Indexed: 01/24/2023] Open
Abstract
Background In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke. Methods/Design 300 patients (age >49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (<70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI plaques in cryptogenic stroke patients ipsilateral to the ischemic stroke compared to the contralateral side and to patients with defined stroke etiology. Secondary outcomes include the association of AHA-LT VI plaques with the recurrence rates of ischemic events up to 36 months, rates of new ischemic lesions on cerebral MRI (including clinically silent lesions) after 12 months and the influence of specific AHA-LT VI plaque features on the progression of atherosclerotic disease burden, on specific infarct patterns, biomarkers and aortic arch plaques. Discussion CAPIAS will provide important insights into the role of non-stenosing carotid artery plaques in cryptogenic stroke. The results might have implications for our understanding of stroke mechanism, offer new diagnostic options and provide the basis for the planning of targeted interventional studies. Trial Registration NCT01284933
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97
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Chiu B, Chen Y, Canton G, Kerwin WS. Relationships between local geometrical features and hemodynamic flow properties. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:723-6. [PMID: 24109789 DOI: 10.1109/embc.2013.6609602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke is among the leading causes of death and disability worldwide. Most strokes are ischemic, mostly caused by the blockage of a cerebral artery by a thrombotic embolus. Carotid atherosclerosis and the subsequent plaque rupture can be a major source of these emboli. It is well known that blood flow affects where atherosclerotic plaque will arise. In particular, vascular wall shear stress (WSS) has been linked to the initiation and progression of carotid plaque. However, it is difficult to measure WSS in vivo and it is time-consuming to compute WSS using computational fluid dynamics packages. The goals of this paper are (i) to identify a set of local geometric parameters that are correlated with WSS and (ii) to develop a regression model to predict WSS from the geometric parameters. We validated our regression model using the root mean squared error (RMSE), adjusted R(2) and Akaike information criterion (AIC). The experimental study involved six carotid arteries with the internal and external carotid arteries (ICA and ECA respectively) analyzed separately. The adjusted R(2)s for 9 of the 12 branches were higher than 0.8. Since the proposed local geometric parameters can be obtained efficiently, these parameters can potentially be used as carotid disease phenotypes that will allow for a much more cost-effective method to identify subjects with elevated stroke risk.
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98
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Canton G, Chiu B, Chen H, Chen Y, Hatsukami TS, Kerwin WS, Yuan C. A framework for the co-registration of hemodynamic forces and atherosclerotic plaque components. Physiol Meas 2013; 34:977-90. [PMID: 23945133 DOI: 10.1088/0967-3334/34/9/977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Local hemodynamic forces, such as wall shear stress (WSS), are thought to trigger cellular and molecular mechanisms that determine atherosclerotic plaque vulnerability to rupture. Magnetic resonance imaging has emerged as a powerful tool to characterize human carotid atherosclerotic plaque composition and morphology, and to identify plaque features shown to be key determinants of plaque vulnerability. Image-based computational fluid dynamics has allowed researchers to obtain time-resolved WSS information of atherosclerotic carotid arteries. A deeper understanding of the mechanisms of initiation and progression of atherosclerosis can be obtained through the comparison of WSS and plaque composition and morphology. To date, however, advance in knowledge has been limited greatly due to the lack of a reliable infrastructure to perform such analysis. The aim of this study is to establish a framework that will allow for the co-registration and analysis of the three-dimensional distribution of WSS and plaque components and morphology. The use of this framework will lead to future studies targeted to determining the role of WSS in atherosclerotic plaque progression and vulnerability.
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Affiliation(s)
- Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
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99
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Sun J, Balu N, Hippe DS, Xue Y, Dong L, Zhao X, Li F, Xu D, Hatsukami TS, Yuan C. Subclinical Carotid Atherosclerosis: Short-term Natural History of Lipid-rich Necrotic Core—A Multicenter Study with MR Imaging. Radiology 2013; 268:61-8. [DOI: 10.1148/radiol.13121702] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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100
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ZHAO QIAN, WU XINHUAI, CAI JIANMING, ZHAO XIHAI, ZHAO SHAOHONG, YANG LI, CAI ZULONG. Association between coronary artery calcium score and carotid atherosclerotic disease. Mol Med Rep 2013; 8:499-504. [DOI: 10.3892/mmr.2013.1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/22/2013] [Indexed: 11/06/2022] Open
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