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Cardiovascular PET/MRI: Initial Clinical Experience. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Korte CL, Fekkes S, Nederveen AJ, Manniesing R, Hansen HRHG. Review: Mechanical Characterization of Carotid Arteries and Atherosclerotic Plaques. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2016; 63:1613-1623. [PMID: 27249826 DOI: 10.1109/tuffc.2016.2572260] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of death and is in the majority of cases due to the formation of atherosclerotic plaques in arteries. Initially, thickening of the inner layer of the arterial wall occurs. Continuation of this process leads to plaque formation. The risk of a plaque to rupture and thus to induce an ischemic event is directly related to its composition. Consequently, characterization of the plaque composition and its proneness to rupture are of crucial importance for risk assessment and treatment strategies. The carotid is an excellent artery to be imaged with ultrasound because of its superficial position. In this review, ultrasound-based methods for characterizing the mechanical properties of the carotid wall and atherosclerotic plaque are discussed. Using conventional echography, the intima media thickness (IMT) can be quantified. There is a wealth of studies describing the relation between IMT and the risk for myocardial infarction and stroke. Also the carotid distensibility can be quantified with ultrasound, providing a surrogate marker for the cross-sectional mechanical properties. Although all these parameters are associated with CVD, they do not easily translate to individual patient risk. Another technique is pulse wave velocity (PWV) assessment, which measures the propagation of the pressure pulse over the arterial bed. PWV has proven to be a marker for global arterial stiffness. Recently, an ultrasound-based method to estimate the local PWV has been introduced, but the clinical effectiveness still needs to be established. Other techniques focus on characterization of plaques. With ultrasound elastography, the strain in the plaque due to the pulsatile pressure can be quantified. This technique was initially developed using intravascular catheters to image coronaries, but recently noninvasive methods were successfully developed. A high correlation between the measured strain and the risk for rupture was established. Acoustic radiation force impulse (ARFI) imaging also provides characterization of local plaque components based on mechanical properties. However, both elastography and ARFI provide an indirect measure of the elastic modulus of tissue. With shear wave imaging, the elastic modulus can be quantified, although the carotid artery is one of the most challenging tissues for this technique due to its size and geometry. Prospective studies still have to establish the predictive value of these techniques for the individual patient. Validation of ultrasound-based mechanical characterization of arteries and plaques remains challenging. Magnetic resonance imaging is often used as the "gold" standard for plaque characterization, but its limited resolution renders only global characterization of the plaque. CT provides information on the vascular tree, the degree of stenosis, and the presence of calcified plaque, while soft plaque characterization remains limited. Histology still is the gold standard, but is available only if tissue is excised. In conclusion, elastographic ultrasound techniques are well suited to characterize the different stages of vascular disease.
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Ehara S, Matsumoto K, Shimada K. The Clinical Value of High-Intensity Signals on the Coronary Atherosclerotic Plaques: Noncontrast T1-Weighted Magnetic Resonance Imaging. Int J Mol Sci 2016; 17:ijms17071187. [PMID: 27455243 PMCID: PMC4964556 DOI: 10.3390/ijms17071187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/02/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022] Open
Abstract
Over the past several decades, significant progress has been made in the pathohistological assessment of vulnerable plaques and in invasive intravascular imaging techniques. However, the assessment of plaque morphology by invasive modalities is of limited value for the detection of subclinical coronary atherosclerosis and the subsequent prediction or prevention of acute cardiovascular events. Recently, magnetic resonance (MR) imaging technology has reached a sufficient level of spatial resolution, which allowed the plaque visualization of large and static arteries such as the carotids and aorta. However, coronary wall imaging by MR is still challenging due to the small size of coronary arteries, cardiac and respiratory motion, and the low contrast-to-noise ratio between the coronary artery wall and the surrounding structures. Following the introduction of carotid plaque imaging with noncontrast T1-weighted imaging (T1WI), some investigators have reported that coronary artery high-intensity signals on T1WI are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although there are several limitations and issues that need to be resolved, this novel MR technique for coronary plaque imaging could influence treatment strategies for atherothrombotic disease and may be useful for understanding the pathophysiological mechanisms of atherothrombotic plaque formation.
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Affiliation(s)
- Shoichi Ehara
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
| | - Kenji Matsumoto
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
| | - Kenei Shimada
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
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Lau JMC, Zheng J. Disease-specific cardiovascular positron emission tomography/magnetic resonance imaging: a brief review of the current literature. Quant Imaging Med Surg 2016; 6:297-307. [PMID: 27429913 DOI: 10.21037/qims.2016.06.07] [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: 01/29/2023]
Abstract
The hybrid positron emission tomography/magnetic resonance (PET/MR) is a new imaging tool that has garnered immense research interest for its potentials to assist clinical investigations. PET/MR combines the quantitative measurement of PET with dynamic functional and anatomic assessment of MR and can deliver a robust clinical examination. Currently, simultaneous cardiovascular PET/MR imaging remains in the pre-clinical research stage, and most institutions have not adopted a clinical PET/MR clinical imaging service. Nevertheless, PET/MR examination has unique promises in several areas of cardiovascular medicine, and in recent years more and more research publications have become available to lend us insight into its utility in cardiovascular imaging. Here we review the existing literature on simultaneous cardiovascular PET/MR imaging, with an emphasis on organizing the current literature into disease-specific discussions. These areas include coronary artery disease (CAD), carotid atherosclerosis, various infiltrative, inflammatory and hereditary heart diseases, myocarditis, vasculitis, and cardiac mass assessment. The purpose of this review is to provide an overview of the current understanding of cardiovascular PET/MR clinical imaging, in a disease-specific manner, from a clinician's perspective. Potential limitations of simultaneous PET/MR, such as cost effectiveness, artifacts, contraindications, and radiation exposure, are briefly discussed.
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Affiliation(s)
- Jeffrey M C Lau
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Jie Zheng
- Department of Radiology, Washington University in St. Louis, MO 63108, USA
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Yoneyama M, Nakamura M, Obara M, Okuaki T, Sashi R, Sawano S, Tatsuno S, Van Cauteren M. Hyperecho PROPELLER-MRI: Application to rapid high-resolution motion-insensitiveT2-weighted black-blood imaging of the carotid arterial vessel wall and plaque. J Magn Reson Imaging 2016; 45:515-524. [DOI: 10.1002/jmri.25377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 06/21/2016] [Indexed: 11/06/2022] Open
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Selwaness M, Bos D, van den Bouwhuijsen Q, Portegies ML, Ikram MA, Hofman A, Franco OH, van der Lugt A, Wentzel JJ, Vernooij MW. Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease. Stroke 2016; 47:1542-7. [DOI: 10.1161/strokeaha.116.012923] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mariana Selwaness
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Daniel Bos
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Quirijn van den Bouwhuijsen
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Marileen L.P. Portegies
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - M. Arfan Ikram
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Albert Hofman
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Oscar H. Franco
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Jolanda J. Wentzel
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Meike W. Vernooij
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
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Skagen K, Evensen K, Scott H, Krohg-Sørensen K, Vatnehol SA, Hol PK, Skjelland M, Russell D. Semiautomated Magnetic Resonance Imaging Assessment of Carotid Plaque Lipid Content. J Stroke Cerebrovasc Dis 2016; 25:2004-10. [PMID: 27234919 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.043] [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] [Received: 08/28/2015] [Revised: 12/16/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The composition of a carotid plaque is important for plaque vulnerability and stroke risk. The main aim of this study was to assess the potential of semiautomated segmentation of carotid plaque magnetic resonance imaging (MRI) in the assessment of the size of the lipid-rich necrotic core (LRNC). METHODS Thirty-four consecutive patients with carotid stenosis of 70% or higher, who were scheduled for carotid endarterectomy, underwent a clinical neurological examination, Color duplex ultrasound, 3-T MRI with an 8-channel carotid coil, and blood tests. All examinations were performed less than 24 hours prior to surgery and plaques were assessed histologically immediately following endarterectomy. Plaques were defined as symptomatic when associated with ipsilateral cerebral ischemic symptoms within 30 days prior to inclusion. The level of agreement between the size of the LRNC and calcification on MRI to the histological estimation of the same tissue components, plaque echolucency on ultrasound, and symptoms was assessed. RESULTS The size of the LRNC on MRI was significantly correlated to the percentage amount of lipid per plaque on histological assessment (P = .010, r = .5), and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques (P = .001, r = -.7). CONCLUSIONS In this study, we found that semiautomated MRI assessments of the percentage LRNC in carotid plaques were significantly correlated to the percentage LRNC per plaque on histological assessment, and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques.
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Affiliation(s)
- Karolina Skagen
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kristin Evensen
- Department of Neurology, Oslo University Hospital, Norway; Vestre Viken, Drammen Hospital, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital, Norway
| | | | | | - Per Kristian Hol
- Institute of Clinical Medicine, University of Oslo, Norway; The Intervention Centre, Oslo University Hospital, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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58
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Harteveld AA, Denswil NP, Siero JCW, Zwanenburg JJM, Vink A, Pouran B, Spliet WGM, Klomp DWJ, Luijten PR, Daemen MJ, Hendrikse J, van der Kolk AG. Quantitative Intracranial Atherosclerotic Plaque Characterization at 7T MRI: An Ex Vivo Study with Histologic Validation. AJNR Am J Neuroradiol 2016; 37:802-10. [PMID: 26705320 DOI: 10.3174/ajnr.a4628] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/27/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE In recent years, several high-resolution vessel wall MR imaging techniques have emerged for the characterization of intracranial atherosclerotic vessel wall lesions in vivo. However, a thorough validation of MR imaging results of intracranial plaques with histopathology is still lacking. The aim of this study was to characterize atherosclerotic plaque components in a quantitative manner by obtaining the MR signal characteristics (T1, T2, T2*, and proton density) at 7T in ex vivo circle of Willis specimens and using histopathology for validation. MATERIALS AND METHODS A multiparametric ultra-high-resolution quantitative MR imaging protocol was performed at 7T to identify the MR signal characteristics of different intracranial atherosclerotic plaque components, and using histopathology for validation. In total, 38 advanced plaques were matched between MR imaging and histology, and ROI analysis was performed on the identified tissue components. RESULTS Mean T1, T2, and T2* relaxation times and proton density values were significantly different between different tissue components. The quantitative T1 map showed the most differences among individual tissue components of intracranial plaques with significant differences in T1 values between lipid accumulation (T1 = 838 ± 167 ms), fibrous tissue (T1 = 583 ± 161 ms), fibrous cap (T1 = 481 ± 98 ms), calcifications (T1 = 314 ± 39 ms), and the intracranial arterial vessel wall (T1 = 436 ± 122 ms). CONCLUSIONS Different tissue components of advanced intracranial plaques have distinguishable imaging characteristics with ultra-high-resolution quantitative MR imaging at 7T. Based on this study, the most promising method for distinguishing intracranial plaque components is T1-weighted imaging.
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Affiliation(s)
- A A Harteveld
- From the Departments of Radiology (A.A.H., J.C.W.S., J.J.M.Z., D.W.J.K., P.R.L., J.H., A.G.v.d.K.)
| | - N P Denswil
- Department of Pathology (N.P.D., M.J.D.), Academic Medical Center, Amsterdam, the Netherlands
| | - J C W Siero
- From the Departments of Radiology (A.A.H., J.C.W.S., J.J.M.Z., D.W.J.K., P.R.L., J.H., A.G.v.d.K.)
| | - J J M Zwanenburg
- From the Departments of Radiology (A.A.H., J.C.W.S., J.J.M.Z., D.W.J.K., P.R.L., J.H., A.G.v.d.K.) Image Sciences Institute (J.J.M.Z.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Vink
- Pathology (A.V., W.G.M.S.)
| | - B Pouran
- Orthopedics (B.P.) Rheumatology (B.P.) Department of Biomedical Engineering (B.P.), Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, the Netherlands
| | | | - D W J Klomp
- From the Departments of Radiology (A.A.H., J.C.W.S., J.J.M.Z., D.W.J.K., P.R.L., J.H., A.G.v.d.K.)
| | - P R Luijten
- From the Departments of Radiology (A.A.H., J.C.W.S., J.J.M.Z., D.W.J.K., P.R.L., J.H., A.G.v.d.K.)
| | - M J Daemen
- Department of Pathology (N.P.D., M.J.D.), Academic Medical Center, Amsterdam, the Netherlands
| | - J Hendrikse
- From the Departments of Radiology (A.A.H., J.C.W.S., J.J.M.Z., D.W.J.K., P.R.L., J.H., A.G.v.d.K.)
| | - A G van der Kolk
- From the Departments of Radiology (A.A.H., J.C.W.S., J.J.M.Z., D.W.J.K., P.R.L., J.H., A.G.v.d.K.)
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Kurosaki Y, Yoshida K, Fukumitsu R, Sadamasa N, Handa A, Chin M, Yamagata S. Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity. J Neurosurg 2016; 124:736-42. [DOI: 10.3171/2015.2.jns142783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity.
METHODS
Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI< 1.40 and ERR ≥ 1.66; Group C = rSI ≥ 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group.
RESULTS
Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01).
CONCLUSIONS
In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, which should be validated by a prospective, randomized study of asymptomatic patients.
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Affiliation(s)
| | - Kazumichi Yoshida
- 2Department of Neurosurgery, Kyoto University School of Medicine, Kyoto, Japan
| | - Ryu Fukumitsu
- 2Department of Neurosurgery, Kyoto University School of Medicine, Kyoto, Japan
| | - Nobutake Sadamasa
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Akira Handa
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Masaki Chin
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Sen Yamagata
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
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Huang C, Pan X, He Q, Huang M, Huang L, Zhao X, Yuan C, Bai J, Luo J. Ultrasound-Based Carotid Elastography for Detection of Vulnerable Atherosclerotic Plaques Validated by Magnetic Resonance Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:365-377. [PMID: 26553205 DOI: 10.1016/j.ultrasmedbio.2015.09.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/27/2015] [Accepted: 09/23/2015] [Indexed: 06/05/2023]
Abstract
Ultrasound-based carotid elastography has been developed to estimate the mechanical properties of atherosclerotic plaques. The objective of this study was to evaluate the in vivo capability of carotid elastography in vulnerable plaque detection using high-resolution magnetic resonance imaging as reference. Ultrasound radiofrequency data of 46 carotid plaques from 29 patients (74 ± 5 y old) were acquired and inter-frame axial strain was estimated with an optical flow method. The maximum value of absolute strain rate for each plaque was derived as an indicator for plaque classification. Magnetic resonance imaging of carotid arteries was performed on the same patients to classify the plaques into stable and vulnerable groups for carotid elastography validation. The maximum value of absolute strain rate was found to be significantly higher in vulnerable plaques (2.15 ± 0.79 s(-1), n = 27) than in stable plaques (1.21 ± 0.37 s(-1), n = 19) (p < 0.0001). Receiver operating characteristic curve analysis was performed, and the area under the curve was 0.848. Therefore, the in vivo capability of carotid elastography to detect vulnerable plaques, validated by magnetic resonance imaging, was proven, revealing the potential of carotid elastography as an important tool in atherosclerosis assessment and stroke prevention.
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Affiliation(s)
- Chengwu Huang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Xiaochang Pan
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Qiong He
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Manwei Huang
- Department of Sonography, China Meitan General Hospital, Beijing, China
| | - Lingyun Huang
- Clinical Sites Research Program, Philips Research China, Shanghai, China
| | - Xihai Zhao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Center for Biomedical Imaging Research, Tsinghua University, Beijing, China.
| | - Chun Yuan
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Center for Biomedical Imaging Research, Tsinghua University, Beijing, China; Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jing Bai
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jianwen Luo
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Center for Biomedical Imaging Research, Tsinghua University, Beijing, China.
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Goel S, Miller A, Agarwal C, Zakin E, Acholonu M, Gidwani U, Sharma A, Kulbak G, Shani J, Chen O. Imaging Modalities to Identity Inflammation in an Atherosclerotic Plaque. Radiol Res Pract 2015; 2015:410967. [PMID: 26798515 PMCID: PMC4699110 DOI: 10.1155/2015/410967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022] Open
Abstract
Atherosclerosis is a chronic, progressive, multifocal arterial wall disease caused by local and systemic inflammation responsible for major cardiovascular complications such as myocardial infarction and stroke. With the recent understanding that vulnerable plaque erosion and rupture, with subsequent thrombosis, rather than luminal stenosis, is the underlying cause of acute ischemic events, there has been a shift of focus to understand the mechanisms that make an atherosclerotic plaque unstable or vulnerable to rupture. The presence of inflammation in the atherosclerotic plaque has been considered as one of the initial events which convert a stable plaque into an unstable and vulnerable plaque. This paper systemically reviews the noninvasive and invasive imaging modalities that are currently available to detect this inflammatory process, at least in the intermediate stages, and discusses the ongoing studies that will help us to better understand and identify it at the molecular level.
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Affiliation(s)
- Sunny Goel
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Avraham Miller
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Chirag Agarwal
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Elina Zakin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Acholonu
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Umesh Gidwani
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY 11203, USA
| | - Guy Kulbak
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - On Chen
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Doherty JR, Dahl JJ, Kranz PG, El Husseini N, Chang HC, Chen NK, Allen JD, Ham KL, Trahey GE. Comparison of Acoustic Radiation Force Impulse Imaging Derived Carotid Plaque Stiffness With Spatially Registered MRI Determined Composition. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:2354-65. [PMID: 25974933 PMCID: PMC4678151 DOI: 10.1109/tmi.2015.2432797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Measurements of plaque stiffness may provide important prognostic and diagnostic information to help clinicians distinguish vulnerable plaques containing soft lipid pools from more stable, stiffer plaques. In this preliminary study, we compare in vivo ultrasonic Acoustic Radiation Force Impulse (ARFI) imaging derived measures of carotid plaque stiffness with composition determined by spatially registered Magnetic Resonance Imaging (MRI) in five human subjects with stenosis > 50%. Ultrasound imaging was implemented on a commercial diagnostic scanner with custom pulse sequences to collect spatially registered 2D longitudinal B-mode and ARFI images. A standardized, multi-contrast weighted MRI sequence was used to obtain 3D Time of Flight (TOF), T1 weighted (T1W), T2 weighted (T2W), and Proton Density Weighted (PDW) transverse image stacks of volumetric data. The MRI data was segmented to identify lipid, calcium, and normal loose matrix components using commercially available software. 3D MRI segmented plaque models were rendered and spatially registered with 2D B-mode images to create fused ultrasound and MRI volumetric images for each subject. ARFI imaging displacements in regions of interest (ROIs) derived from MRI segmented contours of varying composition were compared. Regions of calcium and normal loose matrix components identified by MRI presented as homogeneously stiff regions of similarly low (typically ≈ 1 μm) displacement in ARFI imaging. MRI identified lipid pools > 2 mm(2), found in three out of five subjects, presented as softer regions of increased displacement that were on average 1.8 times greater than the displacements in adjacent regions of loose matrix components in spatially registered ARFI images. This work provides early evidence supporting the use of ARFI imaging to noninvasively identify lipid regions in carotid artery plaques in vivo that are believed to increase the propensity of a plaque to rupture. Additionally, the results provide early training data for future studies and aid in the interpretation and possible clinical utility of ARFI imaging for identifying the elusive vulnerable plaque.
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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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Li M, Le WJ, Tao XF, Li MH, Li YH, Qu N. Advantage in Bright-blood and Black-blood Magnetic Resonance Imaging with High-resolution for Analysis of Carotid Atherosclerotic Plaques. Chin Med J (Engl) 2015; 128:2478-84. [PMID: 26365966 PMCID: PMC4725549 DOI: 10.4103/0366-6999.164933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND About 50% of the cerebral ischemia events are induced by intracranial and extracranial atherosclerosis. This study aimed to evaluate the feasibility and accuracy for displaying atherosclerotic plaques in carotid arteries and analyzing their ingredients by using high-resolution new magnetic resonance imaging (MRI) techniques. METHODS Totally, 49 patients suspected of extracranial carotid artery stenosis were subjected to cranial MRI scan and magnetic resonance angiography (MRA) examination on carotid arteries, and high-resolution bright-blood and black-blood MRI analysis was carried out within 1 week. Digital subtraction angiography (DSA) examination was carried out for 16 patients within 1 month. RESULTS Totally, 103 plaques were detected in the 49 patients, which were characterized by localized or diffusive thickening of the vessel wall, with the intrusion of crescent-shaped abnormal signal into lumens. Fibrous cap was displayed as isointensity in T1-weighted image (T1WI) and hyperintensities in proton density weighted image (PDWI) and T2-weighted image (T2WI), lipid core was displayed as isointensity or slight hyperintensities in T1WI, isointensity, hyperintensities or hypointensity in PDWI, and hypointensity in T2WI. Calcification in plaques was detected in 11 patients. Eight patients were detected with irregular plaque surface or ulcerative plaques, which were characterized by irregular intravascular space surface in the black-blood sequences, black hypointensity band was not detected in three-dimensional time-of-flight, or the hypointensity band was not continuous, and intrusion of hyperintensities into plaques can be detected. Bright-blood and black-blood techniques were highly correlated with the diagnosis of contrast-enhanced MRA in angiostenosis degree, Rs = 0.97, P < 0.001. In comparison to DSA, the sensitivity, specificity, and accuracy of MRI diagnosis of stenosis for ≥50% were 88.9%, 100%, and 97.9%, respectively. CONCLUSIONS High-resolution bright-blood and black-blood sequential MRI analysis can accurately analyze ingredients in atherosclerotic plaques. Determined by DSA, MRI diagnosis of stenosis can correctly evaluate the serious degree of arteriostenosis.
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Affiliation(s)
| | | | - Xiao-Feng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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van Dijk AC, Truijman MTB, Hussain B, Zadi T, Saiedie G, de Rotte AAJ, Liem MI, van der Steen AFW, Daemen MJAP, Koudstaal PJ, Nederkoorn PJ, Hendrikse J, Kooi ME, van der Lugt A. Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK). AJNR Am J Neuroradiol 2015; 36:2127-33. [PMID: 26251429 DOI: 10.3174/ajnr.a4414] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE An important characteristic of vulnerable plaque, intraplaque hemorrhage, may predict plaque rupture. Plaque rupture can be visible on noninvasive imaging as a disruption of the plaque surface. We investigated the association between intraplaque hemorrhage and disruption of the plaque surface. MATERIALS AND METHODS We selected the first 100 patients of the Plaque At RISK study, an ongoing prospective noninvasive plaque imaging study in patients with mild-to-moderate atherosclerotic lesions in the carotid artery. In carotid artery plaques, disruption of the plaque surface (defined as ulcerated plaques and/or fissured fibrous cap) and intraplaque hemorrhage were assessed by using MDCTA and 3T MR imaging, respectively. We used a χ(2) test and multivariable logistic regression to assess the association between intraplaque hemorrhage and disrupted plaque surface. RESULTS One hundred forty-nine carotid arteries in 78 patients could be used for the current analyses. Intraplaque hemorrhage and plaque ulcerations were more prevalent in symptomatic compared with contralateral vessels (hemorrhage, 38% versus 11%; P < .001; and ulcerations, 27% versus 7%; P = .001). Fissured fibrous cap was more prevalent in symptomatic compared with contralateral vessels (13% versus 4%; P = .06). After adjustment for age, sex, diabetes mellitus, and degree of stenosis, intraplaque hemorrhage was associated with disrupted plaque surface (OR, 3.13; 95% CI, 1.25-7.84) in all vessels. CONCLUSIONS Intraplaque hemorrhage is associated with disruption of the plaque surface in patients with a carotid artery stenosis of <70%. Serial studies are needed to investigate whether intraplaque hemorrhage indeed increases the risk of plaque rupture and subsequent ischemic stroke during follow-up.
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Affiliation(s)
- A C van Dijk
- From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.) Neurology (A.C.v.D., P.J.K.)
| | - M T B Truijman
- Departments of Radiology (M.T.B.T., M.E.K.) Clinical Neurophysiology (M.T.B.T.) Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases (M.T.B.T., M.E.K.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - B Hussain
- From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.)
| | - T Zadi
- From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.)
| | - G Saiedie
- From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.)
| | - A A J de Rotte
- Department of Radiology (A.A.J.d.R., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - M I Liem
- Departments of Neurology (M.I.L., P.J.N.)
| | - A F W van der Steen
- Biomedical Engineering (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - M J A P Daemen
- Pathology (M.J.A.P.D.), Amsterdam Medical Center, Amsterdam, the Netherlands
| | | | | | - J Hendrikse
- Department of Radiology (A.A.J.d.R., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - M E Kooi
- Departments of Radiology (M.T.B.T., M.E.K.) Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases (M.T.B.T., M.E.K.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - A van der Lugt
- From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.)
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Zhou Z, Li R, Zhao X, He L, Wang X, Wang J, Balu N, Yuan C. Evaluation of 3D multi-contrast joint intra- and extracranial vessel wall cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2015; 17:41. [PMID: 26013973 PMCID: PMC4446075 DOI: 10.1186/s12968-015-0143-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 05/01/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multi-contrast vessel wall cardiovascular magnetic resonance (CMR) has demonstrated its capability for atherosclerotic plaque morphology measurement and component characterization in different vasculatures. However, limited coverage and partial volume effect with conventional two-dimensional (2D) techniques might cause lesion underestimation. The aim of this work is to evaluate the performance in a) blood suppression and b) vessel wall delineation of three-dimensional (3D) multi-contrast joint intra- and extracranial vessel wall imaging at 3T. METHODS Three multi-contrast 3D black blood (BB) sequences with T1, T2 and heavy T1 weighting and a custom designed 36-channel neurovascular coil covering the entire intra- and extracranial vasculature have been used and investigated in this study. Two healthy subjects were recruited for sequence parameter optimization and twenty-five patients were consecutively scanned for image quality and blood suppression assessment. Qualitative image scores of vessel wall delineation as well as quantitative Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) were evaluated at five typical locations ranging from common carotid arteries to middle cerebral arteries. RESULTS The 3D multi-contrast images acquired within 15mins allowed the vessel wall visualization with 0.8 mm isotropic spatial resolution covering intra- and extracranial segments. Quantitative wall and lumen SNR measurements for each sequence showed effective blood suppression at all selected locations (P < 0.0001). Although the wall-lumen CNR varied across measured locations, each sequence provided good or adequate image quality in both intra- and extracranial segments. CONCLUSIONS The proposed 3D multi-contrast vessel wall technique provides isotropic resolution and time efficient solution for joint intra- and extracranial vessel wall CMR.
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Affiliation(s)
- Zechen Zhou
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Xiaole Wang
- Department of Biomedical Engineering, Tsinghua University, Beijing, China.
| | - Jinnan Wang
- Department of Radiology, University of Washington, Seattle, WA, USA.
- Philips Research North America, Briarcliff Manor, NY, USA.
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, 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, WA, USA.
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van den Bouwhuijsen QJ, Bos D, Ikram MA, Hofman A, Krestin GP, Franco OH, van der Lugt A, Vernooij MW. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. Cerebrovasc Dis 2015; 39:319-24. [DOI: 10.1159/000381138] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/18/2015] [Indexed: 11/19/2022] Open
Abstract
Background: There is a growing amount of evidence suggesting that the composition of carotid atherosclerotic plaques may be of clinical relevance. Yet, little is known on the coexistence of potentially vulnerable and stabilizing components within asymptomatic plaques. Therefore, in this study we set out to investigate the coexistence of intraplaque calcification, hemorrhage and lipid core within the carotid artery using a multi-modality imaging approach. Methods: In 329 subjects from the population-based Rotterdam Study, all with ultrasound-confirmed carotid wall thickening, we performed a multi-detector CT and a high-resolution MRI of the carotid artery bifurcation at both sides. On the CT examinations, we quantified the volume of intraplaque calcification, and using the MRI examinations we rated the presence of intraplaque hemorrhage and of lipid core. In total, we investigated 611 carotid arteries with plaques. With logistic regression models we investigated the relationship of calcification volume - as a potential stabilizing component - with the presence of potential vulnerable components (intraplaque hemorrhage and lipid core) within each carotid plaque. We adjusted all analyses for age, sex and maximal plaque thickness. Next, we stratified on degree of stenosis (≤ or >30%) to evaluate effect modification by atherosclerotic burden. Results: We found that a larger calcification volume was associated with a higher prevalence of intraplaque hemorrhage, and a lower prevalence of lipid core (fully-adjusted odds ratio (OR) per standard deviation (SD) increase in calcification volume: 2.04 (95% confidence intervals (CI): 1.49; 2.78) and 0.72 (95% CI: 0.58; 0.90), respectively). Stratification on the degree of stenosis showed no difference in the association between calcification volume and hemorrhage over strata, while the relationship between a larger calcification volume and a lower prevalence of lipid seemed more pronounced in persons with a high degree of stenosis. Conclusions: In this population-based setting, we found that there is a complex relationship between calcification, intraplaque hemorrhage and lipid core within the carotid atherosclerotic plaque. Plaques with a higher load of calcification contain more often hemorrhagic components, but less often lipid core. Our results suggest that both in small and large plaques, intraplaque calcification may not be a stabilizing factor per se. These findings create an urge for conducting prospective studies investigating the interrelation of these different plaque components with regard to future cerebrovascular events.
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68
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Nieuwstadt HA, Kassar ZAM, van der Lugt A, Breeuwer M, van der Steen AFW, Wentzel JJ, Gijsen FJH. A computer-simulation study on the effects of MRI voxel dimensions on carotid plaque lipid-core and fibrous cap segmentation and stress modeling. PLoS One 2015; 10:e0123031. [PMID: 25856094 PMCID: PMC4391711 DOI: 10.1371/journal.pone.0123031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background The benefits of a decreased slice thickness and/or in-plane voxel size in carotid MRI for atherosclerotic plaque component quantification accuracy and biomechanical peak cap stress analysis have not yet been investigated in detail because of practical limitations. Methods In order to provide a methodology that allows such an investigation in detail, numerical simulations of a T1-weighted, contrast-enhanced, 2D MRI sequence were employed. Both the slice thickness (2 mm, 1 mm, and 0.5 mm) and the in plane acquired voxel size (0.62x0.62 mm2 and 0.31x0.31 mm2) were varied. This virtual MRI approach was applied to 8 histology-based 3D patient carotid atherosclerotic plaque models. Results A decreased slice thickness did not result in major improvements in lumen, vessel wall, and lipid-rich necrotic core size measurements. At 0.62x0.62 mm2 in-plane, only a 0.5 mm slice thickness resulted in improved minimum fibrous cap thickness measurements (a 2–3 fold reduction in measurement error) and only marginally improved peak cap stress computations. Acquiring voxels of 0.31x0.31 mm2 in-plane, however, led to either similar or significantly larger improvements in plaque component quantification and computed peak cap stress. Conclusions This study provides evidence that for currently-used 2D carotid MRI protocols, a decreased slice thickness might not be more beneficial for plaque measurement accuracy than a decreased in-plane voxel size. The MRI simulations performed indicate that not a reduced slice thickness (i.e. more isotropic imaging), but the acquisition of anisotropic voxels with a relatively smaller in-plane voxel size could improve carotid plaque quantification and computed peak cap stress accuracy.
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Affiliation(s)
- Harm A. Nieuwstadt
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
| | - Zaid A. M. Kassar
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Marcel Breeuwer
- Philips Healthcare, Best, the Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Anton F. W. van der Steen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Jolanda J. Wentzel
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
| | - Frank J. H. Gijsen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- * E-mail:
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Matsukawa H, Fujii M, Uemura A, Suzuki K, Yamamoto D, Takahashi O, Niimi Y. Pathology of embolic debris in carotid artery stenting. Acta Neurol Scand 2015; 131:197-202. [PMID: 25312877 DOI: 10.1111/ane.12303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between magnetic resonance (MR) plaque imaging and the pathology of distal embolic debris is unknown. We aimed to evaluate the relationship between the pathology of embolic debris in the embolic filter during carotid artery stenting (CAS), MR plaque imaging, and new ischemic lesions on diffusion-weighted imaging (DWI). METHOD We prospectively reviewed the 36 patients who underwent CAS using a filter-type embolic protection device. Pathology of debris was categorized into thrombosis, inflammatory cells, elastic fiber, and calcification. We compared the clinical parameters, MR plaque imaging, and pathological characteristics of the embolic debris retained in the filter during CAS on univariate analysis. RESULTS Eleven patients had and 25 patients did not have new lesion on DWI. All of DWI-high lesions were identified in affected side middle cerebral artery territory. Embolic debris was microscopically confirmed in 28 patients (78%); thrombosis in 11 (31%), inflammatory cells in 13 (36%), elastic fiber in 12 (33%), and calcification in 9 (25%). Proportion of asymptomatic carotid stenosis, intra-operative bradycardia/hypotension, and inflammatory cells of debris were significantly higher in patients with new DWI-high lesions. There was no significant relationship between the pathological characteristics and MR plaque imaging of distal embolic debris. CONCLUSIONS Our study showed that new DWI-high lesions might be influenced by types of debris in the filter. The need for future studies specifically examine the association of pathology of debris and findings of MR plaque imaging with new DWI-high lesions during CAS is emphasized.
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Affiliation(s)
- H. Matsukawa
- Department of Neurosurgery; St. Luke's International Hospital; Tokyo Japan
| | - M. Fujii
- Department of Neurosurgery; St. Luke's International Hospital; Tokyo Japan
| | - A. Uemura
- Department of Neuroendovascular Therapy; St. Luke's International Hospital; Tokyo Japan
| | - K. Suzuki
- Department of Pathology; St. Luke's International Hospital; Tokyo Japan
| | - D. Yamamoto
- Department of Neurosurgery; St. Luke's International Hospital; Tokyo Japan
| | - O. Takahashi
- Division of General Internal Medicine; Department of Medicine; St. Luke's International Hospital; Tokyo Japan
| | - Y. Niimi
- Department of Neuroendovascular Therapy; St. Luke's International Hospital; Tokyo Japan
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van der Kolk AG, Zwanenburg JJM, Denswil NP, Vink A, Spliet WGM, Daemen MJAP, Visser F, Klomp DWJ, Luijten PR, Hendrikse J. Imaging the intracranial atherosclerotic vessel wall using 7T MRI: initial comparison with histopathology. AJNR Am J Neuroradiol 2014; 36:694-701. [PMID: 25477359 DOI: 10.3174/ajnr.a4178] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/30/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have attempted to characterize intracranial atherosclerotic plaques by using MR imaging sequences. However, dedicated validation of these sequences with histology has not yet been performed. The current study assessed the ability of ultra-high-resolution 7T MR imaging sequences with different image contrast weightings to image plaque components, by using histology as criterion standard. MATERIALS AND METHODS Five specimens of the circle of Wills were imaged at 7T with 0.11 × 0.11 mm in-plane-resolution proton attenuation-, T1-, T2-, and T2*-weighted sequences (through-plane resolution, 0.11-1 mm). Tissue samples from 13 fiducial-marked locations (per specimen) on MR imaging underwent histologic processing and atherosclerotic plaque classification. Reconstructed MR images were matched with histologic sections at corresponding locations. RESULTS Forty-four samples were available for subsequent evaluation of agreement or disagreement between plaque components and image contrast differences. Of samples, 52.3% (n = 23) showed no image contrast heterogeneity; this group comprised solely no lesions or early lesions. Of samples, 25.0% (n = 11, mostly advanced lesions) showed good correlation between the spatial organization of MR imaging heterogeneities and plaque components. Areas of foamy macrophages were generally seen as proton attenuation-, T2-, and T2*- hypointense areas, while areas of increased collagen content showed more ambiguous signal intensities. Five samples showed image-contrast heterogeneity without corresponding plaque components on histology; 5 other samples showed contrast heterogeneity based on intima-media artifacts. CONCLUSIONS MR imaging at 7T has the image contrast capable of identifying both focal intracranial vessel wall thickening and distinguishing areas of different signal intensities spatially corresponding to plaque components within more advanced atherosclerotic plaques.
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Affiliation(s)
| | - J J M Zwanenburg
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.) Image Sciences Institute (J.J.M.Z.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - N P Denswil
- Department of Pathology (N.P.D., M.J.A.P.D.), Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - A Vink
- From the Departments of Pathology (A.V., W.G.M.S.)
| | - W G M Spliet
- From the Departments of Pathology (A.V., W.G.M.S.)
| | - M J A P Daemen
- Department of Pathology (N.P.D., M.J.A.P.D.), Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - F Visser
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.) Philips Healthcare (F.V.), Best, the Netherlands
| | - D W J Klomp
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.)
| | - P R Luijten
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.)
| | - J Hendrikse
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.)
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Li L, Chai JT, Biasiolli L, Robson MD, Choudhury RP, Handa AI, Near J, Jezzard P. Black-Blood Multicontrast Imaging of Carotid Arteries with DANTE-prepared 2D and 3D MR Imaging. Radiology 2014; 273:560-9. [DOI: 10.1148/radiol.14131717] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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72
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Le Ven F, Tizón-Marcos H, Fuchs C, Mathieu P, Pibarot P, Larose E. Valve tissue characterization by magnetic resonance imaging in calcific aortic valve disease. Can J Cardiol 2014; 30:1676-83. [PMID: 25475469 DOI: 10.1016/j.cjca.2014.09.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Calcific aortic valve disease affects 10%-15% of the elderly population, causing considerable morbidity and mortality. There is no imaging technique that allows for the assessment of tissue composition of the valve in vivo. We thus investigated whether multiparametric magnetic resonance imaging (MRI) could characterize and quantify lipid, fibrous, and mineralized tissues within aortic valve (AV) cusps. METHODS AV leaflets were explanted from patients with severe aortic stenosis at the time of valve replacement surgery. Aortic cusps were imaged ex vivo using 1.5 T MRI using 3 gradient-echo sequences with T1, moderate T2, and proton density weightings (T1w, T2w, and PDw). Histopathologic analysis was performed on coregistered slices to identify and measure mineralized tissue, fibrous tissue, and lipid-rich tissue. Area and mean grey values were measured in all 3 weightings by standardized software. RESULTS Four hundred ninety-two regions of interest from 30 AV leaflets were studied. Total leaflet surface and the areas of mineralized (P < 0.0001), fibrous (P = 0.002), and lipid-rich (P = 0.0001) tissues measured by MRI matched closely those measured by histopathologic examination. All 3 weightings provided significant discrimination between median grey values for mineralized, fibrous, and lipid-rich tissues (P < 0.0001 for T1w, moderate T2w, and PDw). A best-fit equation integrating the grey value data from all 3 weightings allowed multiparametric MRI to identify valve leaflet components with areas under the receiver operating characteristic curve of 0.92, 0.81, and 0.72, respectively. CONCLUSIONS AV leaflet characteristics, including tissue composition, distribution, and area, may be successfully measured by multiparametric MRI with good to excellent accuracy.
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Affiliation(s)
- Florent Le Ven
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Helena Tizón-Marcos
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Christina Fuchs
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Patrick Mathieu
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Philippe Pibarot
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Eric Larose
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada.
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IVUS-based FSI models for human coronary plaque progression study: components, correlation and predictive analysis. Ann Biomed Eng 2014; 43:107-21. [PMID: 25245219 DOI: 10.1007/s10439-014-1118-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022]
Abstract
Atherosclerotic plaque progression is believed to be associated with mechanical stress conditions. Patient follow-up in vivo intravascular ultrasound coronary plaque data were acquired to construct fluid-structure interaction (FSI) models with cyclic bending to obtain flow wall shear stress (WSS), plaque wall stress (PWS) and strain (PWSn) data and investigate correlations between plaque progression measured by wall thickness increase (WTI), cap thickness increase (CTI), lipid depth increase (LDI) and risk factors including wall thickness (WT), WSS, PWS, and PWSn. Quarter average values (n = 178-1016) of morphological and mechanical factors from all slices were obtained for analysis. A predictive method was introduced to assess prediction accuracy of risk factors and identify the optimal predictor(s) for plaque progression. A combination of WT and PWS was identified as the best predictor for plaque progression measured by WTI. Plaque WT had best overall correlation with WTI (r = -0.7363, p < 1E-10), cap thickness (r = 0.4541, p < 1E-10), CTI (r = -0.4217, p < 1E-8), LD (r = 0.4160, p < 1E-10), and LDI (r = -0.4491, p < 1E-10), followed by PWS (with WTI: (r = -0.3208, p < 1E-10); cap thickness: (r = 0.4541, p < 1E-10); CTI: (r = -0.1719, p = 0.0190); LD: (r = -0.2206, p < 1E-10); LDI: r = 0.1775, p < 0.0001). WSS had mixed correlation results.
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Fan Z, Yu W, Xie Y, Dong L, Yang L, Wang Z, Conte AH, Bi X, An J, Zhang T, Laub G, Shah PK, Zhang Z, Li D. Multi-contrast atherosclerosis characterization (MATCH) of carotid plaque with a single 5-min scan: technical development and clinical feasibility. J Cardiovasc Magn Reson 2014; 16:53. [PMID: 25184808 PMCID: PMC4222690 DOI: 10.1186/s12968-014-0053-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/08/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multi-contrast weighted imaging is a commonly used cardiovascular magnetic resonance (CMR) protocol for characterization of carotid plaque composition. However, this approach is limited in several aspects including low slice resolution, long scan time, image mis-registration, and complex image interpretation. In this work, a 3D CMR technique, named Multi-contrast Atherosclerosis Characterization (MATCH), was developed to mitigate the above limitations. METHODS MATCH employs a 3D spoiled segmented fast low angle shot readout to acquire data with three different contrast weightings in an interleaved fashion. The inherently co-registered image sets, hyper T1-weighting, gray blood, and T2-weighting, are used to detect intra-plaque hemorrhage (IPH), calcification (CA), lipid-rich necrotic core (LRNC), and loose-matrix (LM). The MATCH sequence was optimized by computer simulations and testing on four healthy volunteers and then evaluated in a pilot study of six patients with carotid plaque, using the conventional multi-contrast protocol as a reference. RESULTS On MATCH images, the major plaque components were easy to identify. Spatial co-registration between the three image sets with MATCH was particularly helpful for the reviewer to discern co-existent components in an image and appreciate their spatial relation. Based on Cohen's kappa tests, moderate to excellent agreement in the image-based or artery-based component detection between the two protocols was obtained for LRNC, IPH, CA, and LM, respectively. Compared with the conventional multi-contrast protocol, the MATCH protocol yield significantly higher signal contrast ratio for IPH (3.1±1.3 vs. 0.4±0.3, p<0.001) and CA (1.6±1.5 vs. 0.7±0.6, p=0.012) with respect to the vessel wall. CONCLUSIONS To the best of our knowledge, the proposed MATCH sequence is the first 3D CMR technique that acquires spatially co-registered multi-contrast image sets in a single scan for characterization of carotid plaque composition. Our pilot clinical study suggests that the MATCH-based protocol may outperform the conventional multi-contrast protocol in several respects. With further technical improvements and large-scale clinical validation, MATCH has the potential to become a CMR method for assessing the risk of plaque disruption in a clinical workup.
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Affiliation(s)
- Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Wei Yu
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Li Dong
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lixin Yang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhanhong Wang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA
| | - Jing An
- MR Collaborations NE Asia, Siemens Healthcare, Beijing, China
| | - Tianjing Zhang
- MR Collaborations NE Asia, Siemens Healthcare, Beijing, China
| | - Gerhard Laub
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA
| | - Prediman Krishan Shah
- Oppenheimer Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Atherosclerosis Prevention and Management Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zhaoqi Zhang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
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75
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Dieleman N, van der Kolk AG, Zwanenburg JJ, Harteveld AA, Biessels GJ, Luijten PR, Hendrikse J. Imaging Intracranial Vessel Wall Pathology With Magnetic Resonance Imaging. Circulation 2014; 130:192-201. [PMID: 25001624 DOI: 10.1161/circulationaha.113.006919] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nikki Dieleman
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaco J.M. Zwanenburg
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anita A. Harteveld
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert J. Biessels
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter R. Luijten
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
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76
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Edelman RR, Flanagan O, Grodzki D, Giri S, Gupta N, Koktzoglou I. Projection MR imaging of peripheral arterial calcifications. Magn Reson Med 2014; 73:1939-45. [DOI: 10.1002/mrm.25320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Robert R. Edelman
- Department of Radiology; NorthShore University HealthSystem; Evanston Illinois USA
- Department of Radiology; Northwestern University; Chicago Illinois USA
| | - Oisin Flanagan
- Department of Radiology; Northwestern University; Chicago Illinois USA
| | | | | | - NavYash Gupta
- Department of Surgery; NorthShore University HealthSystem; Evanston Illinois USA
| | - Ioannis Koktzoglou
- Department of Radiology; NorthShore University HealthSystem; Evanston Illinois USA
- Department of Radiology; University of Chicago; Chicago Illinois USA
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77
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Watanabe Y, Nagayama M, Sakata A, Okumura A, Amoh Y, Ishimori T, Nakashita S, Dodo Y. Evaluation of Fibrous Cap Rupture of Atherosclerotic Carotid Plaque with Thin-Slice Source Images of Time-of-Flight MR Angiography. Ann Vasc Dis 2014; 7:127-33. [PMID: 24995056 DOI: 10.3400/avd.oa.13-00101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/08/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the ability of source image of time-of-flight magnetic resonance angiography (TOF-MRA) in the detection of fibrous cap rupture of atherosclerotic carotid plaques. MATERIALS AND METHODS From the database of radiological information in our hospital, 35 patients who underwent carotid MR imaging and subsequent carotid endoarterectomy within 2 weeks were included in this retrospective study. MR imaging included thin-slice time-of-flight MR angiography, black-blood T1- and T2-weighted imaging. Sensitivity, specificity and accuracy were calculated for the detection of fibrous cap rupture with source image of TOF-MRA. The Cohen k coefficient was also calculated to quantify the degree of concordance of source image of TOF-MRA with histopathological data. RESULTS Sensitivity, specificity and accuracy in the detection of fibrous cap rupture were 90% (95%CI: 81-98), 69% (95%CI: 56-82) and 79% (95%CI: 71-87) with a k value of 0.59. The false positives (n = 15) were caused by partial-volume averaging between fibrous cap and lumen at the shoulder of carotid plaque. The false negatives (n = 5) were underestimated as partial thinning of fibrous cap. CONCLUSION Source image of TOF-MRA can be useful in the detection of fibrous cap rupture with high sensitivity, but further technical improvement should be necessary to overcome shortcomings causing image degradation.
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Affiliation(s)
- Yuji Watanabe
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masako Nagayama
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akihiko Sakata
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Okumura
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshiki Amoh
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takayoshi Ishimori
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Satoru Nakashita
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshihiro Dodo
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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78
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Huang X, Yang C, Canton G, Ferguson M, Yuan C, Tang D. Quantifying effect of intraplaque hemorrhage on critical plaque wall stress in human atherosclerotic plaques using three-dimensional fluid-structure interaction models. J Biomech Eng 2014; 134:121004. [PMID: 23363206 DOI: 10.1115/1.4007954] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent magnetic resonance studies have indicated that intraplaque hemorrhage (IPH) may accelerate plaque progression and play an important role in plaque destabilization. However, the impact of hemorrhage on critical plaque wall stress (CPWS) and strain (CPWSn) has yet to be determined. The objective of this study was to assess the effect of the presence and size of IPH on wall mechanics. The magnetic resonance image (MRI) of one patient with histology-confirmed IPH was used to build eight 3D fluid-structure interaction (FSI) models by altering the dimensions of the existing IPH. As a secondary end point, the combined effect of IPH and fibrous cap thickness (FCT) was assessed. A volume curve fitting method (VCFM) was applied to generate a mesh that would guarantee numerical convergence. Plaque wall stress (PWS), strain (PWSn), and flow shear stress (FSS) were extracted from all nodal points on the lumen surface for analysis. Keeping other conditions unchanged, the presence of intraplaque hemorrhage caused a significant increase (27.5%) in CPWS; reduced FCT caused an increase of 22.6% of CPWS. Similar results were found for CPWSn. Furthermore, combination of IPH presence, reduced FCT, and increased IPH volume caused an 85% and 75% increase in CPWS and CPWSn, respectively. These results show that intraplaque hemorrhage has considerable impact on plaque stress and strain conditions and accurate quantification of IPH could lead to more accurate assessment of plaque vulnerability. Large-scale studies are needed to further validate our findings.
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Affiliation(s)
- Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, PRC.
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79
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Ličev L, Krumnikl M, Škuta J, Babiuch M, Farana R. Advances in the development of an imaging device for plaque measurement in the area of the carotid artery. BIOTECHNOL BIOTEC EQ 2014; 28:355-359. [PMID: 26740760 PMCID: PMC4686974 DOI: 10.1080/13102818.2014.910362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/28/2014] [Indexed: 11/08/2022] Open
Abstract
This paper describes the advances in the development and subsequent testing of an imaging device for three-dimensional ultrasound measurement of atherosclerotic plaque in the carotid artery. The embolization from the atherosclerotic carotid plaque is one of the most common causes of ischemic stroke and, therefore, we consider the measurement of the plaque as extremely important. The paper describes the proposed hardware for enhancing the standard ultrasonic probe to provide a possibility of accurate probe positioning and synchronization with the cardiac activity, allowing the precise plaque measurements that were impossible with the standard equipment. The synchronization signal is derived from the output signal of the patient monitor (electrocardiogram (ECG)), processed by a microcontroller-based system, generating the control commands for the linear motion moving the probe. The controlling algorithm synchronizes the movement with the ECG waveform to obtain clear images not disturbed by the heart activity.
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Affiliation(s)
- Lačezar Ličev
- Faculty of Electrical Engineering and Computer Science, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Michal Krumnikl
- Faculty of Electrical Engineering and Computer Science, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Jaromír Škuta
- Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Marek Babiuch
- Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Radim Farana
- Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
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Tognolini A, Arellano C, Marfori W, Heidari G, Sayre J, Krishnam M, Ruehm S. Comprehensive low-dose imaging of carotid and coronary arteries with a single-injection dual-source CT angiography protocol. Clin Radiol 2014; 69:246-53. [DOI: 10.1016/j.crad.2013.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 09/27/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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81
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Tang D, Kamm RD, Yang C, Zheng J, Canton G, Bach R, Huang X, Hatsukami TS, Zhu J, Ma G, Maehara A, Mintz GS, Yuan C. Image-based modeling for better understanding and assessment of atherosclerotic plaque progression and vulnerability: data, modeling, validation, uncertainty and predictions. J Biomech 2014; 47:834-46. [PMID: 24480706 DOI: 10.1016/j.jbiomech.2014.01.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 01/30/2023]
Abstract
Medical imaging and image-based modeling have made considerable progress in recent years in identifying atherosclerotic plaque morphological and mechanical risk factors which may be used in developing improved patient screening strategies. However, a clear understanding is needed about what we have achieved and what is really needed to translate research to actual clinical practices and bring benefits to public health. Lack of in vivo data and clinical events to serve as gold standard to validate model predictions is a severe limitation. While this perspective paper provides a review of the key steps and findings of our group in image-based models for human carotid and coronary plaques and a limited review of related work by other groups, we also focus on grand challenges and uncertainties facing the researchers in the field to develop more accurate and predictive patient screening tools.
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Affiliation(s)
- Dalin Tang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China; Worcester Polytechnic Institute, Worcester, MA 01609, USA.
| | - Roger D Kamm
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Chun Yang
- Worcester Polytechnic Institute, Worcester, MA 01609, USA; China Information Tech. Designing & Consulting Institute Co., Ltd., Beijing 100048, China
| | - Jie Zheng
- Mallinkcrodt Inst. of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Richard Bach
- Cardiovascular Division, Washington University, St. Louis, MO 63110, USA
| | - Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Thomas S Hatsukami
- Division of Vascular Surgery, University of Washington, Seattle, WA, 98195, USA
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | | | - Gary S Mintz
- The Cardiovascular Research Foundation, NY, NY, USA
| | - Chun Yuan
- Deparment of Radiology, University of Washington, Seattle, WA 98195, USA
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82
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Sadat U, Teng Z, Gillard JH. Biomechanical structural stresses of atherosclerotic plaques. Expert Rev Cardiovasc Ther 2014; 8:1469-81. [DOI: 10.1586/erc.10.130] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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83
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Lei-xing X, Jing-jing G, Jing-xue N, Juan W, Juan L, Chang-zai L, Xiao-xi W, Da-yi Y, Jia-jin L, Xiong-wei Z, Liu-quan C, Yong W, Dan-qing L, Hong-bin L. Combined application of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging in early diagnosis of vulnerable carotid atherosclerotic plaques. J Int Med Res 2013; 42:213-23. [PMID: 24366494 DOI: 10.1177/0300060513502887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To assess the correlations between atherosclerotic plaque characteristics and inflammatory activity by combined use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI). Methods Patients underwent 18F-FDG PET/CT and MRI. Target/background ratios (TBR) of axial sections were determined from mean standard uptake values (SUV). Correlations between TBR and mean vessel wall thickness, total vessel area, lumen area, vessel wall area and normalized wall index were calculated. Plaque types were defined as calcified, collagen, lipid or haemorrhage. Plaques were also classified as thick, thin, or ruptured fibrous cap. Results The study included 31 patients (1178 plaque slices). There was a significant decrease in TBR values across the fibrous cap groups, such that ruptured > thin > thick. Lipid and haemorrhage plaques had significantly higher TBR than calcification and collagen plaques. There were weak positive correlations between TBR and mean vessel wall thickness, vessel wall area and normalized wall index. Conclusions Thin or ruptured plaques, lipid-rich plaques and haemorrhagic plaques possess high inflammatory activity. The combination of 18F-FDG PET/CT and MRI could be useful for qualitative and quantitative diagnosis of carotid atherosclerotic plaques.
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Affiliation(s)
- Xie Lei-xing
- Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
- Department of Cardiology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Gai Jing-jing
- Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Niu Jing-xue
- Department of Neurorehabilitation, China Rehabilitation Research Centre, Beijing, China
| | - Wang Juan
- Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Li Juan
- Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liang Chang-zai
- Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Wang Xiao-xi
- Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yin Da-yi
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liu Jia-jin
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhang Xiong-wei
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Cheng Liu-quan
- Department of Radiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Wang Yong
- Department of Radiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liu Dan-qing
- Department of Radiology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liu Hong-bin
- Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
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Ogura A, Hayakawa K, Maeda F, Kajihara M, Takatsu Y, Yamamura K. Characterization of carotid artery plaque components on magnetic resonance imaging using signal intensity of the phantom as a reference. Acad Radiol 2013; 20:1551-6. [PMID: 24200482 DOI: 10.1016/j.acra.2013.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the properties of plaque by the use of magnetic resonance imaging (MRI), it is necessary to use a material with stable signal intensity (eg, muscle or submandibular gland) as a reference. However, there may be differences between individuals. Therefore, we used a small phantom set on the circumference of the neck as a reference. The signal intensity ratio (SIR) methods using the phantom as a reference were reviewed for discrimination of the properties of plaque in the carotid artery. MATERIALS AND METHODS Three phantoms (phantom 1: water; phantom 2: 5 μmol gadopentetate dimeglumine; and phantom 3: 2.5 μmol gadopentetate dimeglumine) were set around the neck. SIR was calculated for each region of interest and compared according to pathological grade. RESULTS The method using a phantom as a reference reduced the standard deviations of tissue ratios to 0.16 from 0.27 in comparison with the method using muscle and showed a close correlation with pathological grade. In addition, the agreement rates with pathological grade and grades from each SIR using signal intensity of the phantom as a reference were higher than using signal intensity of the muscle as a reference to 0.86 from 0.63 for two-dimensional images and to 0.86 from 0.71 for three-dimensional images. CONCLUSIONS The method described here reduced error compared to the method using muscle as a reference, and the results were closely correlated with pathological grade.
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Affiliation(s)
- Akio Ogura
- Graduate School, Gunma Prefectural College of Health Sciences, 323-1, Kamioki-machi, Maebashi, Gunma, Japan; Department of Radiology, Kyoto City Hospital, Kyoto, Japan.
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85
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Vakil P, Vranic J, Hurley MC, Bernstein RA, Korutz AW, Habib A, Shaibani A, Dehkordi FH, Carroll TJ, Ansari SA. T1 gadolinium enhancement of intracranial atherosclerotic plaques associated with symptomatic ischemic presentations. AJNR Am J Neuroradiol 2013; 34:2252-8. [PMID: 23828109 DOI: 10.3174/ajnr.a3606] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease. MATERIALS AND METHODS We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (>70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1-5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion. RESULTS Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant (P = .001, t test). CONCLUSIONS In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.
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86
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Sui B, Gao P, Lin Y, Jing L, Qin H, Wang T, An J. Association of plaque compositions and stenosis patterns in carotid bifurcation using MR imaging. Neurol Res 2013; 34:366-72. [DOI: 10.1179/1743132812y.0000000031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
| | | | - Yan Lin
- Department of Neuroradiology
| | | | - Haiqiang Qin
- Department of NeurologyBeijing Neurosurgical Institute, Affiliated Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tony Wang
- NeurosurgeryWayne State University, Detroit, MI, USA
| | - Jing An
- Siemens Mindit Magnetic Resonance LtdShenzhen, China
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87
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Tang D, Yang C, Canton G, Wu Z, Hatsukami T, Yuan C. Correlations between carotid plaque progression and mechanical stresses change sign over time: a patient follow up study using MRI and 3D FSI models. Biomed Eng Online 2013; 12:105. [PMID: 24125580 PMCID: PMC3853144 DOI: 10.1186/1475-925x-12-105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that mechanisms governing advanced plaque progression may be different from those for early progression and require further investigation. Serial MRI data and 3D fluid-structure interaction (FSI) models were employed to identify possible correlations between mechanical stresses and advanced plaque progression measured by vessel wall thickness increase (WTI). Long-term patient follow up was used to gather data and investigate if the correlations identified above were reproducible. METHODS In vivo MRI data were acquired from 16 patients in a follow-up study with 2 to 4 scans for each patient (scan interval: average 18 months and standard deviation 6.8 months). A total of 38 scan pairs (baseline and follow-up) were formed for analysis using the carotid bifurcation as the registration point. 3D FSI models were constructed to obtain plaque wall stress (PWS) and flow shear stress (FSS) to quantify their correlations with plaque progression. The Linear Mixed-Effects models were used to study possible correlations between WTI and baseline PWS and FSS with nodal dependence taken into consideration. RESULTS Of the 38 scan pairs, 22 pairs showed positive correlation between baseline PWS and WTI, 1 pair showed negative correlation, and 15 pairs showed no correlation. Thirteen patients changed their correlation sign (81.25%). Between baseline FSS and WTI, 16 pairs showed negative correlation, 1 pair showed positive correlation. Twelve patients changed correlation sign (75%). CONCLUSION Our results showed that advanced plaque progression had an overall positive correlation with plaque wall stress and a negative correlation with flow shear stress at baseline. However, long-term follow up showed that correlations between plaque progress and mechanical stresses (FSS and PWS) identified for one time period were not re-producible for most cases (>80%). Further investigations are needed to identify the reasons causing the correlation sign changes.
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Affiliation(s)
- Dalin Tang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.
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88
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Quantitative evaluation using the plaque/muscle ratio index panels predicts plaque type and risk of embolism in patients undergoing carotid artery stenting. Clin Neurol Neurosurg 2013; 115:1298-303. [DOI: 10.1016/j.clineuro.2012.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 11/05/2012] [Accepted: 12/02/2012] [Indexed: 11/23/2022]
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89
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MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients. PLoS One 2013; 8:e67927. [PMID: 23894291 PMCID: PMC3722215 DOI: 10.1371/journal.pone.0067927] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I-VIII). Within these lesion types, lesion types IV-V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones. METHODS Eighty-three consecutive patients (45 male (54.2%); age 54-88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50-99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I-VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance. RESULTS Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV-V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001). CONCLUSIONS MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.
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Majidi S, Sein J, Watanabe M, Hassan AE, Van de Moortele PF, Suri MFK, Clark HB, Qureshi AI. Intracranial-derived atherosclerosis assessment: an in vitro comparison between virtual histology by intravascular ultrasonography, 7T MRI, and histopathologic findings. AJNR Am J Neuroradiol 2013; 34:2259-64. [PMID: 23811977 DOI: 10.3174/ajnr.a3631] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Atherosclerotic plaque composition and structure contribute to the risk of plaque rupture and embolization. Virtual histology by intravascular ultrasonography and high-resolution MR imaging are new imaging modalities that have been used to characterize plaque morphology and composition in peripheral arteries. MATERIALS AND METHODS The objectives of this study were 1) to determine the correlation between virtual histology-intravascular ultrasonography and histopathologic analysis (reference standard) and 2) to explore the comparative results of 7T MR imaging (versus histopathologic analysis), both to be performed in vitro by use of intracranial arterial segments with atherosclerotic plaques. Thirty sets of postmortem samples of intracranial circulation were prepared for the study. These samples included the middle cerebral artery (n = 20), basilar artery (n = 8), and anterior cerebral artery (n = 2). Virtual histology-intravascular ultrasonography and 7T MR imaging were performed in 34 and 10 points of interest, respectively. The formalin-fixed arteries underwent tissue processing and hematoxylin-eosin staining. The plaques were independently categorized according to revised Stary classification after review of plaque morphology and characteristics obtained from 3 modalities. The proportion of fibrous, fibrofatty, attenuated calcium, and necrotic components in the plaques were determined in histology slides and compared with virtual histology-intravascular ultrasonography and MR imaging. RESULTS Of 34 points of interest in the vessels, 32 had atherosclerotic plaques under direct visualization. Plaques were visualized in gray-scale intravascular ultrasonography as increased wall thickness, outer wall irregularity, and protrusion. The positive predictive value of virtual histology-intravascular ultrasonography for identifying fibroatheroma was 80%. Overall, virtual histology-intravascular ultrasonography accurately diagnosed the type of the plaque in 25 of 34 samples, and κ agreement was 0.58 (moderate agreement). The sensitivity and specificity of virtual histology-intravascular ultrasonography readings for fibroatheroma were 78.9% and 73.3%, respectively. The overall sensitivity and specificity for virtual histology-intravascular ultrasonography were 73.5% and 96.6%, respectively. Plaques were identified in 7T MR imaging as increased wall thickness, luminal stenosis, or outer wall protrusion. The positive predictive value of 7T MR imaging for detecting fibrous and attenuated calcium deposits was 88% and 93%, respectively. CONCLUSIONS This in vitro study demonstrated that virtual histology-intravascular ultrasonography and high-resolution MR imaging are reliable imaging tools to detect atherosclerotic plaques within the intracranial arterial wall, though both imaging modalities have some limitations in accurate characterization of the plaque components. Further clinical studies are needed to determine the clinical utility of plaque morphology and composition assessment by noninvasive tests.
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Affiliation(s)
- S Majidi
- Zeenat Qureshi Stroke Research Center
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91
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Rosa GM, Bauckneht M, Masoero G, Mach F, Quercioli A, Seitun S, Balbi M, Brunelli C, Parodi A, Nencioni A, Vuilleumier N, Montecucco F. The vulnerable coronary plaque: update on imaging technologies. Thromb Haemost 2013; 110:706-22. [PMID: 23803753 DOI: 10.1160/th13-02-0121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/01/2013] [Indexed: 12/21/2022]
Abstract
Several studies have been carried out on vulnerable plaque as the main culprit for ischaemic cardiac events. Historically, the most important diagnostic technique for studying coronary atherosclerotic disease was to determine the residual luminal diameter by angiographic measurement of the stenosis. However, it has become clear that vulnerable plaque rupture as well as thrombosis, rather than stenosis, triggers most acute ischaemic events and that the quantification of risk based merely on severity of the arterial stenosis is not sufficient. In the last decades, substantial progresses have been made on optimisation of techniques detecting the arterial wall morphology, plaque composition and inflammation. To date, the use of a single technique is not recommended to precisely identify the progression of the atherosclerotic process in human beings. In contrast, the integration of data that can be derived from multiple methods might improve our knowledge about plaque destabilisation. The aim of this narrative review is to update evidence on the accuracy of the currently available non-invasive and invasive imaging techniques in identifying components and morphologic characteristics associated with coronary plaque vulnerability.
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Affiliation(s)
- Gian Marco Rosa
- Fabrizio Montecucco, MD, PhD, Division of Cardiology, Faculty of Medicine, Geneva University Hospital, Avenue de la Roseraie 64, 1211 Geneva 4, Switzerland, Tel.: +41 22 372 71 92, Fax: +41 22 382 72 45, E-mail:
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92
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Grimm JM, Schindler A, Freilinger T, Cyran CC, Bamberg F, Yuan C, Reiser MF, Dichgans M, Freilinger C, Nikolaou K, Saam T. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaques using parallel imaging and 3 T black-blood in vivo CMR. J Cardiovasc Magn Reson 2013; 15:44. [PMID: 23705576 PMCID: PMC3693990 DOI: 10.1186/1532-429x-15-44] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 04/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients. METHODS In this prospective monocentric observational study 34 patients (24 males; 70 ±9.3 years) with symptomatic carotid disease defined as ischemic brain lesions in one internal carotid artery territory on diffusion weighted images underwent a carotid bb-CMR at 3 T with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques (PAT factor = 2) within 10 days after symptom onset. All patients underwent extensive clinical workup (lab, brain MR, duplex sonography, 24-hour ECG, transesophageal echocardiography) to exclude other causes of ischemic stroke. Prevalence of American Heart Association lesion type VI (AHA-LT6), status of the fibrous cap, presence of hemorrhage/thrombus and area measurements of calcification, necrotic core and hemorrhage were determined in both carotid arteries in consensus by two reviewers who were blinded to clinical information. McNemar and Wilcoxon's signed rank tests were use for statistical comparison. A p-value <0.05 was considered statistically significant. RESULTS Symptomatic plaques showed a higher prevalence of AHA-LT6 (67.7% vs. 11.8%; p < 0.001; odds ratio = 12.5), ruptured fibrous caps (44.1% vs. 2.9%; p < 0.001; odds ratio = 15.0), juxtaluminal thrombus (26.5 vs. 0%; p < 0.01; odds ratio = 7.3) and intraplaque hemorrhage (58.6% vs. 11.8%; p = 0.01; odds ratio = 3.8). Necrotic core and hemorrhage areas were greater in symptomatic plaques (14.1 mm2 vs. 5.5 mm2 and 13.6 mm2 vs. 5.3 mm2; p < 0.01, respectively). CONCLUSION 3 T bb-CMR is able to differentiate between symptomatic and asymptomatic carotid plaques, demonstrating the potential of bb-CMR to differentiate between stable and vulnerable lesions and ultimately to identify patients with low versus high risk for cardiovascular complications. Best predictors of the symptomatic side were a ruptured fibrous cap, AHA-LT 6, juxtaluminal hemorrhage/thrombus, and intraplaque hemorrhage.
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Affiliation(s)
- Jochen M Grimm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Tobias Freilinger
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-UniversityHospital, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Clemens C Cyran
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Fabian Bamberg
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Chun Yuan
- Department of Radiology, University of WashingtonSchool of Medicine, Seattle, USA
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-UniversityHospital, Munich, Germany
| | - Caroline Freilinger
- Department of Neurology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Konstantin Nikolaou
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
- Institute of Clinical Radiology, University of Munich, Pettenkoferstr 8a, Munich, 80336, Germany
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93
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González A, López-Rueda A, Gutiérrez I, Moniche F, Cayuela A, Bustamante A, Mayol A, Gonzalez-Marcos JR, Gil-Peralta A. Carotid plaque characterization by virtual histology intravascular ultrasound related to the timing of carotid intervention. J Endovasc Ther 2013; 19:764-73. [PMID: 23210875 DOI: 10.1583/jevt-12-3914mr2.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the incidence of vulnerable plaques characterized by virtual histology intravascular ultrasound (VH IVUS) in patients with severe internal carotid artery (ICA) stenosis and its relationship to the timing of protected carotid artery stenting (CAS). METHODS The study included 141 patients (119 men; mean age 66.9 ± 9 years) with severe ICA stenosis undergoing CAS with cerebral protection. Patients were classified in 3 groups: 39 symptomatic early CAS (<14 days from clinical symptoms); 58 symptomatic delayed CAS (range 15-180 days), and 44 asymptomatic CAS. Culprit plaque component was evaluated by VH IVUS. A vulnerable plaque was defined by a thin-cap fibroatheroma and/or calcified thin-cap fibroatheroma. RESULTS The composite disabling stroke/mortality was 2.1%. The incidence of vulnerable plaques was significantly higher in the symptomatic early CAS group (25/39, 64.1%) than in the symptomatic delayed CAS group (26/58, 44.8%; p=0.048) or the asymptomatic CAS group (14/44, 31.8%; p=0.003). Symptomatic patients showed a significantly higher incidence of vulnerable plaques (52.6%) than asymptomatic patients (31.8%, p=0.022). There were no significant differences between the symptomatic delayed and asymptomatic groups (p=0.129). By clinical subgroup, a vulnerable plaque was observed in 29 (52.7%) of the patients with 55 transient ischemic attacks, 22 (52.4%) of the 42 minor stroke patients, and 14 (31.8%) of the 44 asymptomatic patients (p=0.152). CONCLUSION The incidence of vulnerable plaques was significantly higher in symptomatic patients, increasing as the intravascular study was performed closer to the index ischemic episode.
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Affiliation(s)
- Alejandro González
- Department of Radiology and Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain.
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Casciani E, De Vincentiis C, Colaiacomo MC, Gualdi GF. Multi-modal imaging technologies in cardiovascular risk assessment. Ther Apher Dial 2013; 17:138-49. [PMID: 23551670 DOI: 10.1111/j.1744-9987.2012.01132.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Atherosclerotic plaques can be responsible for life-threatening cardiovascular and cerebrovascular events. Some features of the plaque, such as a thin fibrous cap, large necrotic core, macrophage infiltration, neovascularization, and intraplaque hemorrhage, are associated with a major risk of such events and so their assessment is fundamental. Novel imaging techniques, each one with its own strength and drawbacks, can help in the evaluation and quantification of atherosclerosis. An analysis of the recent literature was carried out. The different techniques were compared by evaluating the accuracy of each one in the detection and assessment of the atherosclerotic plaque's features named above.
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Affiliation(s)
- Emanuele Casciani
- Emergency Department, Sant'andrea's Hospital, University of Rome La Sapienza, Rome, Italy.
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Chi J, Chiu B, Cao Y, Liu X, Wang J, Balu N, Yuan C, Xu J. Assessment of femoral artery atherosclerosis at the adductor canal using 3D black-blood MRI. Clin Radiol 2013; 68:e213-21. [DOI: 10.1016/j.crad.2012.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
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96
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Computer Simulations in Stroke Prevention: Design Tools and Virtual Strategies Towards Procedure Planning. Cardiovasc Eng Technol 2013. [DOI: 10.1007/s13239-013-0134-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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97
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Imaging Atherosclerotic Plaques with MRI: Role of Contrast Agents. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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98
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Tang D, Yang C, Zheng J, Canton G, Bach RG, Hatsukami TS, Wang L, Yang D, Billiar KL, Yuan C. Image-based modeling and precision medicine: patient-specific carotid and coronary plaque assessment and predictions. IEEE Trans Biomed Eng 2013; 60:643-51. [PMID: 23362245 DOI: 10.1109/tbme.2013.2242891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Atherosclerotic plaques may rupture without warning and cause acute cardiovascular events such as heart attack and stroke. Current clinical screening tools are insufficient to identify those patients with risks early and prevent the adverse events from happening. Medical imaging and image-based modeling have made considerable progress in recent years in identifying plaque morphological and mechanical risk factors which may be used in developing improved patient screening strategies. The key steps and factors in image-based models for human carotid and coronary plaques were illustrated, as well as grand challenges facing the researchers in the field to develop more accurate screening tools.
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Affiliation(s)
- Dalin Tang
- Southeast University, Nanjing 210018, China.
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99
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den Hartog A, Bovens S, Koning W, Hendrikse J, Luijten P, Moll F, Pasterkamp G, de Borst G. Current Status of Clinical Magnetic Resonance Imaging for Plaque Characterisation in Patients with Carotid Artery Stenosis. Eur J Vasc Endovasc Surg 2013. [DOI: 10.1016/j.ejvs.2012.10.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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100
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Li B, Dong L, Chen B, Ji S, Cai W, Wang Y, Zhang J, Zhang Z, Wang X, Fang J. Turbo fast three-dimensional carotid artery black-blood MRI by combining three-dimensional MERGE sequence with compressed sensing. Magn Reson Med 2012; 70:1347-52. [PMID: 23280949 DOI: 10.1002/mrm.24579] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 11/03/2012] [Accepted: 11/11/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE In this study, we sought to investigate the feasibility of turbo fast three-dimensional (3D) black-blood imaging by combining a 3D motion-sensitizing driven equilibrium rapid gradient echo sequence with compressed sensing. METHODS A pseudo-centric phase encoding order was developed for compressed sensing-3D motion-sensitizing driven equilibrium rapid gradient echo to suppress flow signal in undersampled 3D k-space. Nine healthy volunteers were recruited for this study. Signal-to-tissue ratio, contrast-to-tissue ratio (CTR) and CTR efficiency (CTReff ) between fully sampled and undersampled images were calculated and compared in seven subjects. Moreover, isotropic high resolution images using different compressed sensing acceleration factors were evaluated in two other subjects. RESULTS Wall-lumen signal-to-tissue ratio or CTR were comparable between the undersampled and the fully sampled images, while significant improvement of CTReff was achieved in the undersampled images. At an isotropic high spatial resolution of 0.7 × 0.7 × 0.7 mm(3) , all undersampled images exhibited similar level of the flow suppression efficiency and the capability of delineating outer vessel wall boundary and lumen-wall interface, when compared with the fully sampled images. CONCLUSION The proposed turbo fast compressed sensing 3D black-blood imaging technique improves scan efficiency without sacrificing flow suppression efficiency and vessel wall image quality. It could be a valuable tool for rapid 3D vessel wall imaging.
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Affiliation(s)
- Bo Li
- College of Engineering, Peking University, Beijing, People's Republic of China
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