Characterization of atherosclerotic plaque components by high resolution quantitative MR and US imaging

High-resolution and accelerated multi-parametric mapping with automated characterization of vessel disease using intravascular MRI

BACKGROUND

Atherosclerosis is prevalent in cardiovascular disease, but present imaging modalities have limited capabilities for characterizing lesion stage, progression and response to intervention. This study tests whether intravascular magnetic resonance imaging (IVMRI) measures of relaxation times (T1, T2) and proton density (PD) in a clinical 3 Tesla scanner could characterize vessel disease, and evaluates a practical strategy for accelerated quantification.

METHODS

IVMRI was performed in fresh human artery segments and swine vessels in vivo, using fast multi-parametric sequences, 1-2 mm diameter loopless antennae and 200-300 μm resolution. T1, T2 and PD data were used to train a machine learning classifier (support vector machine, SVM) to automatically classify normal vessel, and early or advanced disease, using histology for validation. Disease identification using the SVM was tested with receiver operating characteristic curves. To expedite acquisition of T1, T2 and PD data for vessel characterization, the linear algebraic method ('SLAM') was modified to accommodate the antenna's highly-nonuniform sensitivity, and used to provide average T1, T2 and PD measurements from compartments of normal and pathological tissue segmented from high-resolution images at acceleration factors of R ≤ 18-fold. The results were validated using compartment-average measures derived from the high-resolution scans.

RESULTS

The SVM accurately classified ~80% of samples into the three disease classes. The 'area-under-the-curve' was 0.96 for detecting disease in 248 samples, with T1 providing the best discrimination. SLAM T1, T2 and PD measures for R ≤ 10 were indistinguishable from the true means of segmented tissue compartments.

CONCLUSION

High-resolution IVMRI measures of T1, T2 and PD with a trained SVM can automatically classify normal, early and advanced atherosclerosis with high sensitivity and specificity. Replacing relaxometric MRI with SLAM yields good estimates of T1, T2 and PD an order-of-magnitude faster to facilitate IVMRI-based characterization of vessel disease.

In-vivo quantitative T2 mapping of carotid arteries in atherosclerotic patients: segmentation and T2 measurement of plaque components

BACKGROUND

Atherosclerotic plaques in carotid arteries can be characterized in-vivo by multicontrast cardiovascular magnetic resonance (CMR), which has been thoroughly validated with histology. However, the non-quantitative nature of multicontrast CMR and the need for extensive post-acquisition interpretation limit the widespread clinical application of in-vivo CMR plaque characterization. Quantitative T2 mapping is a promising alternative since it can provide absolute physical measurements of plaque components that can be standardized among different CMR systems and widely adopted in multi-centre studies. The purpose of this study was to investigate the use of in-vivo T2 mapping for atherosclerotic plaque characterization by performing American Heart Association (AHA) plaque type classification, segmenting carotid T2 maps and measuring in-vivo T2 values of plaque components.

METHODS

The carotid arteries of 15 atherosclerotic patients (11 males, 71 ± 10 years) were imaged at 3 T using the conventional multicontrast protocol and Multiple-Spin-Echo (Multi-SE). T2 maps of carotid arteries were generated by mono-exponential fitting to the series of images acquired by Multi-SE using nonlinear least-squares regression. Two reviewers independently classified carotid plaque types following the CMR-modified AHA scheme, one using multicontrast CMR and the other using T2 maps and time-of-flight (TOF) angiography. A semi-automated method based on Bayes classifiers segmented the T2 maps of carotid arteries into 4 classes: calcification, lipid-rich necrotic core (LRNC), fibrous tissue and recent IPH. Mean ± SD of the T2 values of voxels classified as LRNC, fibrous tissue and recent IPH were calculated.

RESULTS

In 37 images of carotid arteries from 15 patients, AHA plaque type classified by multicontrast CMR and by T2 maps (+ TOF) showed good agreement (76% of matching classifications and Cohen's κ = 0.68). The T2 maps of 14 normal arteries were used to measure T2 of tunica intima and media (T2 = 54 ± 13 ms). From 11865 voxels in the T2 maps of 15 arteries with advanced atherosclerosis, 2394 voxels were classified by the segmentation algorithm as LRNC (T2 = 37 ± 5 ms) and 7511 voxels as fibrous tissue (T2 = 56 ± 9 ms); 192 voxels were identified as calcification and one recent IPH (236 voxels, T2 = 107 ± 25 ms) was detected on T2 maps and confirmed by multicontrast CMR.

CONCLUSIONS

This carotid CMR study shows the potential of in-vivo T2 mapping for atherosclerotic plaque characterization. Agreement between AHA plaque types classified by T2 maps (+TOF) and by conventional multicontrast CMR was good, and T2 measured in-vivo in LRNC, fibrous tissue and recent IPH demonstrated the ability to discriminate plaque components on T2 maps.

Impact of T2 decay on carotid artery wall thickness measurements

PURPOSE

To investigate the impact of T2 relaxation of the carotid wall on measurements of its thickness.

MATERIALS AND METHODS

The common carotid artery wall was imaged using a spin echo sequence acquired at four echo times (17 ms to 68 ms) in 65 participants as part of VALIDATE study. Images were acquired transverse to the artery 1.5 cm proximal to the flow divider. Mean wall thickness, mean wall signal intensity, lumen area, and outer wall area were measured for each echo. Contours were also traced on the image from the fourth echo and then propagated to the images from the preceding echoes. This was repeated using the image from the first echo. Mean wall signal intensity measurements at the four echo times were fit to a mono-exponential decay curve to derive the mean T2 relaxation time for each set of contours.

RESULTS

Mean wall thickness decreased with increasing echo time, with an average thickness reduction of 8.6% between images acquired at the first and last echo times (TE) (0.93 mm at TE 17 ms versus 0.85 mm at TE 68 ms, P < 0.001). Average T2 relaxation time of the carotid wall decreased by 3% when the smaller contours from the last echo were used, which excluded the outer-most layer (54.3 ± 7.6 ms versus 52.7 ± 6.6 ms, P = 0.03).

CONCLUSION

Carotid wall thickness measurements decrease with echo time as expected by the fast T2 relaxation time of the outer-most layer, namely the adventitia. A short echo time is needed for thickness measurements to include adventitia, which plays an important role in plaque development.

Gray blood magnetic resonance for carotid wall imaging and visualization of deep-seated and superficial vascular calcifications

White blood and black blood magnetic resonance imaging methods are often used for lumenography and visualization of the arterial wall, respectively. However, the use of white blood imaging invariably obscures arterial wall boundaries, and thus, impedes precise measurement of arterial wall area. Conversely, black blood imaging imposes strict limits on sequence timing to suppress the arterial lumen, and by itself, precludes separation of superficial calcification from the hypointense arterial lumen. In this work, a three-dimensional arterial wall imaging methodology providing gray blood image contrast is described that remedies the above limitations. When applied to the carotid arteries, the described gray blood imaging method is found to clearly depict the inner and outer arterial wall boundaries as well as superficial and deep-seated vascular calcifications. A tailored phase-encoding schedule is also presented that enables concurrent gray and black blood, or "dual contrast," imaging of the arterial wall with no increase in the acquisition time. Taken together, presented data demonstrate that gray and dual blood contrast magnetic resonance imaging provide an efficient means for viewing and characterizing the composition of atherosclerotic plaques.

Reproducibility of high-resolution MRI for the identification and the quantification of carotid atherosclerotic plaque components: consequences for prognosis studies and therapeutic trials

BACKGROUND AND PURPOSE

Although MRI is increasingly proposed to investigate composition of carotid atherosclerosis, its reproducibility has rarely been addressed. We assessed the reproducibility of MRI for the identification and quantification of carotid atherosclerotic plaque components.

METHODS

Using published criteria, 2 readers independently analyzed the carotid MRI (1.5-T MR units with a 4-channel phased-array surface coil, Machnet) of 85 consecutive patients with symptomatic (40% to 69% according to NASCET method) or asymptomatic (60% or greater) carotid artery stenosis enrolled in an ongoing prognostic study. One reader reevaluated all images. Fibrous cap was also secondarily identified independently on T2-weighted and time-of-flight (TOF) images.

RESULTS

Intraobserver agreement was substantial for the identification of calcifications (kappa [kappa]=0.70; 95% CI: 0.54 to 0.86) and lipid-rich/necrotic core (LR/NC) (kappa=0.69; 0.31 to 0.86), almost perfect for hemorrhages (kappa=0.82; 0.68 to 0.96), and moderate (kappa=0.58; 0.27 to 0.88) and fair (kappa=0.33; 0.09 to 0.56) for fibrous cap identification on T2-weighted and TOF images, respectively. Interobserver agreement was substantial for the identification of calcifications (kappa=0.74; 0.59 to 0.89) and hemorrhages (kappa=0.62; 0.43 to 0.81), and moderate for LR/NC (kappa=0.58; 0.20 to 0.95). Agreement was fair for fibrous cap identification on both T2-weighted (kappa=0.28; -0.03 to 0.59) and on TOF images (kappa=0.26; 0.04 to 0.48). Agreement between T2 and TOF images for fibrous cap identification was slight (kappa=0.16; 0.01 to 0.31). Intra- and interobserver reproducibility for quantitative area measurements of vessel, lumen, plaque, LR/NC, and fibrous components was high with intraclass correlation coefficients ranging from 0.73 to 0.99. However, for the LR/NC, the interval delimited by the Bland-Altman graphs was wide in comparison to the mean.

CONCLUSIONS

Vessel and plaque quantification is reproducible. Reproducibility of MRI for identifying and quantifying carotid plaque components is overall acceptable, but there is still significant variability that should be taken into account in the design of prognosis studies and clinical trials. Reproducibility for fibrous cap identification needs to be improved.

High-Resolution 3 T MR Microscopy Imaging of Arterial Walls

PURPOSE

To achieve a high spatial resolution in MR imaging that allows for clear visualization of anatomy and even histology and documentation of plaque morphology in in vitro samples from patients with advanced atherosclerosis. A further objective of our study was to evaluate whether T2-weighted high-resolution MR imaging can provide accurate classification of atherosclerotic plaque according to a modified American Heart Association classification.

METHODS

T2-weighted images of arteries were obtained in 13 in vitro specimens using a 3 T MR unit (Medspec 300 Avance/Bruker, Ettlingen, Germany) combined with a dedicated MR microscopy system. Measurement parameters were: T2-weighted sequences with TR 3.5 sec, TE 15-120 msec; field of view (FOV) 1.4 x 1.4; NEX 8; matrix 192; and slice thickness 600 microm. MR measurements were compared with corresponding histologic sections.

RESULTS

We achieved excellent spatial and contrast resolution in all specimens. We found high agreement between MR images and histology with regard to the morphology and extent of intimal proliferations in all but 2 specimens. We could differentiate fibrous caps and calcifications from lipid plaque components based on differences in signal intensity in order to differentiate hard and soft atheromatous plaques. Hard plaques with predominantly intimal calcifications were found in 7 specimens, and soft plaques with a cholesterol/lipid content in 5 cases. In all specimens, hemorrhage or thrombus formation, and fibrotic and hyalinized tissue could be detected on both MR imaging and histopathology.

CONCLUSION

High-resolution, high-field MR imaging of arterial walls demonstrates the morphologic features, volume, and extent of intimal proliferations with high spatial and contrast resolution in in vitro specimens and can differentiate hard and soft plaques.

Carotid vulnerable lesions are related to accelerated recurrence for cerebral infarction magnetic resonance imaging study

RATIONALE AND OBJECTIVES

We sought to test the hypothesis that magnetic resonance imaging (MRI)-defined vulnerable plaques correlate to accelerated reoccurrence of cerebrovascular events and to evaluate the potential use of MRI in secondary prevention of ischemic stroke.

MATERIALS AND METHODS

Fifty-three symptomatic participants were recruited from patients sustaining their second MRI-confirmed cerebral infarction. Nine participants were women and 44 were men; the mean age was 69.2 years (range, 55-94 years). Patients were imaged within 7 days after the reoccurrence of cerebral infarction. The MRI diagnostic signals defined a classification of lesion type. We compare the interval between two cerebral infarctions with plaque vulnerability defined by the MRI lesion type. We used a Cox proportional hazards model to calculate the relationship between vulnerable lesions and the interval of cerebral infarction, and we followed these patients for 180 days and compared the recurrent rate for the third-time cerebral infarction between patients with and without vulnerable plaque.

RESULTS

The mean infarction recurrence interval for patients with vulnerable lesions was shorter than the mean interval for patients without vulnerable lesion (310.1 versus 1697.2, P< .001). In patients with recurrent cerebral infarction within 1 year, vulnerable lesions were more frequently detected (76% versus 19%, P< .001). The patients with vulnerable lesions had an 8.8-fold higher hazard risk (8.8; P< .001, 95% confidence interval, 3.9-19.7) than those without vulnerable lesions after adjustment for risk factors. For those with vulnerable plaque, the morbidity of third-time cerebral infarction was higher than those without (24% versus 3%, P = .023).

CONCLUSION

MRI-defined vulnerable lesions in carotid arteries are related to accelerated recurrent cerebral infarction and high recurrent rate. MRI demonstrates clinical value in the secondary prevention of cerebral infarction.

Quantitative assessment of coronary artery plaque vulnerability by high-resolution magnetic resonance imaging and computational biomechanics: a pilot study ex vivo

The risk of atherosclerotic plaque disruption is thought to be closely related to plaque composition and rupture triggers such as external mechanical forces. The purpose of this study was to integrate MR imaging and computational techniques for the quantification of plaque vulnerability with morphologic data and biomechanical stress/strain distributions that were all based on high-resolution MR images of coronary artery plaque specimens ex vivo. Twenty-two coronary artery plaque specimens were selectively collected from 10 cadavers. Multislice T(2)-weighted spin echo images were acquired with a resolution of 100 x 100 microm(2). Histopathological images were used as the gold standard for the identification of plaque components and vulnerability. Plaque components were classified on MR images, and the stress/strain components were calculated with a two-dimensional computational model with fluid-structure interactions. As expected, vulnerable plaques appeared to result from a large lipid pool, a thin fibrous cap, and some critical stress/strain conditions. An empiric vulnerability marker was derived and was closely related to the vulnerability score that was determined through pathologic examination. Noninvasive quantification of the MR contrast and mechanical properties of plaque may provide a comprehensive biomarker for the assessment of vulnerability of atherosclerotic plaques.

Multidetector-row computed tomography and magnetic resonance imaging of atherosclerotic lesions in human ex vivo coronary arteries

In the present study, we tested the ability of multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI) to identify and retrospectively characterize atherosclerotic lesions in human ex vivo coronary arteries. Thirteen ex vivo hearts were studied with MDCT and MRI. MDCT-images were obtained with an isotropic voxel size of 0.6mm(3). MR images were obtained with an in-plane resolution of 195 microm and 3mm slice thickness. All images were matched with histopathology sections. For both modalities, the sensitivity for the detection of any atherosclerotic lesion was evaluated, and a retrospective analysis of plaque morphology according to criteria defined by the American Heart Association (AHA) was performed. At histopathology, 28 atherosclerotic lesions were found. 21 and 23 of these lesions were identified by MDCT and MRI, respectively. Both modalities detected a small number of false-positive lesions. After retrospective matching with histopathology, MDCT as well as MRI were able to differentiate typical morpholocigal features for fatty, fibrous or calcified plaque components. Using the information presented in this study, in vivo coronary artery wall imaging using MDCT as well as MRI could be facilitated and supported for future investigations on this subject.

Imaging of carotid artery disease: from luminology to function?

There have been tremendous advances in our ability to image atheromatous disease, particularly in the carotid artery, which is accessible and large enough to image. The repertoire of methodology available is growing, giving anatomical information on luminal narrowing which is approaching the level at which conventional carotid angiography will become very uncommon as CT and contrast-enhanced MR angiographic techniques become the norm. More exciting is the tentative ability to perform functional plaque imaging addressing enhancement patterns and macrophage activity using MR or positron-emission tomography techniques. These techniques, once rigorously evaluated, may, in addition to complex mathematical modelling of plaque, eventually allow us to assess true plaque risk. Time will best judge whether we will be able to move from the use of simple luminology to assessment of plaque function.

Diffusivity- and T2 imaging at 3 Tesla for the detection of degenerative changes in human-excised tissue with high resolution: atherosclerotic arteries

RATIONALE AND OBJECTIVES

We investigated whether it is possible to investigate degenerative changes in human tissue on a sub-100-microm resolution scale not only on special high-field small-bore MR-microscopy systems but also on a 3T whole-body MR-scanner.

METHODS

Spin-spin relaxation, proton density, and diffusion microimaging were investigated in studying human atherosclerotic arteries. Strong diffusion weighting and high spatial resolution was achieved by means of a strong dedicated gradient system and a small birdcage radiofrequency resonator.

RESULTS

Quantitative parameter maps were obtained at voxel sizes down to 73 x 73 x 600 microm3. The morphologic structure and pathology connected to lipid deposits, plaques, small thrombi, and bifurcations were well visualized.

CONCLUSION

High-resolution parameter-weighted and parameter-imaging at sub-100-microm pixel resolution can be achieved for excised tissue on a 3.0 T whole body MR system. Perspectives for the characterization of atherosclerotic plaques imply not only cost advantages but also equivalence of contrast, especially as to T(2), for in vivo and high-resolution ex vivo investigations on the same MR scanner.

In vivo accuracy of multisequence MR imaging for identifying unstable fibrous caps in advanced human carotid plaques

PURPOSE

To evaluate the in vivo accuracy of a multisequence MRI technique for prospectively identifying one feature of the vulnerable plaque-an unstable fibrous cap-in human carotid atherosclerosis.

MATERIALS AND METHODS

The carotid arteries of 18 endarterectomy patients were preoperatively imaged in a 1.5 T scanner using a multisequence protocol that generated four contrast weightings (3D time of flight (ToF), T1, proton density (PD), and T2) at each slice location. With the use of previously published MR criteria, the images of the vessel wall were first examined for evidence of an unstable fibrous cap. The imaging findings were then correlated with the histology from the surgical specimens.

RESULTS

A blinded review of the MR findings with the histologic state of the fibrous cap revealed that 1). assessing the preoperative appearance of the fibrous cap has a high test sensitivity (0.81) and specificity (0.90) for identifying an unstable cap in vivo; and 2). the availability of different contrast weightings facilitated image interpretation when intimal calcifications or flow artifacts obscured the lumen surface.

CONCLUSION

Multisequence MRI can accurately characterize the in vivo state of the fibrous cap. This finding supports the use of these noninvasive techniques to prospectively identify vulnerable plaques.

Multislice double inversion pulse sequence for efficient black-blood MRI

Over the last several years there has been a rapidly growing interest in high-resolution MRI of the vascular wall to assess the extent of atherosclerotic lesions. Vessels of particular clinical relevance are the carotid and coronary arteries. Currently, the preferred imaging sequence for these studies is a "black-blood" technique based on the double-inversion scheme to null the blood signal. A critical drawback of the black-blood technique, however, has been its single-slice nature, as there is only one point in time during the recovery of the blood magnetization from inversion at which the signal is completely nulled. Consequently, the total scan time can become prohibitively long, particularly when an imaging protocol includes several series of these datasets. In this work, a multiple-slice double-inversion technique is described that can reduce the scan time by a factor of two or more. It is demonstrated in vivo with examples from carotid and coronary arteries that one can acquire multiple slices with sufficient nulling of blood, following a single set of inversion pulses.

Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions

Measurement of vessel stenosis by using ultrasonography or angiography remains the principal method for determining the severity of carotid atherosclerosis and the need for endarterectomy. The ipsilateral stroke rate, however--even in patients with severely stenotic vessels--is relatively low, which suggests that the amount of luminal narrowing may not represent the optimal means of assessing clinical risk. As a result, some patients may undergo unnecessary surgery. Improved imaging techniques are, therefore, needed to enable reliable identification of high-risk plaques that lead to cerebrovascular events. High-spatial-resolution magnetic resonance (MR) imaging has been described as one promising modality for this purpose, because the technique allows direct visualization of diseased vessel wall and can be used to characterize the morphology of individual atherosclerotic carotid plaques. The purpose of this report is to review the current state of carotid plaque MR imaging and the use of carotid MR to evaluate plaque morphology and composition.

Carotid plaque characterization by magnetic resonance imaging: review of the literature

Magnetic resonance imaging (MRI) of carotid plaque has undergone significant improvements in the last decade. Early studies utilizing ex vivo specimens and spin-echo or fast spin-echo imaging led to the conclusion that T2 weighting is the best single contrast to characterize carotid plaque morphology. On these images, the fibrous plaque appears bright and the lipid core is dark; thrombus can have variable intensity. There can be an overlap in T2-weighted signal intensities among the various plaque components, which can be partially offset by the use of multispectral analysis of multiple contrast images. With improvements in coil design, sequence design, and main field and gradient capabilities, accurate in vivo differentiation and measurement of these various carotid plaque components should be possible in 3 to 5 years. Ex vivo and in vivo studies have yielded high-resolution measurements of the complex three-dimensional lumen geometry, which are being used to predict hemodynamic forces acting on the lumenal surface. Carotid plaque burden can be accurately measured in vivo today; ongoing longitudinal studies should lead to a better understanding of the relationship between plaque burden and the risk of thromboembolic complications, as well as the effect of diet and drug therapy in hyperlipidemic patients. With these developments in place or soon to be available, MRI of the diseased carotid artery wall may prove to be even more important than magnetic resonance angiography.

Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography

OBJECTIVES

The aim of the present study was to evaluate the accuracy in determining coronary lesion configuration by multislice computed tomography (MSCT). The results were compared with the findings of intracoronary ultrasound (ICUS).

BACKGROUND

The risk of acute coronary syndromes caused by plaque disruption and thrombosis depends on plaque composition rather than stenosis severity. Thus, the reliable noninvasive assessment of plaque configuration would constitute an important step forward for risk stratification in patients with known or suspected coronary artery disease. Just recently, MSCT scanners became available for general purpose scanning. Due to improved spatial and temporal resolution, this new technology holds promise to allow for differentiation of coronary lesion configuration.

METHODS

The ICUS and MSCT scans (Somatom Volume Zoom, Siemens, Forchheim, Germany) were performed in 15 patients. Plaque composition was analyzed according to ICUS (plaque echogenity: soft, intermediate, calcified) and MSCT criteria (plaque density expressed by Hounsfield units [HU]).

RESULTS

Thirty-four plaques were analyzed. With ICUS, the plaques were classified as soft (n = 12), intermediate (n = 5) and calcified (n = 17). Using MSCT, soft plaques had a density of 14 +/- 26 HU (range -42 to +47 HU), intermediate plaques of 91 +/- 21 HU (61 to 112 HU) and calcified plaques of 419 +/- 194 HU (126 to 736 HU). Nonparametric Kruskal-Wallis test revealed a significant difference of plaque density among the three groups (p < 0.0001).

CONCLUSIONS

Our results indicate that coronary lesion configuration might be correctly differentiated by MSCT. Since also rupture-prone soft plaques can be detected by MSCT, this noninvasive method might become an important diagnostic tool for risk stratification in the near future.

Endovascular stent grafting in the presence of aortic neck filling defects: early clinical experience

OBJECTIVE

Although endovascular grafts have been increasingly applied to the treatment of abdominal aortic aneurysms, their use in clinical trials is limited by well-defined anatomical exclusion criteria. One such criterion is the presence of thrombus within the infrarenal neck of an aneurysm, which is thought to (1) prevent the creation of a permanent watertight seal between the graft and the vessel wall, resulting in an endoleak; (2) contribute to stent migration; and (3) increase the risk of thromboembolism. This article summarizes our experience with endovascular abdominal aortic aneurysm exclusion in 19 patients with large aortic aneurysms, significant medical comorbidities, and apparent thrombus extending into the pararenal aortic neck.

METHODS

Of 268 patients undergoing abdominal aortic aneurysm repair, 19 (7%; 17 men; mean age, 71 years) demonstrated computed tomographic and angiographic evidence of intramural filling defects at the level of the aortic neck. In no instance did these filling defects extend above the renal arteries. Endovascular grafting was performed through use of a balloon-expandable Palmaz stent and an expanded polytetrafluoroethylene graft, delivered and deployed under fluoroscopic guidance. Follow-up at 3, 6, and 12 months and annually thereafter was performed with computed tomography and duplex ultrasound scan.

RESULTS

Spiral computed tomography and aortography revealed an irregular flow-limiting defect, occupying up to 75% of the aortic circumference, in every case. The mean aneurysm size, aortic neck diameter, and neck length before the procedure were 6.1, 2.43, and 1.4 cm, respectively; the mean aortic neck diameter after the procedure was 2.61 cm. No primary endoleaks were observed after graft insertion, and no delayed endoleaks have been detected during follow-up, which ranged from 7 to 48 months (mean, 23 months). In one patient, an asymptomatic renal artery embolus was detected on immediate follow-up computed tomography, and in another patient, an asymptomatic posterior tibial embolus occurred.

CONCLUSION

No primary endoleaks, endograft migration, or significant distal embolization were observed after endografting in patients with aortic neck thrombus. The deployment of the fenestrated portion of the stent, above the thrombus and across the renal arteries, allows for effective renal perfusion, graft fixation, and exclusion of potential mural thrombus from the circulation. The presence of aortic neck thrombus may not necessarily be a contraindication to endovascular repair in select patients.

Muscular transverse relaxation time measurement by magnetic resonance imaging at 4 Tesla in normal and dystrophic dy/dy and dy(2j)/dy(2j) mice

Muscular transverse relaxation times values were measured in vivo in normal mice (strain C57BL6/J, n=14) and in murine models of human congenital muscular dystrophy (dy/dy, n=9; dy(2j)/dy(2j), n=8). A single-slice multi-echo sequence was used. Gastrocnemius/soleus complex, thigh and buttock muscles were studied. Muscular transverse relaxation times values were compared between different muscle groups in each type of animal and between animal groups. Differences were observed between normal and dy(2j)/dy(2j) mice from 3 to 12 weeks of age, and between normal and dy/dy mice at 6 weeks. In specific age ranges, the values of muscular transverse relaxation times in two dystrophic models are different from those in normal mice, and could thus be used as an index of modifications in dystrophic muscle to evaluate therapies.

High resolution ex vivo magnetic resonance imaging of in situ coronary and aortic atherosclerotic plaque in a porcine model

Atherosclerotic plaque composition is central to the pathogenesis of plaque disruption and acute thrombosis. Thus, there is a need for accurate imaging and characterization of atherosclerotic lesions. Even though there is no ideal animal model of atherosclerosis, the porcine model is considered to most closely resemble human atherosclerosis. We report the feasibility of MR imaging and characterizing of atherosclerotic lesions from in situ coronary arteries and aortas in an ex vivo setting and validate this with histopathology. Coronary and aortic atherosclerosis was induced in Yucatan mini-swine (n=4) by a combination of atherogenic diet (6 months) and balloon injury. All coronary arteries were imaged ex vivo on the intact heart, preserving the curvature of their course. The aorta also underwent MR imaging. The MR images were correlated with the matched histopathology sections for both the coronary arteries (n=54) and the aortas (n=43). MR imaging accurately characterized complex atherosclerotic lesions, including calcified, lipid rich, fibrocellular and hemorrhagic regions. Mean wall thickness for the coronary arteries (r=0.94, slope: 0.81) and aortas (r=0.94, slope: 0.81) as well as aortic plaque area (r=0.97, slope: 0.90) was accurately determined by MR imaging (P<0.0001). Coronary artery MR imaging is not limited by the curvature of the coronary arteries in the heart. MR imaging accurately quantifies and characterizes coronary and aortic atherosclerotic lesions, including the vessel wall, in this experimental porcine model of complex atherosclerosis. This model may be useful for future study of MR imaging of atherosclerosis in vivo.