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Lombardo P, Lange-Herr N, Hoppe H, Schwendener N, Jackowski C, Klaus J, Zech WD. Diagnostic accuracy of coronary artery stenosis and thrombosis assessment using unenhanced multiplanar 3D post-mortem cardiac magnetic resonance imaging. Forensic Sci Int 2023; 353:111878. [PMID: 37980856 DOI: 10.1016/j.forsciint.2023.111878] [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: 06/23/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND A 3D sequence was introduced to unenhanced post-mortem cardiac magnetic resonance imaging (PMCMR) to enable multiplanar coronary artery image analysis and to investigate its diagnostic accuracy for the diagnosis of coronary artery stenosis and thrombosis. MATERIALS AND METHODS N = 200 forensic cases with suspected coronary artery pathology underwent 3 Tesla PMCMR (sequence used: T2 weighted transversal 3D turbo spin echo) before autopsy. Main coronary artery stenosis and thrombosis were assessed in PMCMR by multiplanar image analysis by two observers. Coronary artery histology was determined as the gold standard and compared to PMCMR. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) with 95% confidence intervals were calculated. RESULTS For all coronary arteries combined, sensitivity was 75% (PPV 73%) for the diagnosis of stenosis and 72% (PPV 71%) for the diagnosis of thrombosis. Specificity was 92% (NPV 90%) for correct diagnosis of non-existing stenosis and 97% (NPV 97%) for non-existing thrombosis. Sensitivity for correct diagnosis of different degrees of stenosis ranged between 67% and 80% (PPVs 67-82%); specificity ranged between 96% and 99% (NPVs 96-99%). CONCLUSION Multiplanar PMCMR coronary artery stenosis and thrombosis assessment based on an unenhanced T2 weighted 3D sequence provide moderate sensitivity and high specificity for the diagnosis of coronary artery stenosis and/or thrombosis. Hence, 3D T2w PMCMR cannot reliably detect existing coronary artery stenosis and thrombosis but may be particularly useful for the exclusion of stenosis or thrombosis of the main coronary arteries.
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Affiliation(s)
- Paolo Lombardo
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Hanno Hoppe
- Department of Radiology, Lindenhofspital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | | | - Jeremias Klaus
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
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Abstract
PURPOSE To test and validate magnetic resonance imaging (MRI) sequences for peripheral artery lesion characterization and relate the MRI characteristics to the amount of force required for a guidewire to puncture peripheral chronic total occlusions (CTOs) as a surrogate for immediate failure of endovascular therapy. METHODS Diseased superficial femoral, popliteal, and tibial artery segments containing 55 atherosclerotic lesions were excised from the amputated limbs of 7 patients with critical limb ischemia. The lesions were imaged at high resolution (75 μm3 voxels) with T2-weighted (T2W) and ultrashort echo time (UTE) sequences on a 7-T MR scanner. The MR images (n=15) were validated with micro-computed tomography and histology. CTOs (n=40) were classified by their MR signal characteristics as "soft" (signals indicating fat, thrombus, microchannels, or loose fibrous tissue), "hard" (collagen and/or speckled calcium signals), or "calcified" (calcified nodule signals). A 2-kg load cell advanced the back end of a 0.035-inch stiff guidewire at a fixed displacement rate (0.05 mm/s) through the CTOs, and the forces required to cross each lesion were measured. RESULTS T2W images showed fat as hyperintense and hardened tissue as hypointense. Calcium and thrombus appeared as a signal void in conventional MRI sequences but were easily identified in UTE images (thrombus was hyperintense and calcium hypointense). MRI accurately differentiated "hard," "soft," and "calcified" CTOs based on associated guidewire puncture force. The guidewire could not enter "calcified" CTOs (n=6) at all. "Hard" CTOs (n=9) required a significantly higher (p<0.001) puncture force of 1.71±0.51 N vs 0.43±0.36 N for "soft" CTOs (n=25). CONCLUSION MRI characteristics of PAD lesions correlate with guidewire puncture forces, an important aspect of crossability. Future work will determine if clinical MR scanners can be used to predict success in peripheral vascular interventions.
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Affiliation(s)
- Trisha Roy
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2 Division of Vascular Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Garry Liu
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3 Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Noor Shaikh
- 4 Division of Engineering Science, University of Toronto, Ontario, Canada
| | - Andrew D Dueck
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2 Division of Vascular Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Graham A Wright
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3 Department of Medical Biophysics, University of Toronto, Ontario, Canada
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Károlyi M, Seifarth H, Liew G, Schlett CL, Maurovich-Horvat P, Stolzmann P, Dai G, Huang S, Goergen CJ, Nakano M, Otsuka F, Virmani R, Hoffmann U, Sosnovik DE. Classification of coronary atherosclerotic plaques ex vivo with T1, T2, and ultrashort echo time CMR. JACC Cardiovasc Imaging 2013; 6:466-74. [PMID: 23498670 PMCID: PMC3661771 DOI: 10.1016/j.jcmg.2012.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/04/2012] [Accepted: 09/06/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to determine whether the classification of human coronary atherosclerotic plaques with T1, T2, and ultrashort echo time (UTE) cardiac magnetic resonance (CMR) would correlate well with atherosclerotic plaque classification by histology. BACKGROUND CMR has been extensively used to classify carotid plaque, but its ability to characterize coronary plaque remains unknown. In addition, the detection of plaque calcification by CMR remains challenging. Here, we used T1, T2, and UTE CMR to evaluate atherosclerotic plaques in fixed post-mortem human coronary arteries. We hypothesized that the combination of T1, T2, and UTE CMR would allow both calcified and lipid-rich coronary plaques to be accurately detected. METHODS Twenty-eight plaques from human donor hearts with proven coronary artery disease were imaged at 9.4-T with a T1-weighted 3-dimensional fast low-angle shot (FLASH) sequence (250-μm resolution), a T2-weighted rapid acquisition with refocused echoes (RARE) sequence (in-plane resolution 0.156 mm), and an UTE sequence (300-μm resolution). Plaques showing selective hypointensity on T2-weighted CMR were classified as lipid-rich. Areas of hypointensity on the T1-weighted images, but not the UTE images, were classified as calcified. Hyperintensity on the T1-weighted and UTE images was classified as hemorrhage. Following CMR, histological characterization of the plaques was performed with a pentachrome stain and established American Heart Association criteria. RESULTS CMR showed high sensitivity and specificity for the detection of calcification (100% and 90%, respectively) and lipid-rich necrotic cores (90% and 75%, respectively). Only 2 lipid-rich foci were missed by CMR, both of which were extremely small. Overall, CMR-based classification of plaque was in complete agreement with the histological classification in 22 of 28 cases (weighted κ = 0.6945, p < 0.0001). CONCLUSIONS The utilization of UTE CMR allows plaque calcification in the coronary arteries to be robustly detected. High-resolution CMR with T1, T2, and UTE contrast enables accurate classification of human coronary atherosclerotic plaque.
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Affiliation(s)
- Mihály Károlyi
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Harald Seifarth
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Gary Liew
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Christopher L. Schlett
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Pál Maurovich-Horvat
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Paul Stolzmann
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Guangping Dai
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Shuning Huang
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Craig J. Goergen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | | | | | - Udo Hoffmann
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David E. Sosnovik
- Cardiac MR/PET/CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Li F, McDermott MM, Li D, Carroll TJ, Hippe DS, Kramer CM, Fan Z, Zhao X, Hatsukami TS, Chu B, Wang J, Yuan C. The association of lesion eccentricity with plaque morphology and components in the superficial femoral artery: a high-spatial-resolution, multi-contrast weighted CMR study. J Cardiovasc Magn Reson 2010; 12:37. [PMID: 20591197 PMCID: PMC2904754 DOI: 10.1186/1532-429x-12-37] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 07/01/2010] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Atherosclerotic plaque morphology and components are predictors of subsequent cardiovascular events. However, associations of plaque eccentricity with plaque morphology and plaque composition are unclear. This study investigated associations of plaque eccentricity with plaque components and morphology in the proximal superficial femoral artery using cardiovascular magnetic resonance (CMR). METHODS Twenty-eight subjects with an ankle-brachial index less than 1.00 were examined with 1.5 T high-spatial-resolution, multi-contrast weighted CMR. One hundred and eighty diseased locations of the proximal superficial femoral artery (about 40 mm) were analyzed. The eccentric lesion was defined as [(Maximum wall thickness- Minimum wall thickness)/Maximum wall thickness] >or= 0.5. The arterial morphology and plaque components were measured using semi-automatic image analysis software. RESULTS One hundred and fifteen locations were identified as eccentric lesions and sixty-five as concentric lesions. The eccentric lesions had larger wall but similar lumen areas, larger mean and maximum wall thicknesses, and more calcification and lipid rich necrotic core, compared to concentric lesions. For lesions with the same lumen area, the degree of eccentricity was associated with an increased wall area. Eccentricity (dichotomous as eccentric or concentric) was independently correlated with the prevalence of calcification (odds ratio 3.78, 95% CI 1.47-9.70) after adjustment for atherosclerotic risk factors and wall area. CONCLUSIONS Plaque eccentricity is associated with preserved lumen size and advanced plaque features such as larger plaque burden, more lipid content, and increased calcification in the superficial femoral artery.
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Affiliation(s)
- Feiyu Li
- Department of Radiology, Peking University First Hospital, Beijing, China
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Mary McGrae McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Debiao Li
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Timothy J Carroll
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Christopher M Kramer
- Departments of Radiology and Medicine, University of Virginia, Charlottesville, VA, USA
| | - Zhaoyang Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Xihai Zhao
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, NY, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Quantification of calcifications in endarterectomy samples by means of high-resolution ultra-short echo time imaging. Invest Radiol 2010; 45:109-13. [PMID: 20065858 DOI: 10.1097/rli.0b013e3181c8cefa] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) has proven its value for noninvasive assessment and classification of atherosclerotic lesions. MRI provides excellent access to soft tissue information, but its capability for assessing calcified segments of the lesion remains limited. The aim of this study was to investigate the ultra-short echo time (UTE) sequence for accurate quantification of the plaque volumes and qualitative assessment of the calcium density. MATERIAL AND METHODS Images of 35 endarterectomy samples were acquired by a high-resolution UTE sequence (TE = 50 micros) technique and compared with the conventional gradient echo (fast field echo) approach, volume computed tomography, and histology. RESULTS The UTE technique yielded accurate quantification of the volume of the calcification as well as enabled qualitative assessment of the calcium density according to the resulting relative signal intensity. In comparison, the fast field echo technique yielded an average overestimation of the lesion size by about 35% and the low signal intensity did not allow a clear delineation of the different calcium densities. CONCLUSIONS The presented data provide evidence that incorporation of the UTE technique in today's MRI protocols for plaque classification holds the potential to add the missing important information on calcium volume and density solely based on MRI data.
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Syed MA, Oshinski JN, Kitchen C, Ali A, Charnigo RJ, Quyyumi AA. Variability of carotid artery measurements on 3-Tesla MRI and its impact on sample size calculation for clinical research. Int J Cardiovasc Imaging 2009; 25:581-9. [PMID: 19459065 DOI: 10.1007/s10554-009-9468-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 04/30/2009] [Indexed: 11/26/2022]
Abstract
Carotid MRI measurements are increasingly being employed in research studies for atherosclerosis imaging. The majority of carotid imaging studies use 1.5 T MRI. Our objective was to investigate intra-observer and inter-observer variability in carotid measurements using high resolution 3 T MRI. We performed 3 T carotid MRI on 10 patients (age 56 +/- 8 years, 7 male) with atherosclerosis risk factors and ultrasound intima-media thickness > or =0.6 mm. A total of 20 transverse images of both right and left carotid arteries were acquired using T2 weighted black-blood sequence. The lumen and outer wall of the common carotid and internal carotid arteries were manually traced; vessel wall area, vessel wall volume, and average wall thickness measurements were then assessed for intra-observer and inter-observer variability. Pearson and intraclass correlations were used in these assessments, along with Bland-Altman plots. For inter-observer variability, Pearson correlations ranged from 0.936 to 0.996 and intraclass correlations from 0.927 to 0.991. For intra-observer variability, Pearson correlations ranged from 0.934 to 0.954 and intraclass correlations from 0.831 to 0.948. Calculations showed that inter-observer variability and other sources of error would inflate sample size requirements for a clinical trial by no more than 7.9%, indicating that 3 T MRI is nearly optimal in this respect. In patients with subclinical atherosclerosis, 3 T carotid MRI measurements are highly reproducible and have important implications for clinical trial design.
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Affiliation(s)
- Mushabbar A Syed
- Gill Heart Institute, University of Kentucky, Lexington, KY 40536, USA.
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Patola W. MRI in 2007 – The state of the art. Radiography (Lond) 2007. [DOI: 10.1016/j.radi.2007.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sun B, Giddens DP, Long R, Taylor WR, Weiss D, Joseph G, Vega D, Oshinski JN. Automatic plaque characterization employing quantitative and multicontrast MRI. Magn Reson Med 2007; 59:174-80. [DOI: 10.1002/mrm.21279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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