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Tachikawa Y, Maki Y, Ikeda K, Yoshikai H, Toyonari N, Hamano H, Chiwata N, Suzuyama K, Takahashi Y. Flow independent black blood imaging with a large FOV from the neck to the aortic arch: A feasibility study at 3 tesla. Magn Reson Imaging 2024; 108:77-85. [PMID: 38331052 DOI: 10.1016/j.mri.2024.02.001] [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: 09/08/2023] [Revised: 02/03/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To investigate the feasibility of obtaining black-blood imaging with a large FOV from the neck to the aortic arch at 3 T using a newly modified Relaxation-Enhanced Angiography without Contrast and Triggering for Black-Blood Imaging (REACT-BB). MATERIALS AND METHODS REACT-BB provides black-blood images by adjusting the inversion time (TI) in REACT to the null point of blood. The optimal TI for REACT-BB was investigated in 10 healthy volunteers with TI varied from 200 ms to 1400 ms. Contrast ratios were calculated between muscle and three branch arteries of the aortic arch. Additionally, a comparison between REACT-BB and MPRAGE involved evaluating the depiction of high-intensity plaques in 222 patients with stroke or transient ischemic attack. Measurements included plaque-to-muscle signal intensity ratios (PMR), plaque volumes, and carotid artery stenosis rates in 60 patients with high-intensity plaques in carotid arteries. RESULTS REACT-BB with TI = 850 ms produced the black-blood image with the best contrast between blood and background tissues. REACT-BB outperformed MPRAGE in depicting high-intensity plaques in the aortic arch (55.4% vs 45.5%) and exhibited superior overall image quality in visual assessment (3.31 ± 0.70 vs 2.89 ± 0.73; p < 0.05). Although the PMR of REACT-BB was significantly lower than MPRAGE (2.227 ± 0.601 vs 2.285 ± 0.662; P < 0.05), a strong positive correlation existed between REACT-BB and MPRAGE (ρ = 0.935; P < 0.05), and all high-intensity plaques that MPRAGE detected were clearly detected by REACT-BB. CONCLUSION REACT-BB provides black-blood images with uniformly suppressed fat and blood signals over a large FOV from the neck to the aortic arch with comparable or better high-signal plaque depiction than MPRAGE.
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Affiliation(s)
- Yoshihiko Tachikawa
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan.
| | - Yasunori Maki
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Kento Ikeda
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Hikaru Yoshikai
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Nobuyuki Toyonari
- Department of Radiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto 862-0962, Japan
| | - Hiroshi Hamano
- Philips Japan, Philips Building, 2-13-37 Kohnan, Minato-ku, Tokyo 108-8507, Japan
| | - Naoya Chiwata
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Kenji Suzuyama
- Department of Neurosurgery, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Yukihiko Takahashi
- Department of Radiology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
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2
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He Y, Northrup H, Le H, Cheung AK, Berceli SA, Shiu YT. Medical Image-Based Computational Fluid Dynamics and Fluid-Structure Interaction Analysis in Vascular Diseases. Front Bioeng Biotechnol 2022; 10:855791. [PMID: 35573253 PMCID: PMC9091352 DOI: 10.3389/fbioe.2022.855791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 01/17/2023] Open
Abstract
Hemodynamic factors, induced by pulsatile blood flow, play a crucial role in vascular health and diseases, such as the initiation and progression of atherosclerosis. Computational fluid dynamics, finite element analysis, and fluid-structure interaction simulations have been widely used to quantify detailed hemodynamic forces based on vascular images commonly obtained from computed tomography angiography, magnetic resonance imaging, ultrasound, and optical coherence tomography. In this review, we focus on methods for obtaining accurate hemodynamic factors that regulate the structure and function of vascular endothelial and smooth muscle cells. We describe the multiple steps and recent advances in a typical patient-specific simulation pipeline, including medical imaging, image processing, spatial discretization to generate computational mesh, setting up boundary conditions and solver parameters, visualization and extraction of hemodynamic factors, and statistical analysis. These steps have not been standardized and thus have unavoidable uncertainties that should be thoroughly evaluated. We also discuss the recent development of combining patient-specific models with machine-learning methods to obtain hemodynamic factors faster and cheaper than conventional methods. These critical advances widen the use of biomechanical simulation tools in the research and potential personalized care of vascular diseases.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - Hannah Northrup
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ha Le
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
- Vascular Surgery Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Yan Tin Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
- *Correspondence: Yan Tin Shiu,
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3
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Wu J, Xin J, Yang X, Sun J, Xu D, Zheng N, Yuan C. Deep morphology aided diagnosis network for segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black-blood vessel wall MRI. Med Phys 2019; 46:5544-5561. [PMID: 31356693 DOI: 10.1002/mp.13739] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/14/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Early detection of carotid atherosclerosis on the vessel wall (VW) magnetic resonance imaging (MRI) (VW-MRI) images can prevent the progression of cardiovascular disease. However, the manual inspection process of the VW-MRI images is cumbersome and has low reproducibility. Therefore in this paper, by using the convolutional neural networks (CNNs), we develop a deep morphology aided diagnosis (DeepMAD) network for automated segmentation of the VW of carotid artery and for automated diagnosis of the carotid atherosclerosis with the black-blood (BB) VW-MRI (i.e., the T1-weighted MRI) in a slice-by-slice manner. METHODS The proposed DeepMAD network consists of a segmentation subnetwork and a diagnosis subnetwork for performing the segmentation and diagnosis tasks on the BB-VW-MRI images, where the manual labeled lumen area, the manual labeled outer wall area and the manual labeled lesion Types based on the modified American Heart Association (AHA) criteria are used as the ground-truth. Specifically, a deep U-shape CNN with a weighted fusion layer is designed as the segmentation subnetwork, where the lumen area and the outer wall area can be simultaneously segmented under the supervision of the triple Dice loss to provide the vessel wall map as morphological information. Then, the image stream from the BB-VWMRI image and the morphology stream from the obtained vessel wall map are extracted from two deep CNNs and combined to obtain the diagnosis results of atherosclerosis in the diagnosis subnetwork. In addition, the triple input set is formed by three carotid regions of interest (ROIs) from three consecutive slices of the MRI sequence and input to the DeepMAD network, where the first and last slices used as additional adjacent slices to provide 2.5D spatial information along the carotid artery centerline for the intermediate slice, which is the target slice for segmentation and diagnosis in the study. RESULTS Compared to other existing methods, the DeepMAD network can achieve promising segmentation performances (0.9594 Dice for the lumen and 0.9657 Dice for the outer wall) and better diagnosis Accuracy of the carotid atherosclerosis (0.9503 AUC and 0.8916 Accuracy) in the test dataset (including invisible subjects) from same source as the training dataset. In addition, the trained DeepMAD model can be successfully transferred to another test dataset for segmentation and diagnosis tasks with remarkable performance (0.9475 Dice for the lumen and 0.9542 Dice for the outer wall, 0. 9227 AUC and 0.8679 Accuracy for diagnosis). CONCLUSIONS Even without the intervention of reviewers required for previous works, the proposed DeepMAD network automatically segments the lumen and the outer wall together and diagnoses the carotid atherosclerosis with high performances. The DeepMAD network can be used in clinical trials to help radiologists get rid of tedious reading tasks, such as screening review to separate the normal carotid from the atherosclerotic arteries and outlining the vessel wall contours.
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Affiliation(s)
- Jiayi Wu
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jingmin Xin
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Nanning Zheng
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Yuan J, Usman A, Reid SA, King KF, Patterson AJ, Gillard JH, Graves MJ. Three-dimensional black-blood multi-contrast carotid imaging using compressed sensing: a repeatability study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:183-190. [PMID: 28653214 PMCID: PMC5813054 DOI: 10.1007/s10334-017-0640-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this work is to evaluate the repeatability of a compressed sensing (CS) accelerated multi-contrast carotid protocol at 3 T. MATERIALS AND METHODS Twelve volunteers and eight patients with carotid disease were scanned on a 3 T MRI scanner using a CS accelerated 3-D black-blood multi-contrast protocol which comprises T 1w, T 2w and PDw without CS, and with a CS factor of 1.5 and 2.0. The volunteers were scanned twice, the lumen/wall area and wall thickness were measured for each scan. Eight patients were scanned once, the inter/intra-observer reproducibility of the measurements was calculated. RESULTS In the repeated volunteer scans, the interclass correlation coefficient (ICC) for the wall area measurement using a CS factor of 1.5 in PDw, T 1w and T 2w were 0.95, 0.81, and 0.97, respectively. The ICC for lumen area measurement using a CS factor of 1.5 in PDw, T 1w and T 2w were 0.96, 0.92, and 0.96, respectively. In patients, the ICC for inter/intra-observer measurements of lumen/wall area, and wall thickness were all above 0.81 in all sequences. CONCLUSION The results show a CS accelerated 3-D black-blood multi-contrast protocol is a robust and reproducible method for carotid imaging. Future protocol design could use CS to reduce the scanning time.
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Affiliation(s)
- Jianmin Yuan
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK.
| | - Ammara Usman
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
| | | | | | - Andrew J Patterson
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jonathan H Gillard
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Martin J Graves
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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5
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Kerwin WS, Miller Z, Yuan C. Imaging of the high-risk carotid plaque: magnetic resonance imaging. Semin Vasc Surg 2017; 30:54-61. [PMID: 28818259 DOI: 10.1053/j.semvascsurg.2017.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The emergence of the concept of high-risk atherosclerotic plaque has led to considerable interest in noninvasive imaging techniques to identify high-risk features before clinical sequelae. For plaques in the carotid arteries, magnetic resonance imaging has undergone considerable histologic validation to link imaging features to indicators of plaque instability, including plaque burden, intraplaque hemorrhage, fibrous cap disruption, lipid rich necrotic core, and calcification. Recently introduced imaging technologies, especially those focused on three-dimensional imaging sequences, are now poised for integration into the clinical workup of patients with suspected carotid atherosclerosis. The purpose of this article is to review the carotid plaque magnetic resonance imaging techniques that are most ready for integration into the clinic.
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Affiliation(s)
- William S Kerwin
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Zach Miller
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Chun Yuan
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109.
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6
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Meloni MM, Barton S, Xu L, Kaski JC, Song W, He T. Contrast agents for cardiovascular magnetic resonance imaging: an overview. J Mater Chem B 2017; 5:5714-5725. [DOI: 10.1039/c7tb01241a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Contrast agents for Cardiovascular Magnetic Resonance (CMR) play a major role in research and clinical cardiology.
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Affiliation(s)
- Marco M. Meloni
- Molecular and Clinical Sciences Research Institute
- St George's, University of London
- London
- UK
- School of Pharmacy and Chemistry
| | - Stephen Barton
- School of Pharmacy and Chemistry
- Kingston University
- London
- UK
| | - Lei Xu
- Department of Radiology
- Beijing Anzhen Hospital
- Beijing
- China
| | - Juan C. Kaski
- Molecular and Clinical Sciences Research Institute
- St George's, University of London
- London
- UK
| | - Wenhui Song
- UCL Centre for Biomaterials
- Division of surgery & Interventional Science
- University College of London
- London
- UK
| | - Taigang He
- Molecular and Clinical Sciences Research Institute
- St George's, University of London
- London
- UK
- Royal Brompton Hospital
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7
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Lekadir K, Galimzianova A, Betriu A, Del Mar Vila M, Igual L, Rubin DL, Fernandez E, Radeva P, Napel S. A Convolutional Neural Network for Automatic Characterization of Plaque Composition in Carotid Ultrasound. IEEE J Biomed Health Inform 2016; 21:48-55. [PMID: 27893402 DOI: 10.1109/jbhi.2016.2631401] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Characterization of carotid plaque composition, more specifically the amount of lipid core, fibrous tissue, and calcified tissue, is an important task for the identification of plaques that are prone to rupture, and thus for early risk estimation of cardiovascular and cerebrovascular events. Due to its low costs and wide availability, carotid ultrasound has the potential to become the modality of choice for plaque characterization in clinical practice. However, its significant image noise, coupled with the small size of the plaques and their complex appearance, makes it difficult for automated techniques to discriminate between the different plaque constituents. In this paper, we propose to address this challenging problem by exploiting the unique capabilities of the emerging deep learning framework. More specifically, and unlike existing works which require a priori definition of specific imaging features or thresholding values, we propose to build a convolutional neural network (CNN) that will automatically extract from the images the information that is optimal for the identification of the different plaque constituents. We used approximately 90 000 patches extracted from a database of images and corresponding expert plaque characterizations to train and to validate the proposed CNN. The results of cross-validation experiments show a correlation of about 0.90 with the clinical assessment for the estimation of lipid core, fibrous cap, and calcified tissue areas, indicating the potential of deep learning for the challenging task of automatic characterization of plaque composition in carotid ultrasound.
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8
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Coolen BF, Poot DH, Liem MI, Smits LP, Gao S, Kotek G, Klein S, Nederveen AJ. Three‐dimensional quantitative T
1
and T
2
mapping of the carotid artery: Sequence design and in vivo feasibility. Magn Reson Med 2016; 75:1008-17. [DOI: 10.1002/mrm.25634] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/17/2014] [Accepted: 01/05/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Bram F. Coolen
- Department of RadiologyAcademic Medical CenterAmsterdam the Netherlands
| | - Dirk H.J. Poot
- Biomedical Imaging Group Rotterdam, Depts. of Radiology and Medical InformaticsErasmus Medical CenterRotterdam the Netherlands
- Quantitative Imaging Group, Department of Imaging PhysicsDelft University of TechnologyDelft The Netherlands
| | - Madieke I. Liem
- Department of NeurologyAcademic Medical CenterAmsterdam the Netherlands
| | - Loek P. Smits
- Department of Vascular MedicineAcademic Medical CenterAmsterdam the Netherlands
| | - Shan Gao
- Department of Radiology, Division of Image ProcessingLeiden University Medical CenterLeiden The Netherlands
| | - Gyula Kotek
- Department of RadiologyErasmus Medical CenterRotterdam the Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Depts. of Radiology and Medical InformaticsErasmus Medical CenterRotterdam the Netherlands
| | - Aart J. Nederveen
- Department of RadiologyAcademic Medical CenterAmsterdam the Netherlands
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9
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Speelman L, Teng Z, Nederveen AJ, van der Lugt A, Gillard JH. MRI-based biomechanical parameters for carotid artery plaque vulnerability assessment. Thromb Haemost 2016; 115:493-500. [PMID: 26791734 DOI: 10.1160/th15-09-0712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/13/2015] [Indexed: 12/18/2022]
Abstract
Carotid atherosclerotic plaques are a major cause of ischaemic stroke. The biomechanical environment to which the arterial wall and plaque is subjected to plays an important role in the initiation, progression and rupture of carotid plaques. MRI is frequently used to characterize the morphology of a carotid plaque, but new developments in MRI enable more functional assessment of carotid plaques. In this review, MRI based biomechanical parameters are evaluated on their current status, clinical applicability, and future developments. Blood flow related biomechanical parameters, including endothelial wall shear stress and oscillatory shear index, have been shown to be related to plaque formation. Deriving these parameters directly from MRI flow measurements is feasible and has great potential for future carotid plaque development prediction. Blood pressure induced stresses in a plaque may exceed the tissue strength, potentially leading to plaque rupture. Multi-contrast MRI based stress calculations in combination with tissue strength assessment based on MRI inflammation imaging may provide a plaque stress-strength balance that can be used to assess the plaque rupture risk potential. Direct plaque strain analysis based on dynamic MRI is already able to identify local plaque displacement during the cardiac cycle. However, clinical evidence linking MRI strain to plaque vulnerability is still lacking. MRI based biomechanical parameters may lead to improved assessment of carotid plaque development and rupture risk. However, better MRI systems and faster sequences are required to improve the spatial and temporal resolution, as well as increase the image contrast and signal-to-noise ratio.
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Affiliation(s)
- Lambert Speelman
- Dr. Lambert Speelman, Department of Biomedical Engineering, Ee 23.38B, P.O Box 2040, 3000 CA Rotterdam, the Netherlands, Tel.: +31 10 70 44039, Fax: +31 10 70 44720, E-mail:
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10
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Abstract
Plaque imaging by MR imaging provides a wealth of information on the characteristics of individual plaque that may reveal vulnerability to rupture, likelihood of progression, or optimal treatment strategy. T1-weighted and T2-weighted images among other options reveal plaque morphology and composition. Dynamic contrast-enhanced-MR imaging reveals plaque activity. To extract this information, image processing tools are needed. Numerous approaches for analyzing such images have been developed, validated against histologic gold standards, and used in clinical studies. These efforts are summarized in this article.
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Affiliation(s)
- Huijun Chen
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Room No. 109, Haidian District, Beijing, China
| | - Qiang Zhang
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Room No. 120, Haidian District, Beijing, China
| | - William Kerwin
- Department of Radiology, School of Medicine, University of Washington, 850 Republican Street, Seattle, WA 98109, USA.
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In vivo semi-automatic segmentation of multicontrast cardiovascular magnetic resonance for prospective cohort studies on plaque tissue composition: initial experience. Int J Cardiovasc Imaging 2015; 32:73-81. [PMID: 26169389 DOI: 10.1007/s10554-015-0704-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
Automatic in vivo segmentation of multicontrast (multisequence) carotid magnetic resonance for plaque composition has been proposed as a substitute for manual review to save time and reduce inter-reader variability in large-scale or multicenter studies. Using serial images from a prospective longitudinal study, we sought to compare a semi-automatic approach versus expert human reading in analyzing carotid atherosclerosis progression. Baseline and 6-month follow-up multicontrast carotid images from 59 asymptomatic subjects with 16-79 % carotid stenosis were reviewed by both trained radiologists with 2-4 years of specialized experience in carotid plaque characterization with MRI and a previously reported automatic atherosclerotic plaque segmentation algorithm, referred to as morphology-enhanced probabilistic plaque segmentation (MEPPS). Agreement on measurements from individual time points, as well as on compositional changes, was assessed using the intraclass correlation coefficient (ICC). There was good agreement between manual and MEPPS reviews on individual time points for calcification (CA) (area: ICC; 0.85-0.91; volume: ICC; 0.92-0.95) and lipid-rich necrotic core (LRNC) (area: ICC; 0.78-0.82; volume: ICC; 0.84-0.86). For compositional changes, agreement was good for CA volume change (ICC; 0.78) and moderate for LRNC volume change (ICC; 0.49). Factors associated with LRNC progression as detected by MEPPS review included intraplaque hemorrhage (positive association) and reduction in low-density lipoprotein cholesterol (negative association), which were consistent with previous findings from manual review. Automatic classifier for plaque composition produced results similar to expert manual review in a prospective serial MRI study of carotid atherosclerosis progression. Such automatic classification tools may be beneficial in large-scale multicenter studies by reducing image analysis time and avoiding bias between human reviewers.
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12
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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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13
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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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14
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Sun J, Zhao XQ, Balu N, Hippe DS, Hatsukami TS, Isquith DA, Yamada K, Neradilek MB, Cantón G, Xue Y, Fleg JL, Desvigne-Nickens P, Klimas MT, Padley RJ, Vassileva MT, Wyman BT, Yuan C. Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study. Int J Cardiovasc Imaging 2014; 31:95-103. [PMID: 25216871 DOI: 10.1007/s10554-014-0532-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98-0.99) and compositional (ICC range 0.88-0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5-4.9 % for morphology, 36-44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican St Brotman 127, Seattle, WA, 98109, USA,
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15
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DeMarco JK, Huston J. Imaging of high-risk carotid artery plaques: current status and future directions. Neurosurg Focus 2014; 36:E1. [PMID: 24380475 DOI: 10.3171/2013.10.focus13384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper, the authors review the definition of high-risk plaque as developed by experienced researchers in atherosclerosis, including pathologists, clinicians, molecular biologists, and imaging scientists. Current concepts of vulnerable plaque are based on histological studies of coronary and carotid artery plaque as well as natural history studies and include the presence of a lipid-rich necrotic core with an overlying thin fibrous cap, plaque inflammation, fissured plaque, and intraplaque hemorrhage. The extension of these histologically identified high-risk carotid plaque features to human in vivo MRI is reviewed as well. The authors also assess the ability of in vivo MRI to depict these vulnerable carotid plaque features. Next, the ability of these MRI-demonstrated high-risk carotid plaque features to predict the risk of ipsilateral carotid thromboembolic events is reviewed and compared with the risk assessment provided by simple carotid artery stenosis measurements. Lastly, future directions of high-risk carotid plaque MRI are discussed, including the potential for increased clinical availability and more automated analysis of carotid plaque MRI. The ultimate goal of high-risk plaque imaging is to design and run future multicenter trials using carotid plaque MRI to guide individual patient selection and decisions about optimal atherosclerotic treatment strategies.
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Affiliation(s)
- J Kevin DeMarco
- Department of Radiology, Michigan State University, East Lansing, Michigan; and
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16
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Teresa Albelda M, Garcia-España E, Frias JC. Visualizing the atherosclerotic plaque: a chemical perspective. Chem Soc Rev 2014; 43:2858-76. [PMID: 24526041 DOI: 10.1039/c3cs60410a] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis is the major underlying pathologic cause of coronary artery disease. An early detection of the disease can prevent clinical sequellae such as angina, myocardial infarction, and stroke. The different imaging techniques employed to visualize the atherosclerotic plaque provide information of diagnostic and prognostic value. Furthermore, the use of contrast agents helps to improve signal-to-noise ratio providing better images. For nuclear imaging techniques and optical imaging these agents are absolutely necessary. We report on the different contrast agents that have been used, are used or may be used in future in animals, humans, or excised tissues for the distinct imaging modalities for atherosclerotic plaque imaging.
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Affiliation(s)
- Ma Teresa Albelda
- Universidad de Valencia, Instituto de Ciencia Molecular, Edificio de Institutos de Paterna, c/ Catedrático José Beltrán 2, 46071 Valencia, Spain
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17
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Nieuwstadt HA, Speelman L, Breeuwer M, van der Lugt A, van der Steen AFW, Wentzel JJ, Gijsen FJH. The Influence of Inaccuracies in Carotid MRI Segmentation on Atherosclerotic Plaque Stress Computations. J Biomech Eng 2014; 136:021015. [DOI: 10.1115/1.4026178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/09/2013] [Indexed: 11/08/2022]
Abstract
Biomechanical finite element analysis (FEA) based on in vivo carotid magnetic resonance imaging (MRI) can be used to assess carotid plaque vulnerability noninvasively by computing peak cap stress. However, the accuracy of MRI plaque segmentation and the influence this has on FEA has remained unreported due to the lack of a reliable submillimeter ground truth. In this study, we quantify this influence using novel numerical simulations of carotid MRI. Histological sections from carotid plaques from 12 patients were used to create 33 ground truth plaque models. These models were subjected to numerical computer simulations of a currently used clinically applied 3.0 T T1-weighted black-blood carotid MRI protocol (in-plane acquisition voxel size of 0.62 × 0.62 mm2) to generate simulated in vivo MR images from a known underlying ground truth. The simulated images were manually segmented by three MRI readers. FEA models based on the MRI segmentations were compared with the FEA models based on the ground truth. MRI-based FEA model peak cap stress was consistently underestimated, but still correlated (R) moderately with the ground truth stress: R = 0.71, R = 0.47, and R = 0.76 for the three MRI readers respectively (p < 0.01). Peak plaque stretch was underestimated as well. The peak cap stress in thick-cap, low stress plaques was substantially more accurately and precisely predicted (error of −12 ± 44 kPa) than the peak cap stress in plaques with caps thinner than the acquisition voxel size (error of −177 ± 168 kPa). For reliable MRI-based FEA to compute the peak cap stress of carotid plaques with thin caps, the current clinically used in-plane acquisition voxel size (∼0.6 mm) is inadequate. FEA plaque stress computations would be considerably more reliable if they would be used to identify thick-cap carotid plaques with low stresses instead.
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18
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Zhu C, Sadat U, Patterson AJ, Teng Z, Gillard JH, Graves MJ. 3D high-resolution contrast enhanced MRI of carotid atheroma--a technical update. Magn Reson Imaging 2014; 32:594-7. [PMID: 24630443 DOI: 10.1016/j.mri.2014.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 01/21/2014] [Accepted: 01/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Development of a fast 3D high-resolution magnetic resonance imaging (MRI) protocol for improved carotid artery plaque imaging. METHODS Two patients with carotid atherosclerosis disease underwent 3D high-resolution MRI which included time-of-flight and T1-weighted variable flip angle, fast-spin-echo (FSE) imaging, pre- and post-intravenous gadolinium-based contrast agent administration. RESULTS Good quality images with intrinsic blood suppression were obtained pre- and post-contrast administration using a 3D FSE sequence. The plaque burden, lipid core volume, hemorrhage volume and fibrous cap thickness were well determined. CONCLUSIONS 3D high-resolution MR imaging of carotid plaque using TOF and 3D FSE can achieve high isotropic resolution, large coverage, and excellent image quality within a short acquisition time.
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Affiliation(s)
- Chengcheng Zhu
- University Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - Umar Sadat
- Vascular Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Andrew J Patterson
- University Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Zhongzhao Teng
- University Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Jonathan H Gillard
- University Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Martin J Graves
- University Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
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19
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Ukwatta E, Yuan J, Rajchl M, Qiu W, Tessier D, Fenster A. 3-D carotid multi-region MRI segmentation by globally optimal evolution of coupled surfaces. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:770-785. [PMID: 23303689 DOI: 10.1109/tmi.2013.2237784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this paper, we propose a novel global optimization based 3-D multi-region segmentation algorithm for T1-weighted black-blood carotid magnetic resonance (MR) images. The proposed algorithm partitions a 3-D carotid MR image into three regions: wall, lumen, and background. The algorithm performs such partitioning by simultaneously evolving two coupled 3-D surfaces of carotid artery adventitia boundary (AB) and lumen-intima boundary (LIB) while preserving their anatomical inter-surface consistency such that the LIB is always located within the AB. In particular, we show that the proposed algorithm results in a fully time implicit scheme that propagates the two linearly ordered surfaces of the AB and LIB to their globally optimal positions during each discrete time frame by convex relaxation. In this regard, we introduce the continuous max-flow model and prove its duality/equivalence to the convex relaxed optimization problem with respect to each evolution step. We then propose a fully parallelized continuous max-flow-based algorithm, which can be readily implemented on a GPU to achieve high computational efficiency. Extensive experiments, with four users using 12 3T MR and 26 1.5T MR images, demonstrate that the proposed algorithm yields high accuracy and low operator variability in computing vessel wall volume. In addition, we show the algorithm outperforms previous methods in terms of high computational efficiency and robustness with fewer user interactions.
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Affiliation(s)
- Eranga Ukwatta
- Robarts Research Institute, Western University, London ON, N6A 5K8 Canada.
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20
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Kerwin WS. Carotid artery disease and stroke: assessing risk with vessel wall MRI. ISRN CARDIOLOGY 2012; 2012:180710. [PMID: 23209940 PMCID: PMC3504380 DOI: 10.5402/2012/180710] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022]
Abstract
Although MRI is widely used to diagnose stenotic carotid arteries, it also detects characteristics of the atherosclerotic plaque itself, including its size, composition, and activity. These features are emerging as additional risk factors for stroke that can be feasibly acquired clinically. This paper summarizes the state of evidence for a clinical role for MRI of carotid atherosclerosis.
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Affiliation(s)
- William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA 98109, USA ; VPDiagnostics Incorporation, Seattle, WA 98101, USA
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21
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Koktzoglou I. Gray blood magnetic resonance for carotid wall imaging and visualization of deep-seated and superficial vascular calcifications. Magn Reson Med 2012; 70:75-85. [PMID: 22887594 DOI: 10.1002/mrm.24445] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/21/2012] [Accepted: 07/05/2012] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois 60201, USA.
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