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Yu YN, Liu MW, Villablanca JP, Li ML, Xu YY, Gao S, Feng F, Liebeskind DS, Scalzo F, Xu WH. Middle Cerebral Artery Plaque Hyperintensity on T2-Weighted Vessel Wall Imaging Is Associated with Ischemic Stroke. AJNR Am J Neuroradiol 2019; 40:1886-1892. [PMID: 31624115 DOI: 10.3174/ajnr.a6260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/27/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Vessel wall imaging can identify intracranial atherosclerotic plaque and give clues about its components. We aimed to investigate whether the plaque hyperintensity in the middle cerebral artery on T2-weighted vessel wall imaging is associated with ischemic stroke. MATERIALS AND METHODS We retrospectively reviewed our institutional vessel wall MR imaging data base. Patients with an acute ischemic stroke within 7-day onset in the MCA territory were enrolled. Patients with stroke and stenotic MCA plaque (stenosis degree, ≥50%) were included for analysis. Ipsilateral MCA plaque was defined as symptomatic, and contralateral plaque, as asymptomatic. Plaque was manually delineated on T2-weighted vessel wall imaging. The plaque signal was normalized to the ipsilateral muscle signal. The thresholds and volume of normalized plaque signal were investigated using logistic regression and receiver operating characteristic analysis to determine the association between normalized plaque signal and stroke. RESULTS One hundred eight stenotic MCAs were analyzed (from 88 patients, 66 men; mean age, 58 ± 15 years), including 72 symptomatic and 36 asymptomatic MCA plaques. Symptomatic MCA plaque showed larger plaque hyperintensity volume compared with asymptomatic MCA plaque. The logistic regression model incorporating stenosis degree, remodeling ratio, and normalized plaque signal 1.3-1.4 (OR, 6.25; 95% CI, 1.90-20.57) had a higher area under curve in differentiating symptomatic/asymptomatic MCA plaque, compared with a model with only stenosis degree and remodeling ratio (area under curve, 0.884 versus 0.806; P =.008). CONCLUSIONS The MCA plaque hyperintensity on T2-weighted vessel wall imaging is independently associated with ischemic stroke and adds value to symptomatic MCA plaque classification. Measuring the normalized signal intensity may serve as a practical and integrative approach to the analysis of intracranial atherosclerotic plaque.
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Affiliation(s)
- Y-N Yu
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., S.G., W.-H.X.)
| | - M-W Liu
- Neurovascular Imaging Research Core and UCLA Stroke Center (M.-W.L., D.S.L., F.S.), Los Angeles, California
| | | | - M-L Li
- Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Y-Y Xu
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., S.G., W.-H.X.)
| | - S Gao
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., S.G., W.-H.X.)
| | - F Feng
- Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - D S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center (M.-W.L., D.S.L., F.S.), Los Angeles, California
| | - F Scalzo
- Neurovascular Imaging Research Core and UCLA Stroke Center (M.-W.L., D.S.L., F.S.), Los Angeles, California
| | - W-H Xu
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., S.G., W.-H.X.)
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Abstract
Calcification of atherosclerotic lesions was long thought to be an age - related, passive process, but increasingly data has revealed that atherosclerotic calcification is a more active process, involving complex signaling pathways and bone-like genetic programs. Initially, imaging of atherosclerotic calcification was limited to gross assessment of calcium burden, which is associated with total atherosclerotic burden and risk of cardiovascular mortality and of all cause mortality. More recently, sophisticated molecular imaging studies of the various processes involved in calcification have begun to elucidate information about plaque calcium composition and consequent vulnerability to rupture, leading to hard cardiovascular events like myocardial infarction. As such, there has been renewed interest in imaging calcification to advance risk assessment accuracy in an evolving era of precision medicine. Here we summarize recent advances in our understanding of the biologic process of atherosclerotic calcification as well as some of the molecular imaging tools used to assess it.
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Affiliation(s)
- Grant Bailey
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT, 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Judith Meadows
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT, 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Alan R Morrison
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA.
- Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908, USA.
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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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Qiao Y, Hallock KJ, Hamilton JA. Magnetization transfer magnetic resonance of human atherosclerotic plaques ex vivo detects areas of high protein density. J Cardiovasc Magn Reson 2011; 13:73. [PMID: 22107813 PMCID: PMC3278375 DOI: 10.1186/1532-429x-13-73] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 11/22/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Proteins are major plaque components, and their degradation is related to the plaque instability. We sought to assess the feasibility of magnetization transfer (MT) magnetic resonance (MR) for identifying fibrin and collagen in carotid atherosclerotic plaques ex vivo. METHODS Human carotid artery specimens (n = 34) were obtained after resection from patients undergoing endarterectomy. MR was completed within 12 hr after surgery on an 11.7T MR microscope prior to fixation. Two sets of T1W spoiled gradient echo images were acquired with and without the application of a saturation pulse set to 10 kHz off resonance. The magnetization transfer ratio (MTR) was calculated, and the degree of MT contrast was correlated with histology. RESULTS MT with appropriate calibration clearly detected regions with high protein density, which showed a higher MTR (thick fibers (collagen type I) (54 ± 8%)) compared to regions with a low amount of protein including lipid (46 ± 8%) (p = 0.05), thin fibers (collagen type III) (11 ± 6%) (p = 0.03), and calcification (6.8 ± 4%) (p = 0.02). Intraplaque hemorrhage (IPH) with different protein density demonstrated different MT effects. Old (rich in protein debris) and recent IPH (rich in fibrin) had a much higher MTR 69 ± 6% and 55 ± 9%, respectively, compared to fresh IPH (rich in intact red blood cells)(9 ± 3%). CONCLUSIONS MT MR enhances plaque tissue contrast and identifies the protein-rich regions of carotid artery specimens. The additional information from MTR of IPH may provide important insight into the role of IPH on plaque stability, evolution, and the risk for future ischemic events.
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Affiliation(s)
- Ye Qiao
- Department of Physiology and Biophysics, Boston University School of Medicine, 715 Albany Street (W302), Boston, MA 02118-2526, USA
| | - Kevin J Hallock
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - James A Hamilton
- Department of Physiology and Biophysics, Boston University School of Medicine, 715 Albany Street (W302), Boston, MA 02118-2526, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
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Du J, Corbeil J, Znamirowski R, Angle N, Peterson M, Bydder GM, Kahn AM. Direct imaging and quantification of carotid plaque calcification. Magn Reson Med 2010; 65:1013-20. [PMID: 21413065 DOI: 10.1002/mrm.22682] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 09/10/2010] [Accepted: 09/19/2010] [Indexed: 11/09/2022]
Abstract
Carotid plaque calcification normally appears as a signal void with clinical MR sequences. Here, we describe the use of an adiabatic inversion recovery prepared two-dimensional ultrashort echo time sequence to image and characterize carotid plaque calcification using a clinical 3-T scanner. T(1), T 2*, and free water content were measured for seven carotid samples, and the results were compared with micro-CT imaging. Conventional gradient echo and fast spin echo images were also acquired for comparison. Correlations between T(1), T 2*, free water concentration, and mineral density were performed. There was a close correspondence between inversion recovery prepared two-dimensional ultrashort echo time morphologic and micro-CT appearances. Carotid plaque calcification varied significantly from sample to sample, with T(1) s ranging from 94 ± 19 to 328 ± 21 msec, T 2*s ranging from 0.31 ± 0.12 to 2.15 ± 0.25 msec, and free water concentration ranging from 5.7 ± 2.3% to 16.8 ± 3.4%. There was a significant positive correlation between T(1)(R = 0.709; P < 0.074), T 2* (R = 0.816; P < 0.025), and free water concentration, a negative correlation between T(1) (R = 0.773; P < 0.042), T 2* (R = 0.948; P < 0.001) and CT measured mineral density, and a negative correlation between free water concentration (R = 0.936; P < 0.002) and mineral density.
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Affiliation(s)
- Jiang Du
- Department of Radiology, University of California, San Diego, California 92103-8226, USA.
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Roijers RB, Dutta RK, Cleutjens JPM, Mutsaers PHA, de Goeij JJM, van der Vusse GJ. Early Calcifications in Human Coronary Arteries As Determined with a Proton Microprobe. Anal Chem 2007; 80:55-61. [DOI: 10.1021/ac0706628] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ruben B. Roijers
- Cyclotron Laboratory, Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands, Department of Physiology and Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands, and Interfaculty Reactor Institute, Delft University of Technology, Mekelweg 15, 2629 JB Delft, the Netherlands
| | - Raj K. Dutta
- Cyclotron Laboratory, Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands, Department of Physiology and Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands, and Interfaculty Reactor Institute, Delft University of Technology, Mekelweg 15, 2629 JB Delft, the Netherlands
| | - Jack P. M. Cleutjens
- Cyclotron Laboratory, Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands, Department of Physiology and Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands, and Interfaculty Reactor Institute, Delft University of Technology, Mekelweg 15, 2629 JB Delft, the Netherlands
| | - Peter H. A. Mutsaers
- Cyclotron Laboratory, Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands, Department of Physiology and Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands, and Interfaculty Reactor Institute, Delft University of Technology, Mekelweg 15, 2629 JB Delft, the Netherlands
| | - Jeroen J. M. de Goeij
- Cyclotron Laboratory, Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands, Department of Physiology and Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands, and Interfaculty Reactor Institute, Delft University of Technology, Mekelweg 15, 2629 JB Delft, the Netherlands
| | - Ger J. van der Vusse
- Cyclotron Laboratory, Department of Applied Physics, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands, Department of Physiology and Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands, and Interfaculty Reactor Institute, Delft University of Technology, Mekelweg 15, 2629 JB Delft, the Netherlands
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Qiao Y, Ronen I, Viereck J, Ruberg FL, Hamilton JA. Identification of atherosclerotic lipid deposits by diffusion-weighted imaging. Arterioscler Thromb Vasc Biol 2007; 27:1440-6. [PMID: 17379838 PMCID: PMC2910580 DOI: 10.1161/atvbaha.107.141028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The content and distribution of lipids is an important aspect of plaque vulnerability, but lipids are present within a heterogeneous environment, impeding detection by magnetic resonance imaging. Our goal was to achieve accurate detection of mobile lipids by a single magnetic resonance imaging sequence. METHODS AND RESULTS Carotid endarectomy specimens (n=23) were imaged ex vivo at a high magnetic field (11.7 T) within 24 hours after surgery. Three contrast-weighted (T1W, T2W, and diffusion-weighted imaging [DWI]) image sequences were acquired and then coregistered with histological preparations for lipids (Oil red O and polarized light microscopy) and fibrous tissue (trichrome). Contrast-to-noise ratios were measured and compared for the 3 contrast weightings. Contrast-to-noise ratio measurement in regions identified as lipid versus fibrous tissue showed greater differences by DWI (4.5+/-0.63 versus 0.64+/-0.08; P<0.05) as compared with T2W (2.83+/-0.36 versus 1.36+/-0.37; P<0.05). We validated the presence and distribution of lipids (mainly cholesteryl esters) by both histology and image-guide spectroscopy. The basis for distinguishing mobile lipid and water inside the plaque was illustrated by diffusion-weighted spectroscopy. CONCLUSIONS Biophysical properties of plaque lipids can confer selective identification by DWI, as opposed to standard T1W and T2W imaging sequences. Successful translation of DWI in vivo could identify of features of vulnerable plaque.
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Affiliation(s)
- Ye Qiao
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA 02118, USA
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