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Zhang Y, Cui B, Yang H, Ma J, Yang Y, Yang B, Ma Y, Jiao L, Li X, Lu J. Morphological feature and mapping inflammation in classified carotid plaques in symptomatic and asymptomatic patients: A hybrid 18F-FDG PET/MR study. Front Neurosci 2023; 17:1144248. [PMID: 37025371 PMCID: PMC10070967 DOI: 10.3389/fnins.2023.1144248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose To investigate morphological and inflamed-metabolism features of carotid atherosclerotic plaques between symptomatic and asymptomatic patients with hybrid 18F-FDG PET/MR imaging. Methods A total of 20 symptomatic and 20 asymptomatic patients with carotid plaques underwent hybrid 18F-FDG PET/MR scans. American heart association (AHA) lesion types were classified, and plaque compositions were further determined on consecutive MRI axial sections in both carotid arteries. 18F-FDG uptake in carotid arteries was quantified using region of interest (ROI) methods based on maximum standardized uptake values (SUVmax) and target-to-background ratio (TBR) on corresponding positron emission tomography (PET) images. Results A total of seventy-one carotid plaques were quantified. AHA type VI was the most common (23, 32.4%), and the region of carotid bifurcation was the most common place presenting lesions (32, 45.1%). Compared with the asymptomatic group, the prevalence of high-risk features including plaque burden, lumen stenosis, maximum necrotic core area, and maximum intra-plaque hemorrhage area increased in the symptomatic group. Carotid TBR values of plaque in symptomatic group (TBR = 2.56 ± 0.34) was significantly higher than that in asymptomatic group (TBR = 1.57 ± 0.14) (P < 0.05). hs-CRP is an independent risk factor for the stability of carotid plaque. The correlation between normalized wall index (NWI) and TBR values was significantly positive in both the symptomatic and the asymptomatic groups (P < 0.01), and both NWI and TBR were significantly correlated with the level of hs-CRP (P < 0.01). Conclusion Integrated 18F-FDG PET/MR scans presented distinct risk features between symptomatic and asymptomatic patients. Hybrid 18F-FDG PET/MR systems combined with clinical serum hs-CRP may help distinguish vulnerable carotid plaques.
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Affiliation(s)
- Yue Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Bixiao Cui
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Hongwei Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Jie Ma
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yu Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
- *Correspondence: Jie Lu,
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Lu X, Calabretta R, Wadsak W, Haug AR, Mayerhöfer M, Raderer M, Zhang X, Li J, Hacker M, Li X. Imaging Inflammation in Atherosclerosis with CXCR4-Directed [ 68Ga]PentixaFor PET/MRI-Compared with [ 18F]FDG PET/MRI. Life (Basel) 2022; 12:life12071039. [PMID: 35888127 PMCID: PMC9320215 DOI: 10.3390/life12071039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/18/2022] [Accepted: 07/06/2022] [Indexed: 01/24/2023] Open
Abstract
(1) This study compared [68Ga]PentixaFor uptake in active arterial segments with corresponding [18F]FDG arterial uptake as well as the relationship with cardiac [68Ga]PentixaFor uptake. (2) Method: Tracer uptake on atherosclerotic lesions in the large arteries was measured and target-to-background ratios (TBR) were calculated to adjust background signals with two investigators blinded to the other PET scan. On a patient-based and lesion-to-lesion analysis, TBR values of two tracers were compared and the relationship with cardiac inflammation was further explored. Furthermore, two cardiovascular risk-related groups were divided to explore the value of risk stratification of the two tracers in atherosclerosis. (3) Results: [68Ga]PentixaFor PET/MRI identified more lesions (88% vs. 48%; p < 0.001) and showed higher uptake than [18F]FDG PET/MRI (TBR, 1.90 ± 0.36 vs. 1.63 ± 0.29; p < 0.001). In the patient-based analysis, the TBR of [68Ga]PentixaFor uptake was also significantly higher than [18F]FDG uptake (1.85 ± 0.20 vs. 1.42 ± 0.19; p < 0.001). The TBR of active lesions for [68Ga]PentixaFor was significantly increased in the high-risk group (n = 9), as compared to the low-risk group (n = 10) (2.02 ± 0.15 vs. 1.86 ± 0.10, p = 0.015), but not for [18F]FDG (1.85 ± 0.10 vs. 1.80 ± 0.07, p = 0.149). (4) Conclusion: [68Ga]PentixaFor PET/MRI identified many more lesions than [18F]FDG PET/MRI. Patients with high-risk cardiovascular factors illustrated an increased uptake of [68Ga]PentixaFor. There was a correlation between the elevated uptake of [68Ga]PentixaFor in the active arterial segments and heart.
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Affiliation(s)
- Xia Lu
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (X.L.); (R.C.); (W.W.); (A.R.H.); (J.L.); (M.H.)
- Department of Nuclear Medicine, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
| | - Raffaella Calabretta
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (X.L.); (R.C.); (W.W.); (A.R.H.); (J.L.); (M.H.)
| | - Wolfgang Wadsak
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (X.L.); (R.C.); (W.W.); (A.R.H.); (J.L.); (M.H.)
- Center for Biomarker Research in Medicine, CBmed, 8036 Graz, Austria
| | - Alexander R. Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (X.L.); (R.C.); (W.W.); (A.R.H.); (J.L.); (M.H.)
| | - Marius Mayerhöfer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;
- Division of General and Pediatric, Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
| | - Jingle Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (X.L.); (R.C.); (W.W.); (A.R.H.); (J.L.); (M.H.)
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (X.L.); (R.C.); (W.W.); (A.R.H.); (J.L.); (M.H.)
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (X.L.); (R.C.); (W.W.); (A.R.H.); (J.L.); (M.H.)
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
- Correspondence: ; Tel.: +43-1-40400-55580
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Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities. J Clin Med 2022; 11:jcm11051361. [PMID: 35268451 PMCID: PMC8911129 DOI: 10.3390/jcm11051361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.
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Saba L, Sanagala SS, Gupta SK, Koppula VK, Johri AM, Khanna NN, Mavrogeni S, Laird JR, Pareek G, Miner M, Sfikakis PP, Protogerou A, Misra DP, Agarwal V, Sharma AM, Viswanathan V, Rathore VS, Turk M, Kolluri R, Viskovic K, Cuadrado-Godia E, Kitas GD, Sharma N, Nicolaides A, Suri JS. Multimodality carotid plaque tissue characterization and classification in the artificial intelligence paradigm: a narrative review for stroke application. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1206. [PMID: 34430647 PMCID: PMC8350643 DOI: 10.21037/atm-20-7676] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non-invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari, Italy
| | - Skandha S Sanagala
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India.,CSE Department, Bennett University, Greater Noida, UP, India
| | - Suneet K Gupta
- CSE Department, Bennett University, Greater Noida, UP, India
| | - Vijaya K Koppula
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, Rhode Island, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, Rhode Island, USA
| | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention, National and Kapodistrian University of Athens, Athens, Greece
| | - Durga P Misra
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, VA, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Vijay S Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | | | | | | | - George D Kitas
- R & D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Neeraj Sharma
- Department of Biomedical Engineering, IIT-BHU, Banaras, UP, India
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia, Nicosia, Cyprus
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
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5
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Sui B, Gao P. High-resolution vessel wall magnetic resonance imaging of carotid and intracranial vessels. Acta Radiol 2019; 60:1329-1340. [PMID: 30727746 DOI: 10.1177/0284185119826538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Binbin Sui
- Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Radiology Department, Beijing Neurosurgical Institute, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Peiyi Gao
- Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Radiology Department, Beijing Neurosurgical Institute, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
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6
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Association between carotid 18F-NaF and 18F-FDG uptake on PET/CT with ischemic vascular brain disease on MRI in patients with carotid artery disease. Ann Nucl Med 2019; 33:907-915. [PMID: 31571042 DOI: 10.1007/s12149-019-01403-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Atherosclerosis is a dynamic and complex process characterized by the formation and progression of plaque mediated by various pathophysiologic steps including inflammation and calcification. The present study aimed to evaluate the association between carotid 18F-sodium fluoride (NaF) and 18F-fluorodeoxyglucose (FDG) uptake with the severity of ischemic vascular brain disease on MRI in patients with carotid artery disease. METHODS A total of 28 patients who were scheduled to undergo clinically indicated carotid endarterectomy or stenting for carotid artery disease were examined with 18F-NaF and 18F-FDG PET/CT and brain MRI. The PET/CT images were evaluated by qualitative and semiquantitative analyses. The maximum standardized uptake value (SUV) for the plaque and the average of mean SUV within the lumen of both internal jugular veins was calculated, and the target-to-blood pool ratio (TBR) was determined. The ischemic vascular brain disease on MRI was graded separately in the bilateral hemisphere as 0, 1, 2, and 3, with 0 being absent and 3 being the most severe. RESULTS In two patients, only a unilateral carotid artery was analyzed because of previous indwelling stent. 18F-NaF focal uptake was observed in 50 carotid arteries. 18F-FDG focal uptake was observed in 47 carotid arteries. The mean (± SD) 18F-NaF TBR (2.93 ± 0.89) was significantly higher than the mean (± SD) 18F-FDG TBR (2.41 ± 0.84) (p < 0.001). The mean (± SD) values of 18F-NaF TBR were 2.63 ± 0.76 in grade 1, 2.90 ± 0.91 in grade 2, and 3.81 ± 0.60 in grade 3. Significant differences in 18F-NaF TBR were observed between grades 1 and 3 (p < 0.001) and grades 2 and 3 (p = 0.02). The mean (± SD) values of 18F-FDG TBR were 2.35 ± 0.77 in grade 1, 2.23 ± 0.48 in grade 2, and 2.87 ± 1.32 in grade 3. No significant differences in 18F-FDG TBR were noted between any of the ischemic vascular brain disease grades. CONCLUSIONS These preliminary results suggest that carotid 18F-NaF uptake in patients with carotid artery disease may be associated with the severity of the ischemic vascular brain disease observed on MRI.
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Chiocchi M, Chiaravalloti A, Morosetti D, Loreni G, Gandini R, Mancino S, Fabiano S, Simonetti G. Virtual histology-intravascular ultrasound as a diagnostic alternative for morphological characterization of carotid plaque. J Cardiovasc Med (Hagerstown) 2019; 20:335-342. [DOI: 10.2459/jcm.0b013e328356a5d2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Intraplaque Microvascular Flow Signal in Superb Microvascular Imaging and Magnetic Resonance Imaging Carotid Plaque Imaging in Patients with Atheromatous Carotid Artery Stenosis. J Stroke Cerebrovasc Dis 2018; 27:3529-3534. [PMID: 30197167 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/08/2018] [Indexed: 01/19/2023] Open
Abstract
Carotid artery atherosclerosis is one of the major risk factors for ischemic stroke. Intraplaque neovascularization (IPN) is one of the steps toward the development of vulnerable plaque. Superb microvascular imaging (SMI) is a new ultrasonographic technique for visualizing low-velocity and microvascular flow by clutter suppression to extract flow signals from large to small vessels and enables visualization of intraplaque microvascular flow (IMVF) without echo contrast media. We aimed to investigate the association between IMVF signal in SMI and MRI plaque imaging among patients with atherosclerotic carotid stenosis. We prospectively enrolled patients (>18 years old) with mild to severe carotid stenosis (more than 50% in cross-sectional area) diagnosed by carotid ultrasonography between August 2017 and April 2018, irrespective of sex and history of stroke. A total of 40 patients (31 men, 9 women; mean age, 75.1 ± 10.0 years) were enrolled. SMI revealed IPN findings in 21 patients. SMI clearly visualized the direction of pulsatile flow movement in microvessels and IPN was easily classified into the two types of Type V (n=2) and Type E (n=19). Multivariate logistic regression analysis presented that microvascular flow signal in carotid plaque on SMI was identified as a significant predictor of intraplaque hemorrhage as evaluated by MRI (OR, 8.46; 95%CI, 1.44-49.9; p=0.018). This study demonstrated a significant association between the presence of IMVF signal in SMI and intraplaque hemorrhage characterized by high-intensity lesions on MRI T1-FFE images.
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9
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Affiliation(s)
- Ying Wang
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael T Osborne
- Department of Radiology, Massachusetts General Hospital, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Brian Tung
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ming Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yaming Li
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
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10
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Zafar H, Leahy M, Wijns W, Kolios M, Zafar J, Johnson N, Sharif F. Photoacoustic cardiovascular imaging: a new technique for imaging of atherosclerosis and vulnerable plaque detection. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aab640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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11
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Rovella V, Anemona L, Cardellini M, Scimeca M, Saggini A, Santeusanio G, Bonanno E, Montanaro M, Legramante IM, Ippoliti A, Di Daniele N, Federici M, Mauriello A. The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors. Cardiovasc Diabetol 2018; 17:46. [PMID: 29598820 PMCID: PMC5874994 DOI: 10.1186/s12933-018-0685-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/10/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the last decade, several studies have reported an unexpected and seemingly paradoxical inverse correlation between BMI and incidence of cardiovascular diseases. This so called "obesity paradox effect" has been mainly investigated through imaging methods instead of histologic evaluation, which is still the best method to study the instability of carotid plaque. Therefore, the purpose of our study was to evaluate by histology the role of obesity in destabilization of carotid plaques and the interaction with age, gender and other major cerebrovascular risk factors. METHODS A total of 390 carotid plaques from symptomatic and asymptomatic patients submitted to endarterectomy, for whom complete clinical and laboratory assessment of major cardiovascular risk factors was available, were studied by histology. Patients with a BMI ≥ 30.0 kg/m2 were considered as obese. Data were analyzed by multivariate logistic regression and for each variable in the equation the estimated odds ratio (OR) was calculated. RESULTS Unstable carotid plaque OR for obese patients with age < 70 years was 5.91 (95% CI 1.17-29.80), thus being the highest OR compared to that of other risk factors. Unstable carotid plaque OR decreased to 4.61 (95% CI 0.54-39.19) in males ≥ 70 years, being only 0.93 (95% CI 0.25-3.52) among women. When obesity featured among metabolic syndrome risk factors, the OR for plaque destabilization was 3.97 (95% CI 1.81-6.22), a significantly higher value compared to OR in non-obese individuals with metabolic syndrome (OR = 1.48; 95% CI 0.86-2.31). Similar results were obtained when assessing the occurrence of acute cerebrovascular symptoms. CONCLUSIONS Results from our study appear to do not confirm any paradoxical effect of obesity on the carotid artery district. Conversely, obesity is confirmed to be an independent risk factor for carotid plaque destabilization, particularly in males aged < 70 years, significantly increasing such risk among patients with metabolic syndrome.
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Affiliation(s)
- Valentina Rovella
- Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Marina Cardellini
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
- IRCCS San Raffaele, Via di Val Cannuta 247, 00166 Rome, Italy
- OrchideaLab S.r.l, Via del Grecale 6, Morlupo, Rome, RM Italy
| | - Andrea Saggini
- Anatomic Pathology, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Giuseppe Santeusanio
- Anatomic Pathology, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Elena Bonanno
- Anatomic Pathology, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Manuela Montanaro
- Anatomic Pathology, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | | | - Arnaldo Ippoliti
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Daniele
- Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Mauriello
- Anatomic Pathology, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
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12
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Kirkham EM, Hatsukami TS, Heckbert SR, Sun J, Canton G, Yuan C, Weaver EM. Association between Snoring and High-Risk Carotid Plaque Features. Otolaryngol Head Neck Surg 2017; 157:336-344. [PMID: 28695757 PMCID: PMC5940929 DOI: 10.1177/0194599817715634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/14/2017] [Indexed: 01/17/2023]
Abstract
Objectives Previous studies have demonstrated an association between snoring and carotid disease independent of sleep apnea. The aim of this study was to quantify the association between self-reported snoring and high-risk carotid plaque features on magnetic resonance imaging (MRI) that predict stroke. Study Design Cross-sectional. Setting Tertiary care university hospital and affiliated county hospital. Methods We surveyed 133 subjects with asymptomatic carotid artery disease that had been previously evaluated with high-resolution MRI. The survey captured data on self-reported snoring (exposure) and covariates (age, sex, body mass index, and sleep apnea via the STOP-Bang questionnaire). A subset of patients underwent home sleep apnea testing. High-risk carotid plaque features were identified on the high-resolution MRI and included thin/ruptured fibrous cap and intraplaque hemorrhage (outcomes). We quantified the association between snoring and high-risk carotid plaque features with the chi-square test (unadjusted analysis) and multivariate logistic regression adjusting for the covariates. Results Of 133 subjects surveyed, 61 (46%) responded; 32 (52%) reported snoring. Significantly higher proportions of snorers than nonsnorers had a thin/ruptured fibrous cap (56% vs 25%, P = .01) and intraplaque hemorrhage (63% vs 29%, P < .01). In multivariate analysis, snoring was associated with thin/ruptured fibrous cap (odds ratio, 4.4; 95% CI, 1.1-16.6; P = .04) and intraplaque hemorrhage (odds ratio, 8.2; 95% CI, 2.1-31.6; P < .01) after adjusting for age, sex, body mass index, and sleep apnea. Conclusion This pilot study suggests a significant independent association between snoring and high-risk carotid plaque features on MRI. Further study is warranted to confirm these results in a larger cohort of subjects.
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Affiliation(s)
- Erin M Kirkham
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- 2 Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Susan R Heckbert
- 3 Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jie Sun
- 4 Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Gador Canton
- 5 Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- 4 Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Edward M Weaver
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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13
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Jiang Y, Peng W, Tian B, Zhu C, Chen L, Wang X, Liu Q, Wang Y, Xiang Z, Degnan AJ, Teng Z, Saloner D, Lu J. Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI. AJNR Am J Neuroradiol 2017; 38:1716-1722. [PMID: 28684455 DOI: 10.3174/ajnr.a5266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/23/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE High-resolution 3T MR imaging can visualize intracranial atherosclerotic plaque. However, histologic validation is still lacking. This study aimed to evaluate the ability of 3T MR imaging to identify and quantitatively assess intracranial atherosclerotic plaque components ex vivo with histologic validation. MATERIALS AND METHODS Fifty-three intracranial arterial specimens with atherosclerotic plaques from 20 cadavers were imaged by 3T MR imaging with T1, T2, and proton-density-weighted FSE and STIR sequences. The signal characteristics and areas of fibrous cap, lipid core, calcification, fibrous tissue, and healthy vessel wall were recorded on MR images and compared with histology. Fibrous cap thickness and maximum wall thickness were also quantified. The percentage of areas of the main plaque components, the ratio of fibrous cap thickness to maximum wall thickness, and plaque burden were calculated and compared. RESULTS The signal intensity of the lipid core was significantly lower than that of the fibrous cap on T2-weighted, proton-density, and STIR sequences (P < .01) and was comparable on T1-weighted sequences (P = 1.00). Optimal contrast between the lipid core and fibrous cap was found on T2-weighted images. Plaque component mean percentages were comparable between MR imaging and histology: fibrous component (81.86% ± 10.59% versus 81.87% ± 11.59%, P = .999), lipid core (19.51% ± 10.76% versus 19.86% ± 11.56%, P = .863), and fibrous cap (31.10% ± 11.28% versus 30.83% ± 8.51%, P = .463). However, MR imaging overestimated mean calcification (9.68% ± 5.21% versus 8.83% ± 5.67%, P = .030) and plaque burden (65.18% ± 9.01% versus 52.71% ± 14.58%, P < .001). CONCLUSIONS Ex vivo 3T MR imaging can accurately identify and quantitatively assess intracranial atherosclerotic plaque components, providing a direct reference for in vivo intracranial plaque imaging.
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Affiliation(s)
- Y Jiang
- From the Department of Radiology (Y.J.), Wuhan General Hospital of the People's Liberation Army, Wuhan, China.,Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - W Peng
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - B Tian
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - L Chen
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - X Wang
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Q Liu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Y Wang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - Z Xiang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - A J Degnan
- Department of Radiology (A.J.D.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Z Teng
- Department of Radiology (Z.T.), University of Cambridge, Cambridge, UK
| | - D Saloner
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - J Lu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
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14
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Oshakbayev K, Dukenbayeva B, Togizbayeva G, Gazaliyeva M, Syzdykova A, Daurenbekov K, Issa P. Accumulated substancies and calorific capacity in adipose tissue: Physical and chemical clinical trial. BBA CLINICAL 2017. [PMID: 28626640 PMCID: PMC5466547 DOI: 10.1016/j.bbacli.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Aim To study physical and chemical structures and properties including calorific value of human adipose tissue in different anatomical location in autopsy-assigned clinical trial. Methods A pilot physical and chemical descriptive randomized autopsy-assigned trial. Adipose tissue 252 sampled from 36 individuals at autopsy who between 36 and 63 years old died from road accidents. Interventions: Chemical functional groups and calorific value were studied using infrared and atomic adsorptive spectrometries, elemental chemical analysis and differential scanning calorimetry. Adipose tissue was sampled from the 7 various anatomical locations. Results The highest levels of the analysed chemical substancies were found in dense atherosclerotic plaque. Dense atherosclerotic plaque contains the most of metabolic products, organic and inorganic elements. Dense atherosclerotic plaque has the most of calorific value. The lowest calorific capacity has a pararenal fat. Conclusions Human body lipids serve as a harbor for various organic substances, they may absorb different metabolic products, and they have different calorific capacity depending on their location and forms. Atherosclerotic plaque contains the most of organic and inorganic elements, and brings the highest energy potential. The body adipose tissue is heterogeneous in content and in property. Atherosclerosis plaque contains the largest amount of organic/inorganic functional groups. Atherosclerosis plaque is a harbor for various organic substances. Adipose tissue has different calorific capacity depending on its locations and forms. Plaques bring the highest of energy potential in compare to other fats.
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Affiliation(s)
| | | | | | | | - Alma Syzdykova
- Nazarbayev University Medical Center, Astana, Kazakhstan
| | | | - Pernekul Issa
- Kazakh University for technology and business, Astana, Kazakhstan
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15
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Lin R, Chen S, Liu G, Xue Y, Zhao X. Association Between Carotid Atherosclerotic Plaque Calcification and Intraplaque Hemorrhage. Arterioscler Thromb Vasc Biol 2017; 37:1228-1233. [PMID: 28450297 DOI: 10.1161/atvbaha.116.308360] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
Objective—
Carotid intraplaque hemorrhage (IPH) is associated with cardiovascular events. Calcification, which frequently accompanies IPH, may play a role in IPH occurrence. In this study, we aimed to investigate the associations between calcification characteristics and IPH in carotid plaques.
Approach and results—
One hundred seventeen patients with cerebrovascular symptoms and carotid plaques detected by ultrasound were recruited and underwent multicontrast magnetic resonance imaging. Advanced carotid plaques with composition measured by magnetic resonance imaging were included in the analysis. Carotid calcifications were divided into the following categories: surface, mixed, and deep calcification. They were also classified into single and multiple calcifications according to quantity. Logistic regression models utilizing generalized estimating equations were performed to evaluate the relationship between calcification and IPH. Of 117 subjects, 85 with 142 plaques were included in the final analysis, whereas 32 were excluded because of lack of plaque compositions. Of the 142 plaques, 40 (28.2%) had IPH. Plaques with IPH showed greater prevalence of calcification than those without (87.5% versus 55.9%;
P
=0.005). After adjusting for age, low-density lipoprotein, maximum wall thickness, and maximum soft plaque thickness, multiple calcifications (odd ratio, 10.1; 95% confidence interval, 3.3–30.4), surface calcification (odd ratio, 29.4; 95% confidence interval, 4.1–210.8), and mixed calcifications (odd ratio, 27.9; 95% confidence interval, 7.3–107.1) were found to be strongly associated with the presence of IPH (all
P
<0.05).
Conclusions—
Surface calcification and multiple calcifications in carotid atherosclerotic plaques are independently associated with the presence of IPH, suggesting that both quantity and location of calcification may play important roles in the occurrence of IPH. These findings may provide novel insights for understanding mechanisms of IPH.
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Affiliation(s)
- Ruolan Lin
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.)
| | - Shuo Chen
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.)
| | - Gaifen Liu
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.)
| | - Yunjing Xue
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.).
| | - Xihai Zhao
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.).
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16
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Three-dimensional black-blood T 2 mapping with compressed sensing and data-driven parallel imaging in the carotid artery. Magn Reson Imaging 2017; 37:62-69. [DOI: 10.1016/j.mri.2016.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 11/22/2022]
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17
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Arabul MU, Heres M, Rutten MCM, van Sambeek MR, van de Vosse FN, Lopata RGP. Toward the detection of intraplaque hemorrhage in carotid artery lesions using photoacoustic imaging. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:41010. [PMID: 28008447 DOI: 10.1117/1.jbo.22.4.041010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/01/2016] [Indexed: 05/06/2023]
Abstract
Photoacoustic imaging (PAI) may have the ability to reveal the composition and the anatomical structure of carotid plaques, which determines its mechanical properties and vulnerability. We used PAI and plane wave ultrasound (PUS) imaging to obtain three-dimensional (3-D) images of endarterectomy samples ex vivo and compared the results with histology to investigate the potential of PAI-based identification of intraplaque hemorrhage. Seven carotid plaque samples were obtained from patients undergoing carotid endarterectomy and imaged with a fully integrated hand-held photoacoustic (PA) probe, consisting of a pulsed diode laser ( t pulse = 130 ?? ns , E pulse = 1 ?? mJ , ? = 808 ?? nm ) and a linear array transducer ( f c = 7.5 ?? MHz ). The samples were rotated 360 deg with 10 deg steps, and data were spatially compounded to obtain complete 3-D images of the plaques. Areas of high absorption in the 3-D datasets were identified and compared to histological data of the plaques. Data in six out of seven endarterectomy samples revealed the presence of intraplaque hemorrhages that were not visible in the PUS images. Due to the noninvasive nature of PAI, this ex vivo study may elucidate preclinical studies toward the in vivo, noninvasive, vulnerability assessment of the atherosclerotic carotid plaque.
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Affiliation(s)
- Mustafa Umit Arabul
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Maarten Heres
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Marcel C M Rutten
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Marc R van Sambeek
- Catharina Hospital Eindhoven, Department of Vascular Surgery, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Frans N van de Vosse
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Richard G P Lopata
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
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18
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Zhu J, Bornstedt A, Merkle N, Liu N, Rottbauer W, Ma G, Rasche V. T2-prepared segmented 3D-gradient-echo for fast T2-weighted high-resolution three-dimensional imaging of the carotid artery wall at 3T: a feasibility study. Biomed Eng Online 2016; 15:165. [PMID: 28155713 PMCID: PMC5259811 DOI: 10.1186/s12938-016-0276-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The multi-contrast assessment of the carotid artery wall has become an important diagnostic tool for the characterization of atherosclerotic plaque and vessel wall thickening. For providing the required T1-, T2-, and proton density weighted contrast, multi-slice turbo spin echo (TSE) techniques are normally applied. The straightforward extension of the TSE techniques to volumetric imaging of large sections of the carotid arteries is limited by the resulting long acquisition times. Where the acquisition of a T1-weighted contrast can be accelerated by applying a T1-weighted fast gradient echo technique, acceleration of the T2-weighted contrast is not as straightforward. METHODS In this work, the combination of a T2 preparation and a conventional fast gradient echo technique (T2P-3DGE) was evaluated for rapid acquisition of a T2-weighted image contrast. Acquisition parameters were optimized in an initial in vitro study in direct comparison to the conventional T2-weighted TSE (T2W-3DTSE) technique. Subsequently, the T2P-3DGE technique was evaluated in vivo. RESULTS In direct comparison, the T2P-3DGE sequence provided similar T2 contrast as the respective T2W-3DTSE sequence. After correction of an observed intensity offset, most likely caused by the additional T1-weighting of the T2P-3DGE sequence, no significant difference between the two T2-weighted sequences were observed in phantom data. The good correlation of the image contrast between the two sequences was confirmed in the initial in-vivo study, proving a potential reduction of the scan time for T2P-3DGE to 25% of the respective T2W-3DTSE technique. CONCLUSION The in vitro as well as the in vivo results clearly indicate the potential of the T2P-3DGE technique for providing similar T2 image contrast as in the conventional techniques. Thereby, the acquisition times could be substantially reduced to about 25% of the respective 3D-TSE technique.
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Affiliation(s)
- Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Axel Bornstedt
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Nico Merkle
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Naifeng Liu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China.
| | - Volker Rasche
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany.
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19
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Singh N, Moody AR, Roifman I, Bluemke DA, Zavodni AEH. Advanced MRI for carotid plaque imaging. Int J Cardiovasc Imaging 2015; 32:83-9. [PMID: 26293362 PMCID: PMC4706840 DOI: 10.1007/s10554-015-0743-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 10/28/2022]
Abstract
Atherosclerosis is the ubiquitous underling pathological process that manifests in heart attack and stroke, cumulating in the death of one in three North American adults. High-resolution magnetic resonance imaging (MRI) is able to delineate atherosclerotic plaque components and total plaque burden within the carotid arteries. Using dedicated hardware, high resolution images can be obtained. Combining pre- and post-contrast T1, T2, proton-density, and magnetization-prepared rapid acquisition gradient echo weighted fat-saturation imaging, plaque components can be defined. Post-processing software allows for semi- and fully automated quantitative analysis. Imaging correlation with surgical specimens suggests that this technique accurately differentiates plaque features. Total plaque burden and specific plaque components such as a thin fibrous cap, large fatty or necrotic core and intraplaque hemorrhage are accepted markers of neuroischemic events. Given the systemic nature of atherosclerosis, emerging science suggests that the presence of carotid plaque is also an indicator of coronary artery plaque burden, although the preliminary data primarily involves patients with stable coronary disease. While the availability and cost-effectiveness of MRI will ultimately be important determinants of whether carotid MRI is adopted clinically in cardiovascular risk assessment, the high accuracy and reliability of this technique suggests that it has potential as an imaging biomarker of future risk.
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Affiliation(s)
- Navneet Singh
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Idan Roifman
- Division of Cardiology, Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - David A Bluemke
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Anna E H Zavodni
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada.
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20
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Usman A, Sadat U, Graves MJ, Gillard JH. Magnetic resonance imaging of atherothrombotic plaques. J Clin Neurosci 2015; 22:1722-6. [PMID: 26254092 DOI: 10.1016/j.jocn.2015.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/28/2015] [Indexed: 11/27/2022]
Abstract
Atherosclerosis remains the leading cause of long term morbidity and mortality worldwide, despite significant advances in its management. Vulnerable atherothrombotic plaques are predominantly responsible for thromboembolic ischaemic events in arterial beds, such as the carotid, coronary and lower limb arteries. MRI has emerged as a non-invasive, non-irradiating and highly reproducible imaging technique which allows detailed morphological and functional assessment of such plaques. It also has the potential to monitor the efficacy of established and evolving anti-atherosclerosis drugs. It is envisaged that by careful identification and understanding of the underlying cellular and molecular mechanisms that govern atherosclerosis, novel treatment strategies can be formulated which may reduce the persistent high mortality and morbidity rates associated with this disease. MRI shows promise in achieving this goal.
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Affiliation(s)
- Ammara Usman
- University Department of Radiology, Addenbrooke's Hospital, Post Office Box 218, Level 5, Hills Road, Cambridge CB20QQ, UK.
| | - Umar Sadat
- Cambridge Vascular Unit, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Martin J Graves
- University Department of Radiology, Addenbrooke's Hospital, Post Office Box 218, Level 5, Hills Road, Cambridge CB20QQ, UK
| | - Jonathan H Gillard
- University Department of Radiology, Addenbrooke's Hospital, Post Office Box 218, Level 5, Hills Road, Cambridge CB20QQ, UK
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21
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Secondary prevention at 360°: the important role of diagnostic imaging. Radiol Med 2015; 120:511-25. [DOI: 10.1007/s11547-014-0484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
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22
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Kadoglou N, Sfyroeras G, Spathis A, Gkekas C, Gastounioti A, Mantas G, Nikita K, Karakitsos P, Liapis C. Galectin-3, Carotid Plaque Vulnerability, and Potential Effects of Statin Therapy. Eur J Vasc Endovasc Surg 2015; 49:4-9. [DOI: 10.1016/j.ejvs.2014.10.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
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23
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Le Ven F, Tizón-Marcos H, Fuchs C, Mathieu P, Pibarot P, Larose E. Valve tissue characterization by magnetic resonance imaging in calcific aortic valve disease. Can J Cardiol 2014; 30:1676-83. [PMID: 25475469 DOI: 10.1016/j.cjca.2014.09.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Calcific aortic valve disease affects 10%-15% of the elderly population, causing considerable morbidity and mortality. There is no imaging technique that allows for the assessment of tissue composition of the valve in vivo. We thus investigated whether multiparametric magnetic resonance imaging (MRI) could characterize and quantify lipid, fibrous, and mineralized tissues within aortic valve (AV) cusps. METHODS AV leaflets were explanted from patients with severe aortic stenosis at the time of valve replacement surgery. Aortic cusps were imaged ex vivo using 1.5 T MRI using 3 gradient-echo sequences with T1, moderate T2, and proton density weightings (T1w, T2w, and PDw). Histopathologic analysis was performed on coregistered slices to identify and measure mineralized tissue, fibrous tissue, and lipid-rich tissue. Area and mean grey values were measured in all 3 weightings by standardized software. RESULTS Four hundred ninety-two regions of interest from 30 AV leaflets were studied. Total leaflet surface and the areas of mineralized (P < 0.0001), fibrous (P = 0.002), and lipid-rich (P = 0.0001) tissues measured by MRI matched closely those measured by histopathologic examination. All 3 weightings provided significant discrimination between median grey values for mineralized, fibrous, and lipid-rich tissues (P < 0.0001 for T1w, moderate T2w, and PDw). A best-fit equation integrating the grey value data from all 3 weightings allowed multiparametric MRI to identify valve leaflet components with areas under the receiver operating characteristic curve of 0.92, 0.81, and 0.72, respectively. CONCLUSIONS AV leaflet characteristics, including tissue composition, distribution, and area, may be successfully measured by multiparametric MRI with good to excellent accuracy.
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Affiliation(s)
- Florent Le Ven
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Helena Tizón-Marcos
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Christina Fuchs
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Patrick Mathieu
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Philippe Pibarot
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada
| | - Eric Larose
- Département Multidisciplinaire De Cardiologie, Institut Universitaire de Cardiologie et de pneumologie de Québec, and Faculté de Médecine de l'Université Laval, Québec, Québec, Canada.
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24
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Symptomatic unruptured isolated middle cerebral artery dissection: clinical and magnetic resonance imaging features. Clin Neuroradiol 2014; 26:81-91. [DOI: 10.1007/s00062-014-0337-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
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25
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Makowski MR, Botnar RM. MR imaging of the arterial vessel wall: molecular imaging from bench to bedside. Radiology 2013; 269:34-51. [PMID: 24062561 DOI: 10.1148/radiol.13102336] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular diseases remain the leading cause of morbidity and mortality in the Western world and developing countries. In clinical practice, in vivo characterization of atherosclerotic lesions causing myocardial infarction, ischemic stroke, and other complications remains challenging. Imaging methods, limited to the assessment luminal stenosis, are the current reference standard for the assessment of clinically significant coronary and carotid artery disease and the guidance of treatment. These techniques do not allow distinction between stable and potentially vulnerable atherosclerotic plaque. Magnetic resonance (MR) imaging is a modality well suited for visualization and characterization of the relatively thin arterial vessel wall, because it allows imaging with high spatial resolution and excellent soft-tissue contrast. In clinical practice, atherosclerotic plaque components of the carotid artery and aorta may be differentiated and characterized by using unenhanced vessel wall MR imaging. Additional information can be gained by using clinically approved nonspecific contrast agents. With the advent of targeted MR contrast agents, which enhance specific molecules or cells, pathologic processes can be visualized at a molecular level with high spatial resolution. In this article, the pathophysiologic changes of the arterial vessel wall underlying the development of atherosclerosis will be first reviewed. Then basic principles and properties of molecular MR imaging contrast agents will be introduced. Additionally, recent advances in preclinical molecular vessel wall imaging will be reviewed. Finally, the clinical feasibility of arterial vessel wall imaging at unenhanced and contrast material-enhanced MR imaging of the aortic, carotid, and coronary vessel wall will be discussed.
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Affiliation(s)
- Marcus R Makowski
- Division of Imaging Sciences, BHF Centre of Excellence, Wellcome Trust and EPSRC Medical Engineering Center, and NIHR Biomedical Research Centre, King's College London, 4th Floor, Lambeth Wing, St Thomas Hospital, London SE1 7EH, England
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26
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Association Between the Volume of Carotid Artery Plaque and Its Subcomponents and the Volume of White Matter Lesions in Patients Selected for Endarterectomy. AJR Am J Roentgenol 2013; 201:W747-52. [DOI: 10.2214/ajr.12.10217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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27
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Narumi S, Sasaki M, Ohba H, Ogasawara K, Kobayashi M, Natori T, Hitomi J, Itagaki H, Takahashi T, Terayama Y. Predicting carotid plaque characteristics using quantitative color-coded T1-weighted MR plaque imaging: correlation with carotid endarterectomy specimens. AJNR Am J Neuroradiol 2013; 35:766-71. [PMID: 24091440 DOI: 10.3174/ajnr.a3741] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR plaque imaging is used to evaluate the risk of embolic complications during carotid endarterectomy and carotid artery stent placement. However, its performance for characterizing intraplaque components has varied across studies and is generally suboptimal. Hence, we correlated MR imaging results with histologic findings to determine whether a combination of high-contrast T1-weighted imaging and quantitative image analysis could readily determine plaque characteristics. MATERIALS AND METHODS We prospectively examined 40 consecutive patients before carotid endarterectomy by using a 1.5T scanner and axial T1-weighted spin-echo images under optimized scanning conditions. The percentage areas of intraplaque fibrous tissue, lipid/necrosis, and hemorrhage were calculated automatically by using the software with previously reported cutoff values and were compared with those of the specimens. The thickness of the fibrous cap was also measured manually. RESULTS The percentage areas of fibrous, lipid/necrotic, and hemorrhagic components were 5.7%-98.7%, 1.3%-65.7%, and 0%-82.0%, respectively, as determined by the MR images, whereas the corresponding values were 4.8%-92.3%, 7.0%-93.8%, and 0%-70.4%, respectively, as determined by histologic examination. Significant positive correlation and agreement were observed between MR images and histologic specimens (r = 0.92, 0.79, and 0.92; intraclass correlation coefficients = 0.91, 0.67, and 0.89; respectively). Thickness of the fibrous caps on MR images (0.21-0.87 mm) and in the specimens (0.14-0.83 mm) also showed positive correlation and agreement (r = 0.61, intraclass correlation coefficient = 0.59). CONCLUSIONS Quantitative analysis of high-contrast T1-weighted images can accurately evaluate the composition of carotid plaques in carotid endarterectomy candidates.
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Affiliation(s)
- S Narumi
- From the Department of Neurology and Gerontology (S.N., H.O., T.N., Y.T.)
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Du J, Peterson M, Kansal N, Bydder GM, Kahn A. Mineralization in calcified plaque is like that of cortical bone-Further evidence from ultrashort echo time (UTE) magnetic resonance imaging of carotid plaque calcification and cortical bone. Med Phys 2013; 40:102301. [DOI: 10.1118/1.4819944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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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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Naim C, Cloutier G, Mercure E, Destrempes F, Qin Z, El-Abyad W, Lanthier S, Giroux MF, Soulez G. Characterisation of carotid plaques with ultrasound elastography: feasibility and correlation with high-resolution magnetic resonance imaging. Eur Radiol 2013; 23:2030-41. [PMID: 23417249 DOI: 10.1007/s00330-013-2772-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/19/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the ability of ultrasound non-invasive vascular elastography (NIVE) strain analysis to characterise carotid plaque composition and vulnerability as determined by high-resolution magnetic resonance imaging (MRI). METHODS Thirty-one subjects with 50 % or greater carotid stenosis underwent NIVE and high-resolution MRI of internal carotid arteries. Time-varying strain images (elastograms) of segmented plaques were generated from ultrasonic raw radiofrequency sequences. On MRI, corresponding plaques and components were segmented and quantified. Associations between strain parameters, plaque composition and symptomatology were estimated with curve-fitting regressions and Mann-Whitney tests. RESULTS Mean stenosis and age were 72.7 % and 69.3 years, respectively. Of 31 plaques, 9 were symptomatic, 17 contained lipid and 7 were vulnerable on MRI. Strains were significantly lower in plaques containing a lipid core compared with those without lipid, with 77-100 % sensitivity and 57-79 % specificity (P < 0.032). A statistically significant quadratic fit was found between strain and lipid content (P < 0.03). Strains did not discriminate symptomatic patients or vulnerable plaques. CONCLUSIONS Ultrasound NIVE is feasible in patients with significant carotid stenosis and can detect the presence of a lipid core with high sensitivity and moderate specificity. Studies of plaque progression with NIVE are required to identify vulnerable plaques. KEY POINTS • Non-invasive vascular elastography (NIVE) provides additional information in vascular ultrasound • Ultrasound NIVE is feasible in patients with significant carotid stenosis • Ultrasound NIVE detects a lipid core with high sensitivity and moderate specificity • Studies on plaque progression with NIVE are required to identify vulnerable plaques.
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Affiliation(s)
- Cyrille Naim
- Department of Radiology, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada.
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McCormick M, Varghese T, Wang X, Mitchell C, Kliewer MA, Dempsey RJ. Methods for robust in vivo strain estimation in the carotid artery. Phys Med Biol 2012; 57:7329-53. [PMID: 23079725 DOI: 10.1088/0031-9155/57/22/7329] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A hierarchical block-matching motion tracking algorithm for strain imaging is presented. Displacements are estimated with improved robustness and precision by utilizing a Bayesian regularization algorithm and an unbiased subsample interpolation technique. A modified least-squares strain estimator is proposed to estimate strain images from a noisy displacement input while addressing the motion discontinuity at the wall-lumen boundary. Methods to track deformation over the cardiac cycle incorporate a dynamic frame skip criterion to process data frames with sufficient deformation to produce high signal-to-noise displacement and strain images. Algorithms to accumulate displacement and/or strain on particles in a region of interest over the cardiac cycle are described. New methods to visualize and characterize the deformation measured with the full 2D strain tensor are presented. Initial results from patients imaged prior to carotid endarterectomy suggest that strain imaging detects conditions that are traditionally considered high risk including soft plaque composition, unstable morphology, abnormal hemodynamics and shear of plaque against tethering tissue can be exacerbated by neoangiogenesis. For example, a maximum absolute principal strain exceeding 0.2 is observed near calcified regions adjacent to turbulent flow, protrusion of the plaque into the arterial lumen and regions of low echogenicity associated with soft plaques. Non-invasive carotid strain imaging is therefore a potentially useful tool for detecting unstable carotid plaque.
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Affiliation(s)
- M McCormick
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA
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den Hartog AG, Bovens SM, Koning W, Hendrikse J, Pasterkamp G, Moll FL, de Borst GJ. PLACD-7T Study: Atherosclerotic Carotid Plaque Components Correlated with Cerebral Damage at 7 Tesla Magnetic Resonance Imaging. Curr Cardiol Rev 2012; 7:28-34. [PMID: 22294972 PMCID: PMC3131713 DOI: 10.2174/157340311795677743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 10/16/2010] [Accepted: 01/07/2011] [Indexed: 11/22/2022] Open
Abstract
Introduction: In patients with carotid artery stenosis histological plaque composition is associated with plaque stability and with presenting symptomatology. Preferentially, plaque vulnerability should be taken into account in pre-operative work-up of patients with severe carotid artery stenosis. However, currently no appropriate and conclusive (non-) invasive technique to differentiate between the high and low risk carotid artery plaque in vivo is available. We propose that 7 Tesla human high resolution MRI scanning will visualize carotid plaque characteristics more precisely and will enable correlation of these specific components with cerebral damage. Study objective: The aim of the PlaCD-7T study is 1: to correlate 7T imaging with carotid plaque histology (gold standard); and 2: to correlate plaque characteristics with cerebral damage ((clinically silent) cerebral (micro) infarcts or bleeds) on 7 Tesla high resolution (HR) MRI. Design: We propose a single center prospective study for either symptomatic or asymptomatic patients with haemodynamic significant (70%) stenosis of at least one of the carotid arteries. The Athero-Express (AE) biobank histological analysis will be derived according to standard protocol. Patients included in the AE and our prospective study will undergo a pre-operative 7 Tesla HR-MRI scan of both the head and neck area. Discussion: We hypothesize that the 7 Tesla MRI scanner will allow early identification of high risk carotid plaques being associated with micro infarcted cerebral areas, and will thus be able to identify patients with a high risk of periprocedural stroke, by identification of surrogate measures of increased cardiovascular risk.
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Affiliation(s)
- A G den Hartog
- Departments of Vascular Surgery, Utrecht, the Netherlands, Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
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Narumi S, Sasaki M, Ohba H, Ogasawara K, Kobayashi M, Hitomi J, Mori K, Ohura K, Yamaguchi M, Kudo K, Terayama Y. Prediction of carotid plaque characteristics using non-gated MR imaging: correlation with endarterectomy specimens. AJNR Am J Neuroradiol 2012; 34:191-7. [PMID: 22837309 DOI: 10.3174/ajnr.a3249] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Electrocardiographic gating, commonly used in MR carotid plaque imaging, can negatively affect intraplaque contrast if the TR is inappropriate. The present study aimed to determine whether a non-gated technique with appropriate TRs can accurately evaluate intraplaque characteristics in specimens excised by CEA. MATERIALS AND METHODS We prospectively examined 40 consecutive patients who underwent CEA (59-82 years of age) by using a 1.5T scanner. Axial T1WI with a TR of 500 ms and PDWI and T2WI with a TR of 3000 ms with a self-navigated rotating-blade scan instead of cardiac gating were obtained. Signal intensities of the plaque and adjacent muscle were measured, and the CR on T1WI, PDWI, and T2WI as well as the gray-scale median on US were correlated with the pathologic findings of the CEA specimens. RESULTS On T1WI, the CRs of the carotid plaques differed significantly among groups in which the main components were histologically confirmed as fibrous tissue, lipid/necrosis, and hemorrhage (0.54-1.17, 1.16-1.53, and 1.40-2.29, respectively). The sensitivity and specificity for discriminating lipid/necrosis/hemorrhage from fibrous tissue were 96% and 100%, respectively. On T2WI, the CRs of plaques with lipid/necrosis were significantly higher than those of other groups, but the CRs on PDWI and the gray-scale median on US were not significantly different among the groups. CONCLUSIONS Non-gated MR plaque imaging, particularly T1WI, can readily predict the intraplaque main components of the carotid artery with high sensitivity and specificity.
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Affiliation(s)
- S Narumi
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan.
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Asymptomatic carotid plaque rupture with unexpected thrombosis over a non-canonical vulnerable lesion. Atherosclerosis 2011; 218:356-62. [PMID: 21813127 DOI: 10.1016/j.atherosclerosis.2011.06.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/23/2011] [Accepted: 06/28/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Several studies have demonstrated that carotid plaque rupture and thrombosis represent the most important factors correlated with the onset of acute cerebrovascular symptoms. Nevertheless, ruptured thrombotic plaques have been described also in asymptomatic patients. What still needs to be clarified is why a plaque rupture leads either to an acute ischemic syndrome or, in a minor group of patients, remains asymptomatic. The purpose of this study was to systematically compare the histologic features of thrombotic plaques both in asymptomatic and symptomatic patients in order to identify specific findings that could explain the peculiar clinical behavior that characterizes each of the clinical settings. METHODS A total of 157 thrombotic plaques from 60 asymptomatic patients and 97 with major stroke who consecutively underwent CEA were serially sectioned and studied by histology. RESULTS A minute cap disruption very frequently characterizes thrombotic plaques of asymptomatic patients and it was always smaller than large ulcers observed in thrombotic symptomatic plaques (651 ± 687μm vs. 4150 ± 3526, p=0.001). In asymptomatics this typical feature was associated with fewer inflammatory cells (20.1 ± 8.8 vs. 33.9 ± 26.1 cells × hpf, p=0.001), smaller lipidic-necrotic core (33.9%± 2.9% vs. 42.0% ± 2.4%; p=0.04) and larger calcification (16.2 ± 12.8% vs. 8.1 ± 12.2%, p=0.02). Symptomatic patients with thrombotic plaques showed higher incidence of metabolic syndrome (p=0.002) and moderate-high Framingham risk scores (p=0.001) comparing to asymptomatic individuals. CONCLUSION The transformation from a stable to a vulnerable plaque is a gradual process in the natural history of the disease and plaque rupture is an event not necessarily occurring at a late phase but also at earlier one. In this case, the rupture will be most likely smaller and clinically asymptomatic.
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Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Current clinical techniques that rely on stenosis measurement alone appear to be insufficient for risk prediction in atherosclerosis patients. Many novel imaging methods have been developed to study atherosclerosis progression and to identify new features that can predict future clinical risk. MRI of atherosclerotic vessel walls is one such method. It has the ability to noninvasively evaluate multiple biomarkers of the disease such as luminal stenosis, plaque burden, tissue composition and plaque activity. In addition, the accuracy of in vivo MRI has been validated against histology with high reproducibility, thus paving the way for application to epidemiological studies of disease pathogenesis and, by serial MRI, in monitoring the efficacy of therapeutic intervention. In this review, we describe the various MR techniques used to evaluate aspects of plaque progression, discuss imaging-based measurements (imaging biomarkers), and also detail their validation. The application of plaque MRI in clinical trials as well as emerging imaging techniques used to evaluate plaque compositional features and biological activities are also discussed.
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Affiliation(s)
- Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, NY, 10510
- Department of Radiology, University of Washington, Seattle, WA, 98109
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, 98109
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, 98109
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, 98109
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Li F, Yarnykh VL, Hatsukami TS, Chu B, Balu N, Wang J, Underhill HR, Zhao X, Smith R, Yuan C. Scan-rescan reproducibility of carotid atherosclerotic plaque morphology and tissue composition measurements using multicontrast MRI at 3T. J Magn Reson Imaging 2009; 31:168-76. [PMID: 20027584 DOI: 10.1002/jmri.22014] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Feiyu Li
- Department of Radiology, University of Washington, Seattle, Washington 98109, USA
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37
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Narumi S, Sasaki M, Ohba H, Ogasawara K, Hitomi J, Mori K, Ohura K, Ono A, Terayama Y. Altered carotid plaque signal among different repetition times on T1-weighted magnetic resonance plaque imaging with self-navigated radial-scan technique. Neuroradiology 2009; 52:285-90. [DOI: 10.1007/s00234-009-0642-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 11/25/2009] [Indexed: 11/29/2022]
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Dong L, Kerwin WS, Ferguson MS, Li R, Wang J, Chen H, Canton G, Hatsukami TS, Yuan C. Cardiovascular magnetic resonance in carotid atherosclerotic disease. J Cardiovasc Magn Reson 2009; 11:53. [PMID: 20003520 PMCID: PMC2806867 DOI: 10.1186/1532-429x-11-53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 12/15/2009] [Indexed: 11/13/2022] Open
Abstract
Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.
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Affiliation(s)
- Li Dong
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Rui Li
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, NY, USA
| | - Huijun Chen
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Strauss HW. Capping it off. J Nucl Cardiol 2009; 16:686-8. [PMID: 19633901 DOI: 10.1007/s12350-009-9124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 07/09/2009] [Indexed: 10/20/2022]
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Liapis CD, Bell PRF, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, Biasi G, Norgren L. ESVS Guidelines. Invasive Treatment for Carotid Stenosis: Indications, Techniques. Eur J Vasc Endovasc Surg 2009; 37:1-19. [PMID: 19286127 DOI: 10.1016/j.ejvs.2008.11.006] [Citation(s) in RCA: 412] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 11/07/2008] [Indexed: 12/18/2022]
Affiliation(s)
- C D Liapis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
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