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Ishimaru H, Ikebe Y, Izumo T, Imai H, Morikawa M, Ideguchi R, Ishiyama A, Koike H, Uetani M, Toya R. Assessment for Carotid Atherosclerotic Plaque Using Vessel Wall Magnetic Resonance Imaging: A Multireader ROC Study to Determine Optimal Sequence for Detecting Vessel Wall Calcification. J Vasc Res 2024; 61:122-128. [PMID: 38547846 DOI: 10.1159/000538175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/27/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION We aimed to compare conventional vessel wall MR imaging techniques and quantitative susceptibility mapping (QSM) to determine the optimal sequence for detecting carotid artery calcification. METHODS Twenty-two patients who underwent carotid vessel wall MR imaging and neck CT were enrolled. Four slices of 6-mm sections from the bilateral internal carotid bifurcation were subdivided into 4 segments according to clock position (0-3, 3-6, 6-9, and 9-12) and assessed for calcification. Two blinded radiologists independently reviewed a total of 704 segments and scored the likelihood of calcification using a 5-point scale on spin-echo imaging, FLASH, and QSM. The observer performance for detecting calcification was evaluated by a multireader, multiple-case receiver operating characteristic study. Weighted κ statistics were calculated to assess interobserver agreement. RESULTS QSM had a mean area under the receiver operating characteristic curve of 0.85, which was significantly higher than that of any other sequence (p < 0.01) and showed substantial interreader agreement (κ = 0.68). A segment with a score of 3-5 was defined as positive, and a segment with a score of 1-2 was defined as negative; the sensitivity and specificity of QSM were 0.75 and 0.87, respectively. CONCLUSION QSM was the most reliable MR sequence for the detection of plaque calcification.
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Affiliation(s)
- Hideki Ishimaru
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yohei Ikebe
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurolosurgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Imai
- MR Research and Collaboration, Siemens Healthcare K.K, Osaki, Shinagawa, Tokyo, Japan
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Reiko Ideguchi
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Ayano Ishiyama
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirofumi Koike
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Ryo Toya
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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2
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Fote GM, Raefsky S, Mock K, Chaudhari A, Shafie M, Yu W. Intracranial Arterial Calcifications: Potential Biomarkers of Stroke Risk and Outcome. Front Neurol 2022; 13:900579. [PMID: 36119671 PMCID: PMC9475140 DOI: 10.3389/fneur.2022.900579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Intracranial artery calcifications (IAC), a common and easily identifiable finding on computed tomorgraphy angiography (CTA), has gained recognition as a possible risk factor for ischemic stroke. While atherosclerosis of intracranial arteries is believed to be a mechanism that commonly contributes to ischemic stroke, and coronary artery calcification is well-established as a predictor of both myocardial infarction (MI) and ischemic stroke risk, IAC is not currently used as a prognostic tool for stroke risk or recurrence. This review examines the pathophysiology and prevalence of IAC, and current evidence suggesting that IAC may be a useful tool for prediction of stroke incidence, recurrence, and response to acute ischemic stroke therapy.
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Affiliation(s)
- Gianna M. Fote
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Sophia Raefsky
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Kelton Mock
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Amit Chaudhari
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Amit Chaudhari
| | - Mohammad Shafie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
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3
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Saba L, Chen H, Cau R, Rubeis G, Zhu G, Pisu F, Jang B, Lanzino G, Suri J, Qi Y, Wintermark M. Impact Analysis of Different CT Configurations of Carotid Artery Plaque Calcifications on Cerebrovascular Events. AJNR Am J Neuroradiol 2022; 43:272-279. [PMID: 35121588 PMCID: PMC8985662 DOI: 10.3174/ajnr.a7401] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE CT is considered the standard reference both for quantification and characterization of carotid artery calcifications. Our aim was to investigate the relationship among different types of calcium configurations detected with CT within the plaque with a novel classification and to investigate the prevalence of cerebrovascular events. MATERIALS AND METHODS Seven hundred ninety patients (men = 332; mean age, 69.7 [SD, 13] years; 508 symptomatic for cerebrovascular symptoms and 282 asymptomatic) who underwent computed tomography of the carotid arteries were retrospectively included in this institutional review board-approved study. The plaque was classified into 6 types according to the different types of calcium configurations as the following: type 1, complete absence of calcification within the plaque; type 2, intimal or superficial calcifications; type 3, deep or bulky calcifications; type 4, adventitial calcifications with internal soft plaque of <2 mm thickness; type 5, mixed patterns with intimal and bulky calcifications; and type 6, positive rim sign. RESULTS The highest prevalence of cerebrovascular events was observed for type 6, for which 89 of the 99 cases were symptomatic. Type 6 plaque had the highest degree of correlation with TIA, stroke, symptoms, and ipsilateral infarct for both sides with a higher prevalence in younger patients. The frequency of symptoms observed by configuration type significantly differed between right and left plaques, with symptoms observed more frequently in type 6 calcification on the right side (50/53; 94%) than on the left side (39/46; 85%, P < .001). CONCLUSIONS We propose a novel carotid artery plaque configuration classification that is associated with the prevalence of cerebrovascular events. If confirmed in longitudinal analysis, this classification could be used to stratify the risk of occurrence of ischemic events.
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Affiliation(s)
- L. Saba
- From the Department of Radiology (L.S., R.C., F.P.), Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - H. Chen
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
| | - R. Cau
- From the Department of Radiology (L.S., R.C., F.P.), Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - G.D. Rubeis
- Department of Radiology, UOC of Diagnostic and Interventional Neuroradiology (G.D.R.), San Camillo-Forlanini Hospital, Rome, Italy
| | - G. Zhu
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
| | - F. Pisu
- From the Department of Radiology (L.S., R.C., F.P.), Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - B. Jang
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
| | - G. Lanzino
- Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - J.S. Suri
- Stroke Monitoring and Diagnostic Division (J.S.S.), AtheroPoint, Roseville, California
| | - Y. Qi
- Department of Xuanwu Hospital (Y.Q.), Capital Medical University, Beijing, Chin
| | - M. Wintermark
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
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Du H, Yang W, Chen X. Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease. Front Neurol 2022; 12:789035. [PMID: 35140673 PMCID: PMC8818681 DOI: 10.3389/fneur.2021.789035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial artery calcification (IAC) was regarded as a proxy for intracranial atherosclerosis (ICAS). IAC could be easily detected on routine computer tomography (CT), which was neglected by clinicians in the previous years. The evolution of advanced imaging technologies, especially vessel wall scanning using high resolution-magnetic resonance imaging (HR-MRI), has aroused the interest of researchers to further explore the characteristics and clinical impacts of IAC. Recent histological evidence acquired from the human cerebral artery specimens demonstrated that IAC could mainly involve two layers: the intima and the media. Accumulating evidence from histological and clinical imaging studies verified that intimal calcification is more associated with ICAS, while medial calcification, especially the internal elastic lamina, contributes to arterial stiffness rather than ICAS. Considering the highly improved abilities of novel imaging technologies in differentiating intimal and medial calcification within the large intracranial arteries, this review aimed to describe the histological and imaging features of two types of IAC, as well as the risk factors, the hemodynamic influences, and other clinical impacts of IAC occurring in intimal or media layers.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Xiangyan Chen
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Jiang C, Zhang J, Zhu J, Wang X, Wen Z, Zhao X, Yuan C. Association between coexisting intracranial artery and extracranial carotid artery atherosclerotic diseases and ipsilateral cerebral infarction: a Chinese Atherosclerosis Risk Evaluation (CARE-II) study. Stroke Vasc Neurol 2021; 6:595-602. [PMID: 33903178 PMCID: PMC8717767 DOI: 10.1136/svn-2020-000538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/19/2020] [Accepted: 12/18/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To evaluate the association between coexisting intracranial and extracranial carotid artery atherosclerotic diseases and ipsilateral acute cerebral infarct (ACI) in symptomatic patients by using magnetic resonance (MR) vessel wall imaging. METHODS Symptomatic patients were recruited from a cross-sectional, multicentre study of Chinese Atherosclerosis Risk Evaluation (CARE-II). All patients underwent MR imaging for extracranial carotid arterial wall, intracranial artery and brain. Coexisting intracranial stenosis ≥50% and extracranial carotid artery mean wall thickness (MWT) ≥1 mm and plaque compositions at the same side were evaluated and the ipsilateral ACI was identified. The association between coexisting atherosclerotic diseases and ACI was evaluated using logistic regression. RESULTS 351 patients were recruited. Patients with ipsilateral ACI had significantly greater prevalence of coexisting intracranial stenosis ≥50% and carotid MWT ≥1 mm (20.5% vs 4.9%, p<0.001), calcification (15.1% vs 4.4%, p=0.001) and lipid-rich necrotic core (LRNC) (19.2% vs 7.8%, p=0.002) compared with those without. Coexisting intracranial artery stenosis ≥50% and carotid MWT ≥1 mm (OR 5.043, 95% CI 2.378 to 10.694; p<0.001), calcification (OR 3.864, 95% CI 1.723 to 8.664; p=0.001) and LRNC (OR 2.803, 95% CI 1.455 to 5.401; p=0.002) were significantly associated with ipsilateral ACI. After adjusting for confounding factors, the aforementioned associations remained statistically significant (intracranial stenosis ≥50% coexisting with carotid MWT ≥1 mm: OR 4.313, 95% CI 1.937 to 9.601, p<0.001; calcification: OR 3.606, 95% CI 1.513 to 8.593, p=0.004; LRNC: OR 2.358, 95% CI 1.166 to 4.769, p=0.017). CONCLUSIONS Coexistence of intracranial artery severe stenosis and extracranial carotid artery large burden and intraplaque components of calcification and LRNC are independently associated with ipsilateral ACI. TRIAL REGISTRATION NUMBER https://www.clinicaltrials.gov/. Unique identifier: NCT02017756.
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Affiliation(s)
- Chunxiu Jiang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Zhang
- Department of Radiology, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Jianbin Zhu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xianlong Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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6
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The Impact of Coronary Artery Calcification on Long-Term Cardiovascular Outcomes. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Decades of research and experimental studies have investigated various strategies to prevent acute coronary events. However, significantly efficient preventive methods have not been developed and still remains a challenge to determine if a coronary atherosclerotic plaque will become vulnerable and unstable. This review aims to assess the significance of plaque vulnerability markers, more precisely the role of spotty calcifications in the development of major cardiac events, given that coronary calcification is a hallmark of atherosclerosis. Recent studies have suggested that microcalcifications, spotty calcifications, and the presence of the napkin-ring sign are predictive vulnerable plaque features, and their presence may cause plaque instability.
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7
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Ignatyev IM, Gafurov MR, Krivosheeva NV. Criteria for Carotid Atherosclerotic Plaque Instability. Ann Vasc Surg 2020; 72:340-349. [PMID: 32927044 DOI: 10.1016/j.avsg.2020.08.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study aim is to determine the criteria for carotid atherosclerotic plaque instability with the use of an advanced ultrasound technology, immunohistochemical analysis, and electron paramagnetic resonance (EPR) and assess their correlations with histologic results. METHODS A total of 92 patients were included in the study and were examined by ultrasound duplex scanning and ultrasound elastography. Plaques harvested during carotid endarterectomy were obtained for histologic analysis, immunofluorescent assay, and EPR spectroscopic measurements. RESULTS Multivariate logistic regression analysis showed that plaques with an area >90 mm2 (odds ratio [OR], 4.05; 95% confidence interval [CI], 1.32-13.2; P = 0.006), plaque volume index > 0.6 cm3 (OR, 2.72; 95% CI, 1.05-9.58; P = 0.04), and juxtaluminal black area ≥8 mm2 (OR, 2.82; 95% CI, 1.22-6. 23; P = 0.02) were statistically significant independent predictors of histologically verified unstable plaques. Unstable plaques occurred in 94% of the patients with these indicators. Significant increases in the number of CD68+ and CD36+ cells (inflammatory markers) and CD31+ cells (neovasculogenesis markers) were revealed in unstable plaques by the immunohistochemical assay. EPR data analysis showed that divalent manganese could serve as a marker of plaque instability. CONCLUSIONS Additional ultrasound criteria, verified by histologic studies, significantly increased the information content for identifying patients with unstable plaques, which can be of great importance in stratifying the risk of ischemic stroke, especially in asymptomatic patients. The degree of calcification is not a mandatory criterion for plaque stabilization.
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Affiliation(s)
- Igor M Ignatyev
- Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia.
| | - Marat R Gafurov
- Institute of Physics of the Kazan (Volga Region) Federal University, Kazan, Russia
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8
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Shi X, Gao J, Lv Q, Cai H, Wang F, Ye R, Liu X. Calcification in Atherosclerotic Plaque Vulnerability: Friend or Foe? Front Physiol 2020; 11:56. [PMID: 32116766 PMCID: PMC7013039 DOI: 10.3389/fphys.2020.00056] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Calcification is a clinical marker of atherosclerosis. This review focuses on recent findings on the association between calcification and plaque vulnerability. Calcified plaques have traditionally been regarded as stable atheromas, those causing stenosis may be more stable than non-calcified plaques. With the advances in intravascular imaging technology, the detection of the calcification and its surrounding plaque components have evolved. Microcalcifications and spotty calcifications represent an active stage of vascular calcification correlated with inflammation, whereas the degree of plaque calcification is strongly inversely related to macrophage infiltration. Asymptomatic patients have a higher content of plaque calcification than that in symptomatic patients. The effect of calcification might be biphasic. Plaque rupture has been shown to correlate positively with the number of spotty calcifications, and inversely with the number of large calcifications. There may be certain stages of calcium deposition that may be more atherogenic. Moreover, superficial calcifications are independently associated with plaque rupture and intraplaque hemorrhage, which may be due to the concentrated and asymmetrical distribution of biological stress in plaques. Conclusively, calcification of differential amounts, sizes, shapes, and positions may play differential roles in plaque homeostasis. The surrounding environments around the calcification within plaques also have impacts on plaque homeostasis. The interactive effects of these important factors of calcifications and plaques still await further study.
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Affiliation(s)
- Xuan Shi
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Southeast University, Nanjing, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
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9
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Lu M, Cui Y, Peng P, Qiao H, Cai J, Zhao X. Shape and Location of Carotid Atherosclerotic Plaque and Intraplaque Hemorrhage: A High-resolution Magnetic Resonance Imaging Study. J Atheroscler Thromb 2019; 26:720-727. [PMID: 30626781 PMCID: PMC6711842 DOI: 10.5551/jat.47449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: The present study aimed to investigate the association between shape and location of atherosclerotic plaques and intraplaque hemorrhage (IPH) in carotid arteries using magnetic resonance (MR) imaging. Methods: Overall, 114 symptomatic patients (mean age: 64.9±10.9 years; 81 males) who underwent MR imaging and had advanced carotid plaques were included in analysis. IPH presence and carotid plaque shape and location (below and above bifurcation) were evaluated. The plaque shape was defined as follows: type-I: the arc-length of plaque is greater in the upstream; type-II: the arc-length of plaque in downstream and upstream is equal; and type-III: the arc-length of plaque is greater in downstream. The plaque shape and location were compared between plaques with and without IPH and their associations with IPH were determined. Results: Of 181detectedplaques, 57 (31.5%) had IPH. Compared with plaques without IPH, those with IPH had higher incidence of the plaque shape of type-I (66.7% vs. 32.2%, P<0.001), lower incidence of plaque shape of type-III (24.6% vs. 50.0%, P=0.001), and were more likely located above carotid bifurcation (71.9% vs. 48.4%, P=0.003). The plaque shape of type-I (OR, 4.01; 95%CI, 1.36–11.83; P=0.012) and location above bifurcation (OR, 3.21; 95%CI, 1.07–9.61; P=0.037) of carotid plaques were significantly associated with IPH after adjusting for confounder factors. Conclusions: Carotid plaque shape and location are significantly associated with the occurrence of IPH. Our findings could provide new insights for the pathogenesis of IPH and vulnerably plaques.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, PLA General Hospital.,Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | | | - Peng Peng
- Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | | | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
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Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque. Eur Radiol 2018; 28:4968-4977. [PMID: 29876705 PMCID: PMC6223859 DOI: 10.1007/s00330-018-5535-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/18/2018] [Accepted: 05/11/2018] [Indexed: 01/09/2023]
Abstract
Objective Intraplaque hemorrhage (IPH) and ulceration of carotid atherosclerotic plaques have been associated with vulnerability while calcification has been conventionally thought protective. However, studies suggested calcification size and location may increase plaque vulnerability. This study explored the association between calcium configurations and ulceration with IPH. Methods One hundred thirty-seven consecutive symptomatic patients scheduled for carotid endarterectomy were recruited. CTA and CTP were performed prior to surgery. Plaque samples were collected for histology. According to the location, calcifications were categorized into superficial, deep and mixed types; according to the size and number, calcifications were classified as thick and thin, multiple and single. Results Seventy-one plaques had IPH (51.8%) and 83 had ulceration (60.6%). The appearance of IPH and ulceration was correlated (r = 0.49; p < 0.001). The incidence of multiple, superficial and thin calcifications was significantly higher in lesions with IPH and ulceration compared with those without. After adjusting factors including age, stenosis and ulceration, the presence of calcification [OR (95% CI), 3.0 (1.1-8.2), p = 0.035], multiple calcification [3.9 (1.4-10.9), p = 0.009] and superficial calcification [3.4 (1.1-10.8), p = 0.001] were all associated with IPH. ROC analysis showed that the AUC of superficial and multiple calcifications in detecting IPH was 0.63 and 0.66, respectively (p < 0.05). When the ulceration was combined, AUC increased significantly to 0.82 and 0.83, respectively. Results also showed that patients with lesions of both ulceration and IPH have significantly reduced brain perfusion in the area ipsilateral to the infarction. Conclusions Superficial and multiple calcifications and ulceration were associated with carotid IPH, and they may be a surrogate for higher risk lesions. Key Points • CTA-defined superficial and multiple calcifications in carotid atherosclerotic plaques are independently associated with the presence of intraplaque hemorrhage. • The combination of superficial and multiple calcifications and ulceration is highly predictive of carotid intraplaque hemorrhage. • Patients with lesions of both ulceration and intraplaque hemorrhage have significantly reduced brain perfusion in the area ipsilateral to the infarction.
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11
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Li B, Li H, Dong L, Huang G. Fast carotid artery MR angiography with compressed sensing based three-dimensional time-of-flight sequence. Magn Reson Imaging 2017; 43:129-135. [DOI: 10.1016/j.mri.2017.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/13/2017] [Indexed: 11/15/2022]
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12
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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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13
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Li B, Li H, Kong H, Dong L, Zhang J, Fang J. Compressed sensing based simultaneous black- and gray-blood carotid vessel wall MR imaging. Magn Reson Imaging 2017; 38:214-223. [DOI: 10.1016/j.mri.2017.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
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14
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Xie G, Bi X, Liu J, Yang Q, Natsuaki Y, Conte AH, Liu X, Li K, Li D, Fan Z. Three-dimensional coronary dark-blood interleaved with gray-blood (cDIG) magnetic resonance imaging at 3 tesla. Magn Reson Med 2015; 75:997-1007. [PMID: 25858528 DOI: 10.1002/mrm.25585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE Three-dimensional (3D) dark-blood MRI has shown great potential in coronary artery plaque evaluation. However, substantial variability in quantification could result from superficial calcification because of its low signal. To address this issue, a 3D coronary dark-blood interleaved with gray-blood (cDIG) technique was developed. METHODS cDIG is based on a balanced steady-state free precession readout combined with a local re-inversion-based double-inversion-recovery (LocReInv-DIR) preparation. The LocReInv-DIR is applied every two RR intervals. Dark-blood and gray-blood contrasts are collected in the first and second RR interval, respectively. To improve the respiratory gating efficiency, two independent navigators were developed to separately gate the respiratory motion for the two interleaved acquisitions. In vivo experiments in eight healthy subjects and one patient were conducted to validate the technique. RESULTS cDIG provided dual-contrasts without compromise in scan time. The dark-blood images with cDIG demonstrated excellent wall and lumen signal performances and morphological measurements. Advantageously, cDIG yielded a second contrast that was shown to help identify the superficial calcification in the coronary plaque of a patient. CONCLUSION A novel technique was developed for obtaining 3D coronary vessel wall and gray lumen images. The additional contrast may aid in identifying calcified nodules and thus potentially improve the evaluation of coronary plaque burden.
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Affiliation(s)
- Guoxi Xie
- Shenzhen Key Lab for MRI, BCMIIS, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, China.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xiaoming Bi
- Siemens Healthcare, Los Angeles, California, USA
| | - Jiabin Liu
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | | | - Xin Liu
- Shenzhen Key Lab for MRI, BCMIIS, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, China
| | - Kuncheng Li
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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15
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Effect of Calcification Modulus and Geometry on Stress in Models of Calcified Atherosclerotic Plaque. Cardiovasc Eng Technol 2014. [DOI: 10.1007/s13239-014-0186-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Abstract
The extracellular matrix (ECM) is an essential component of the human body that is responsible for the proper function of various organs. Changes in the ECM have been implicated in the pathogenesis of several cardiovascular conditions including atherosclerosis, restenosis, and heart failure. Matrix components, such as collagens and noncollagenous proteins, influence the function and activity of vascular cells, particularly vascular smooth muscle cells and macrophages. Matrix proteins have been shown to be implicated in the development of atherosclerotic complications, such as plaque rupture, aneurysm formation, and calcification. ECM proteins control ECM remodeling through feedback signaling to matrix metalloproteinases (MMPs), which are the key players of ECM remodeling in both normal and pathological conditions. The production of MMPs is closely related to the development of an inflammatory response and is subjected to significant changes at different stages of atherosclerosis. Indeed, blood levels of circulating MMPs may be useful for the assessment of the inflammatory activity in atherosclerosis and the prediction of cardiovascular risk. The availability of a wide variety of low-molecular MMP inhibitors that can be conjugated with various labels provides a good perspective for specific targeting of MMPs and implementation of imaging techniques to visualize MMP activity in atherosclerotic plaques and, most interestingly, to monitor responses to antiatheroslerosis therapies. Finally, because of the crucial role of ECM in cardiovascular repair, the regenerative potential of ECM could be successfully used in constructing engineered scaffolds and vessels that mimic properties of the natural ECM and consist of the native ECM components or composite biomaterials. These scaffolds possess a great promise in vascular tissue engineering.
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17
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Yamada S, Oshima M, Watanabe Y, Ogata H, Hashimoto K, Miyake H. Intramural location and size of arterial calcification are associated with stenosis at carotid bifurcation. Eur J Radiol 2014; 83:957-963. [PMID: 24637069 DOI: 10.1016/j.ejrad.2014.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/08/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the association between internal carotid artery (ICA) stenosis and intramural location and size of calcification at the ICA origins and the origins of the cervical arteries proximal to the ICA. METHOD A total of 1139 ICAs were evaluated stenosis and calcification on the multi-detector row CT angiography. The intramural location was categorized into none, outside and inside location. The calcification size was evaluated on the 4-point grading scale. The multivariate analyses were adjusted for age, serum creatinine level, hypertension, hyperlipidemia, diabetes mellitus, smoking and alcohol habits. RESULTS Outside calcification at the ICA origins showed the highest multivariate odds ratio (OR) for the presence of ICA stenosis (30.0) and severe calcification (a semicircle or more of calcification at the arterial cross-sectional surfaces) did the second (14.3). In the subgroups of >70% ICA stenosis, the multivariate OR of outside location increased to 44.8 and that of severe calcification also increased to 32.7. Four of 5 calcified carotid plaque specimens extracted by carotid endarterectomy were histologically confirmed to be calcified burdens located outside the internal elastic lamia which were defined as arterial medial calcification. CONCLUSIONS ICA stenosis was strongly associated with severe calcification located mainly outside the carotid plaque. Outside calcification at the ICA origins should be evaluated separately from inside calcification, as a marker for the ICA stenosis. Additionally, we found that calcification at the origins of the cervical arteries proximal to the ICA was significantly associated with the ICA stenosis.
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Affiliation(s)
- Shigeki Yamada
- Department of Neurosurgery & Stroke Center, Rakuwakai Otowa Hospital, Otowachinji-cho 2, Yamashina-ku, Kyoto 607-8602, Japan; Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan; Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan.
| | - Marie Oshima
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan.
| | - Yoshihiko Watanabe
- Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan.
| | - Hideki Ogata
- Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan.
| | - Kenji Hashimoto
- Department of Neurosurgery, Kishiwada Municipal Hospital, 1001 Gakuhara-cho, Kishiwada city, Osaka 596-8501, Japan.
| | - Hidenori Miyake
- Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan.
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Zhongzhao Teng, Jing He, Sadat U, Mercer JR, Xiaoyan Wang, Bahaei NS, Thomas OM, Gillard JH. How Does Juxtaluminal Calcium Affect Critical Mechanical Conditions in Carotid Atherosclerotic Plaque? An Exploratory Study. IEEE Trans Biomed Eng 2014; 61:35-40. [DOI: 10.1109/tbme.2013.2275078] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Bartels S, Franco AR, Rundek T. Carotid intima-media thickness (cIMT) and plaque from risk assessment and clinical use to genetic discoveries. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.permed.2012.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Koktzoglou I. Gray blood magnetic resonance for carotid wall imaging and visualization of deep-seated and superficial vascular calcifications. Magn Reson Med 2012; 70:75-85. [PMID: 22887594 DOI: 10.1002/mrm.24445] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/21/2012] [Accepted: 07/05/2012] [Indexed: 11/06/2022]
Abstract
White blood and black blood magnetic resonance imaging methods are often used for lumenography and visualization of the arterial wall, respectively. However, the use of white blood imaging invariably obscures arterial wall boundaries, and thus, impedes precise measurement of arterial wall area. Conversely, black blood imaging imposes strict limits on sequence timing to suppress the arterial lumen, and by itself, precludes separation of superficial calcification from the hypointense arterial lumen. In this work, a three-dimensional arterial wall imaging methodology providing gray blood image contrast is described that remedies the above limitations. When applied to the carotid arteries, the described gray blood imaging method is found to clearly depict the inner and outer arterial wall boundaries as well as superficial and deep-seated vascular calcifications. A tailored phase-encoding schedule is also presented that enables concurrent gray and black blood, or "dual contrast," imaging of the arterial wall with no increase in the acquisition time. Taken together, presented data demonstrate that gray and dual blood contrast magnetic resonance imaging provide an efficient means for viewing and characterizing the composition of atherosclerotic plaques.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois 60201, USA.
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21
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Liu XS, Zhao HL, Cao Y, Lu Q, Xu JR. Comparison of carotid atherosclerotic plaque characteristics by high-resolution black-blood MR imaging between patients with first-time and recurrent acute ischemic stroke. AJNR Am J Neuroradiol 2012; 33:1257-61. [PMID: 22345496 DOI: 10.3174/ajnr.a2965] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE It has been shown that patients with a first ischemic stroke are at high risk of developing recurrent stroke due to carotid atherosclerotic plaque rupture. However, no one has defined the difference in plaques between initial and recurrent stroke. This study sought to investigate the characteristics of carotid plaque between patients with first-time and recurrent acute ischemic stroke by using MR imaging. MATERIALS AND METHODS Eighty-nine patients with recent acute ischemic stroke were recruited. All subjects underwent carotid high-resolution black-blood MR imaging. The index carotid arteries, defined as the arteries responsible for the ipsilateral stroke, were analyzed quantitatively and qualitatively. Carotid plaque burden and compositional features between patients with first-time and recurrent ischemic stroke were compared. RESULTS Of 89 recruited patients, 51 had first-time stroke and 38 had recurrent stroke. The mean WA, WT, and PWV were greater in patients with recurrent stroke than in patients with first-time stroke (all, P < .05). Compared with patients with first-time stroke, those with recurrent stroke showed significantly higher prevalence of calcification (44.7% versus 23.5%, P = .035) as well as a larger volume of LRNC (179.14 ± 254.81 mm(2) versus 71.65 ± 111.15 mm(2), P = .027). IPH or fibrous cap rupture or both were observed in 15.8% of patients with recurrent stroke and 3.9% of patients with first-time stroke. CONCLUSIONS Carotid plaques in patients with recurrent ischemic stroke are significantly aggravated compared with those in patients with first-time stroke, and monitoring carotid plaques in patients with initial stroke by MR imaging may be helpful for secondary stroke prevention.
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Affiliation(s)
- X S Liu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Young VEL, Sadat U, Gillard JH. Noninvasive carotid artery imaging with a focus on the vulnerable plaque. Neuroimaging Clin N Am 2011; 21:391-405, xi-xii. [PMID: 21640306 DOI: 10.1016/j.nic.2011.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Currently carotid imaging has 2 main focuses: assessment of luminal stenosis and classification of atherosclerotic plaque characteristics. Measurement of the degree of stenosis is the main assessment used for current treatment decision making, but an evolving idea that is now driving imaging is the concept of vulnerable plaque, which is where plaque components are identified and used to define which plaques are at high risk of causing symptoms compared with those at low risk. This review article covers the methods used for noninvasive assessment of carotid luminal stenosis and the options available for plaque imaging.
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Affiliation(s)
- V E L Young
- University Department of Radiology, Addenbrookes Hospital, Box 218, Hills Road, Cambridge CB2 0QQ, UK.
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Comparison of carotid arterial morphology and plaque composition between patients with acute coronary syndrome and stable coronary artery disease: a high-resolution magnetic resonance imaging study. Int J Cardiovasc Imaging 2011; 27:715-26. [PMID: 21468749 DOI: 10.1007/s10554-011-9858-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the differences in carotid arterial morphology and plaque composition between patients with acute coronary syndrome (ACS) and patients with stable coronary artery disease (SCAD). Twenty-eight patients (12 ACS patients and 16 SCAD patients) underwent carotid high-resolution MRI examination using a 3.0-Tesla (3.0T) MRI scanner. The indicators of carotid arterial morphology included the maximum total vessel area (Max-TVA), mean TVA, minimum lumen area (Min-LA), mean LA, maximum wall area (Max-WA), mean WA, maximum wall thickness (Max-WT), mean WT, maximum normalized wall index (Max-NWI), mean NWI, and maximum stenosis (Max-stenosis). The indicators of plaque composition included the prevalence and mean area percentage (%) of lipid-rich necrotic core (LRNC), calcification (Ca), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR). None of the indicators of carotid arterial morphology had significant differences (all P > 0.05) between the ACS and SCAD patients. The prevalence and plaque composition area percentage of LRNC, Ca, and IPH did not exhibit significant differences between the two groups. However, carotid plaques in the ACS patients presented a higher prevalence of FCR than SCAD patients (P < 0.05). This study revealed a similar carotid arterial morphology between ACS and SCAD patients. However, FCR is more common in carotid plaques with ACS than in those with SCAD. Ruptured carotid plaques may be a forewarning factor for those patients who are at high risk of ACS.
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Costa RA, Reiber JHC, Rybicki FJ, Schoenhagen P, Stillman AA, de Sutter J, van de Veire NRL, van der Wall EE. Cardiovascular imaging 2010 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2011; 27:309-19. [PMID: 21347592 PMCID: PMC3092067 DOI: 10.1007/s10554-011-9834-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 01/20/2023]
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