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Hu J, Hu N, Hu T, Zhang J, Han D, Wang H. Associations between preprocedural carotid artery perivascular fat density and early in-stent restenosis after carotid artery stenting. Heliyon 2023; 9:e16220. [PMID: 37346364 PMCID: PMC10279783 DOI: 10.1016/j.heliyon.2023.e16220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives This study investigated the association between perivascular fat density (PFD) via preoperative computed tomographic angiography (CTA) and early in-stent restenosis (ISR) after carotid artery stenting (CAS). Methods We retrospectively evaluated 248 consecutive patients who had undergone initial CAS and received a preoperative cervical CTA examination between January 2019 and October 2020. The patients were categorized into two according to whether they sustained ISR during the 2 years postoperative follow-up period. Correlations between PFD and ISR were assessed, and multivariate regression for evaluating predictors of ISR was conducted. Receiver operating characteristic (ROC) curves were used to determine the cutoff value for the PFD. Results A total of 181 eligible patients (mean age 61.25 ± 10.35 years, 57 male) were enrolled. The ISR group had a higher proportion of closed-cell stents (48.8% versus 27.5%; p = 0.009) and a greater degree of residual stenosis (28[20,33] % versus 20[14.75,30] %; p < 0.001) than the non-ISR group. The ISR group had a higher mean HU value of PFD than the non-ISR group on the operated side (-42.26 ± 6.81 versus -59.66 ± 10.75; p < 0.001). The degree of residual stenosis (OR 1.146, 95%CI 1.071-1.226, p < 0.001) and PFD on the operated side (OR1.353, 95%CI 1.215-1.506, p < 0.001) were significantly associated with the ISR. Conclusions The occurrence of the early ISR after CAS is associated with a higher PFD on the operated side. The results indicate that PFD is a promising marker to predict the ISR after CAS.
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Affiliation(s)
- Jun Hu
- Faculty of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Na Hu
- Department of Radiology, Chengde Central Hospital, Chengde, China
| | - Tiemin Hu
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jiwei Zhang
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Dong Han
- Department of Radiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Hong Wang
- Faculty of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
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Zhang R, Zhang Q, Ji A, Lv P, Acosta-Cabronero J, Fu C, Ding J, Guo D, Teng Z, Lin J. Prediction of new cerebral ischemic lesion after carotid artery stenting: a high-resolution vessel wall MRI-based radiomics analysis. Eur Radiol 2022; 33:4115-4126. [PMID: 36472695 DOI: 10.1007/s00330-022-09302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Carotid artery stenting (CAS) is an established treatment for local stenosis. The most common complication is new ipsilateral ischemic lesions (NIILs). This study aimed to develop models considering lesion morphological and compositional features, and radiomics to predict NIILs. MATERIALS AND METHODS One hundred and forty-six patients who underwent brain MRI and high-resolution vessel wall MR imaging (hrVWI) before and after CAS were retrospectively recruited. Lumen and outer wall boundaries were segmented on hrVWI as well as atherosclerotic components. A traditional model was constructed with patient clinical information, and lesion morphological and compositional features. Least absolute shrinkage and selection operator algorithm was performed to determine key radiomics features for reconstructing a radiomics model. The model in predicting NIILs was trained and its performance was tested. RESULTS Sixty-one patients were NIIL-positive and eighty-five negative. Volume percentage of intraplaque hemorrhage (IPH) and patients' clinical presentation (symptomatic/asymptomatic) were risk factors of NIILs. The traditional model considering these two features achieved an area under the curve (AUC) of 0.778 and 0.777 in the training and test cohorts, respectively. Twenty-two key radiomics features were identified and the model based on these features achieved an AUC of 0.885 and 0.801 in the two cohorts. The AUCs of the combined model considering IPH volume percentage, clinical presentation, and radiomics features were 0.893 and 0.842 in the training and test cohort respectively. CONCLUSIONS Compared with traditional features (clinical and compositional features), the combination of traditional and radiomics features improved the power in predicting NIILs after CAS. KEY POINTS • Volume percentage of IPH and symptomatic events were independent risk factors of new ipsilateral ischemic lesions (NIILs). • Radiomics features derived from carotid artery high-resolution vessel wall imaging had great potential in predicting NIILs after CAS. • The combination model with radiomics and traditional features further improved the diagnostic performance than traditional features alone.
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Affiliation(s)
- Ranying Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, China
| | - Aihua Ji
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | | | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK.
- Nanjing Jingsan Medical Science and Technology, Nanjing, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China.
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Culleton S, Baradaran H, Kim SE, Stoddard G, Roberts J, Treiman G, Parker D, Duff K, McNally JS. MRI Detection of Carotid Intraplaque Hemorrhage and Postintervention Cognition. AJNR Am J Neuroradiol 2022; 43:1762-1769. [PMID: 36357151 DOI: 10.3174/ajnr.a7701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/01/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive improvement has been reported after carotid revascularization and attributed to treating stenosis and correcting hypoperfusion. This study investigated the effect of carotid intraplaque hemorrhage on postintervention cognition. MATERIALS AND METHODS In this institutional review board-approved single-center study, consecutive patients scheduled for carotid surgery were recruited for preoperative carotid MR imaging (MPRAGE) and pre- and postintervention cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status. Pre- and postintervention scores were compared using t tests and multivariable linear regression. RESULTS Twenty-three participants were included, with endarterectomy performed in 20 (87%) and angioplasty/stent placement, in 3 (13%). Overall, statistically significant improvements occurred in the pre- versus postintervention mean Total Scale score (92.1 [SD, 15.5] versus 96.1 [SD, 15.8], P = .04), immediate memory index (89.4 [SD, 18.2] versus 97.7 [SD, 14.9], P < .001), and verbal index (96.1 [SD, 14.1] versus 103.0 [SD, 12.0], P = .002). Intraplaque hemorrhage (+) participants (n = 11) had no significant improvement in any category, and the attention index significantly decreased (99.4 [SD, 18.0] versus 93.5 [SD, 19.4], P = .045). Intraplaque hemorrhage (-) participants (n = 12) significantly improved in the Total Scale score (86.4 [SD, 11.8] versus 95.5 [SD, 12.4], P = .004), immediate memory index (82.3 [SD, 14.6] versus 96.2 [SD, 14.1], P = .002), delayed memory index (94.3 [SD, 14.9] versus 102.4 [SD, 8.0], P = .03), and verbal index (94.3 [SD, 13.2] versus 101.5 [SD, 107.4], P = .009). Postintervention minus preintervention scores for intraplaque hemorrhage (+) versus (-) groups showed statistically significant differences in the Total Scale score (-0.4 [SD, 6.8] versus 8.0 [SD, 8.5], P = .02), attention index (-5.9 [SD, 8.5] versus 4.3 [SD, 11.9], P = .03), and immediate memory index (4.2 [SD, 6.7] versus 12.2 [SD, 10.2], P = .04). CONCLUSIONS Cognitive improvement was observed after carotid intervention, and this was attributable to intraplaque hemorrhage (-) plaque. MR imaging detection of intraplaque hemorrhage status may be an important determinant of cognitive change after intervention.
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Affiliation(s)
- S Culleton
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - H Baradaran
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - S-E Kim
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - G Stoddard
- Utah Center for Advanced Imaging Research, Division of Epidemiology (G.S.)
| | - J Roberts
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - G Treiman
- Department of Internal Medicine, Department of Surgery (G.T.)
| | - D Parker
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
| | - K Duff
- Center for Alzheimer's Care, Imaging and Research (K.D.), University of Utah, Salt Lake City, Utah
| | - J S McNally
- From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.)
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Lv P, Ji A, Zhang R, Guo D, Tang X, Lin J. Circumferential degree of carotid calcification is associated with new ischemic brain lesions after carotid artery stenting. Quant Imaging Med Surg 2021; 11:2669-2676. [PMID: 34079732 DOI: 10.21037/qims-20-1244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The relationship between plaque calcification and new ischemic brain lesions after carotid artery stenting (CAS) remains controversial. The purpose of this study was to determine if the circumferential degree of carotid calcification is associated with new ischemic brain lesions on diffusion-weighted imaging (DWI) after CAS. Methods A total of 96 patients with carotid stenosis of ≥50% who underwent CAS were enrolled in the study. All patients underwent preoperative carotid computed tomography (CT), and preoperative and postoperative brain MRI. The brain MRI sequences included T1WI, T2WI, T2-fluid-attenuated inversion recovery (FLAIR), and DWI. The location, circumferential degree, volume, percentage volume, maximum density, mean density, Agatston score of carotid calcification, and total plaque volume were assessed and compared between patients with and without new ischemic brain lesions after CAS. Univariate and multivariate analyses were performed to evaluate predictors of new ischemic brain lesions. Results All of the 96 patients (67.8±6.8 years of age, 83.3% men) were included in the analysis. New ischemic brain lesions on DWI were observed in 40 patients (41.7%). Patients with new ischemic brain lesions after CAS had a larger circumferential degree of calcification than those without new ischemic brain lesions (P<0.001). There was only a possible trend toward significance for the percentage volume of calcification between the two groups with and without new brain ischemic lesions (P=0.07). No significant differences were found regarding the location (P=0.18), volume (P=0.37), maximum density (P=0.44), mean density (P=0.39), Agatston score (P=0.28), and total plaque volume (P=0.33) of carotid calcification between the DWI+ and DWI- groups. In the multivariate analysis, an increased risk of new ischemic brain lesions was observed in patients with a high score for the circumferential degree of calcification [score 3; odds ratio (OR): 10.7, P<0.001; score 4, OR: 11.7, P=0.038]. Conclusions The circumferential degree of carotid calcification was associated with new ischemic brain lesions after CAS. CAS should be avoided if possible for carotid stenosis with large circumferential calcified plaques.
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Affiliation(s)
- Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Aihua Ji
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ranying Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao Tang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
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Predictors of Ipsilateral New Ischemic Lesions on Diffusion-Weighted Imaging after Carotid Artery Stenting in Asymptomatic Patients: A Retrospective Observational Study with Conventional Multicontrast MRI. Ann Vasc Surg 2021; 74:95-104. [PMID: 33508458 DOI: 10.1016/j.avsg.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to identify the independent risk factors for ipsilateral new ischemic lesions (NILs) during carotid artery stenting (CAS). METHODS In patients treated with CAS, the association between postoperative ipsilateral NILs on diffusion-weighted imaging (DWI) and patient demographics, intraoperative factors, the presence of plaque components, the semiquantitative grading of component size on multicontrast magnetic resonance imaging (MRI) were retrospectively analyzed. RESULTS Ipsilateral NILs on DWI were detected in 85 (39.2%) patients. The debris was observed on the surface embolic protection devices in 70.97% of patients. Univariate analysis showed that different stages of intraplaque hemorrhage (IPH) (along with lipid-rich necrotic core [LRNC]) (P < 0.001), size of IPH (P < 0.001), calcification (CA) (P = 0.045), and LRNC (without IPH) (P < 0.001) as well as postdilation (P < 0.001)), stent type (P = 0.001), and aortic arch ulcer (P = 0.004) were associated with postoperative ipsilateral NILs. Multivariate logistic regression analysis showed that the acute and recent IPH (along with LRNC) (odds ratio [OR]: 5.77, P < 0.002 and OR: 28.66, P < 0.001, respectively), LRNC size in Grade 2 (OR: 6.10, P < 0.001) were independent risk factors for ipsilateral NILs. Aortic arch ulcer (OR: 3.44, P = 0.002), postdilation (OR: 4.72, P = 0.04) and open cell stent (OR: 2.88, P < 0.016) were also significantly related to ipsilateral NILs on DWI after CAS. There was a significant correlation between IPH at different stages and their grade of size (correlation coefficient: 0.89; P < 0.001). CONCLUSION The IPH and larger LRNC along with the aortic arch ulcer, postdilation and open cell stent are associated with increased risk of ipsilateral NILs on DWI after CAS procedure. Preoperative staging of IPH and semiquantitative grading of size of plaque components based on multi-contrast MRI may be useful for predicting ipsilateral cerebral ischemic events after CAS.
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Beyhan M, Acu B, Gökçe E, Fırat MM. Evaluation of ischemic lesions after carotid artery stenting with diffusion-weighted imaging. World J Clin Cases 2020; 8:1859-1870. [PMID: 32518775 PMCID: PMC7262714 DOI: 10.12998/wjcc.v8.i10.1859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Almost 90% of cerebral thromboembolism cases are caused by atherosclerosis. Craniocervical atherosclerosis is often observed at the carotid bifurcation and is responsible for 20%-30% of all stroke cases. The course of atherosclerotic carotid artery stenosis varies depending on the grade of stenosis and characteristics of the plaque. Carotid artery stenting (CAS) can be used as a less invasive method in patients with symptomatic and asymptomatic high-grade carotid artery stenosis. Diffusion-weighted imaging (DWI) is an effective method for detection of silent or symptomatic acute ischemic lesions that may arise due to CAS or carotid endarterectomy. The number and volume of new ischemic lesions are determined using DWI.
AIM To evaluate the number and volume of ischemic lesions and their cerebral parenchymal and vascular distribution after CAS using DWI.
METHODS Forty-seven male (73.4%) and seventeen female (26.6%) patients (total, n = 64) aged 42-84 years (mean 67.96 ± 8.03 years) diagnosed with carotid stenosis between October 2006 and July 2012 were included in this retrospective study. Twelve of the cases (18.8%) were asymptomatic, while fifty-two (81.2%) were symptomatic. The area where the stenosis was highest was measured, and the stenosis rate was determined using the North American Symptomatic Carotid Endarterectomy Trial method. DWI of the cases was evaluated by two radiologists experienced in neuroradiology (B.A. with more than 15 years of experience, E.G. with more than 10 years of experience). Routine DWI examinations were carried out by a 1.5 T MR device 1 h before and after the operation. Since the ischemic lesions that developed in the first hour and in the follow-up period of 5-24 h were assumed to be due to CAS, all lesions within the first 24 h were considered as new ischemias.
RESULTS In the present study, 39 new ischemic lesions were detected in 20 cases. The average number of new lesions after all CAS operations was 0.62. They were mostly located in the occipital lobes, followed by the frontal and parietal lobes. These new ischemic lesions were most common in the middle cerebral artery territory, followed by the posterior cerebral artery territory and middle cerebral artery-posterior cerebral artery watershed areas. New lesions were found in 31.2% (20/64) of patients, including 17 (26.5%) in ipsilateral and three (4.6%) in contralateral hemispheres. New bilateral lesions were detected in one case (1.5%). The average volume of the new ischemic lesions detected by the two observers was 1.10 cm³. The numbers of newly appearing ischemic lesions in DWI after CAS were significantly higher in cases where stenting was applied on the left side of the carotid artery and in cases where longer plaques (> 1 cm) were responsible for the narrowing in symptomatic patients. The stenosis rate was low in the group with ulcerated plaques.
CONCLUSION New ischemic lesions due to CAS appear mostly in the main arterial territory but they may also occur in watershed areas.
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Affiliation(s)
- Murat Beyhan
- Department of Radiology, Tokat Gaziosmanpasa University Faculty of Medicine, Tokat 60100, Turkey
| | - Berat Acu
- Department of Radiology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir 26480, Turkey
| | - Erkan Gökçe
- Department of Radiology, Tokat Gaziosmanpasa University Faculty of Medicine, Tokat 60100, Turkey
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Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2020; 36:769-787. [PMID: 32281010 DOI: 10.1007/s10554-020-01845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zhao G, Tang X, Tang H, Lin J, Sun W, Fan Z, Fu C, Guo D. Recent Intraplaque Hemorrhage Is Associated with a Higher Risk of Ipsilateral Cerebral Embolism During Carotid Artery Stenting. World Neurosurg 2020; 137:e298-e307. [PMID: 32014542 DOI: 10.1016/j.wneu.2020.01.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to identify which stage of intraplaque hemorrhage (IPH) is an independent risk factor for ipsilateral new ischemic lesions (NILs) after carotid artery stenting (CAS). METHODS In 268 patients treated with CAS, the association between postoperative ipsilateral NILs on diffusion-weighted imaging (DWI) and patient demographics, intraoperative factors, and plaque characteristics on multicontrast atherosclerosis characterization sequence was retrospectively analyzed. RESULTS A total of 268 patients were enrolled in the study. Ipsilateral NILs on DWI were detected in 32.8% of patients. Univariate analysis showed that the stage of IPH (along with lipid-rich necrotic core [LRNC]) (P < 0.001) in the carotid plaque, predilation (P = 0.012), stent type (P = 0.002), and aortic arch ulcer (P = 0.009) were associated with postoperative ipsilateral NILs, whereas other patient-related factors (P >0.05), type of embolic protection device (P = 0.072), postdilation (P = 0.388), calcification (P = 0.140), and LRNC (without IPH) (P = 0.086) were not. Multivariate logistic regression analysis showed that the acute and recent IPH (along with LRNC) (odds ratio [OR], 3.78, P = 0.011 and OR, 16.73, P < 0.001, respectively), aortic arch ulcer (OR, 2.46; P = 0.006), predilation (OR, 4.78; P = 0.015), and open cell stent (OR, 4.19; P < 0.001) were significantly associated with postoperative ipsilateral NILs on DWI. CONCLUSIONS Screening for recent IPH in carotid plaques using multicontrast atherosclerosis characterization sequence may identify plaques at a higher risk for cerebral embolism during CAS.
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Affiliation(s)
- Gefei Zhao
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hanfei Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiang Lin
- Department of Radiology, Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Sun
- Department of Radiology, Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaoyang Fan
- Departments of Medicine and Bioengineering, University of California, Los Angeles, California, USA; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Daqiao Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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