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Yan H, Geng D, Zhao W, Li S, Du X, Zhang S, Wang H. Differences in intracranial atherosclerosis plaque between posterior circulation and anterior circulation on high-resolution magnetic resonance imaging: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107616. [PMID: 38316284 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107616] [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: 07/29/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The clinical characteristics and mechanisms of stroke caused by anterior circulation atherosclerotic plaques (ACAPs) and posterior circulation atherosclerotic plaques (PCAPs) are distinct. We aimed to compare the differences in vulnerability, morphology, and distribution between ACAPs and PCAPs based on hign-resolution magnetic resonance imaging (HR-MRI). MATERIALS AND METHODS The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database were retrieved from inception through May 2023. Meta-analysis was performed by R 4.2.1 software. The quality of the literature was assessed by the Agency for Healthcare Research and Quality (AHRQ). Subgroup analysis was conducted to explore the heterogeneity of the pooled results. RESULTS There were a total of 13 articles, including 1194 ACAPs and 1037 PCAPs. The pooled estimates demonstrated that the incidence of intraplaque hemorrhage in the PCAPs was higher (OR 1.72, 95%CI 1.35-2.18). The plaque length (SMD 0.23, 95%CI 0.06-0.39) and remodeling index (SMD 0.29, 95%CI 0.14-0.44) of PCAPs were larger than those in ACAPs. However, there were no evident differences in significant enhancement or stenosis degree between the two groups. CONCLUSION There were more unstable features in PCAPs, highlighting an elevated risk of recurrent ischemic stroke in the posterior circulation. Furthermore, PCAPs were prone to developing penetrating artery disease due to their wider distribution. Nevertheless, posterior circulation arteries exhibited a greater propensity for outward remodeling, which may lead treatment team to miss the optimal intervention stage by being overlooked on angiographic detection.
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Affiliation(s)
- Han Yan
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Dandan Geng
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Wannian Zhao
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Shasha Li
- Hebei North University, Zhangjiakou, Hebei, China.
| | - Xiaomeng Du
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Shijing Zhang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China; Hebei North University, Zhangjiakou, Hebei, China.
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China; Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China.
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Karda IWAM, Wan Ismail WF, Kamal AF. Massage manipulation and progression of osteosarcoma, does it really correlate: a combination of prospective and retrospective cohort study. Sci Rep 2023; 13:18541. [PMID: 37899365 PMCID: PMC10613611 DOI: 10.1038/s41598-023-45808-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/24/2023] [Indexed: 10/31/2023] Open
Abstract
In Indonesia, the challenge of osteosarcoma progression is further worsened by patients' dependence on traditional massage therapy, low socio-economy, and educational status. This study aims to analyze the differences in the characteristics, laboratory findings, surgery techniques, degree of histopathological necrosis, and metastasis between osteosarcoma patients with and without prior massage manipulation therapy. This research is an analytical observational study with a prospective and retrospective cohort design. Patients were treated and followed for one year to evaluate the occurrence of metastasis. Prospective data was collected through interviews, and secondary data was collected from the patient's medical record. Of 84 subjects analyzed, 69% had a history of massage. There was an increase in LDH and ALP in patients with massage manipulation (p = 0.026). The median time to metastasis from baseline in the massage group (4 months) was statistically significant compared to the non-manipulation group (12 months) (p < 0.0001). This research found that massage therapy significantly increases LDH and ALP levels, making amputations more likely to be performed and a higher risk of metastasis that lowered the survival rate. The onset of metastasis was three times faster in patients with prior massage therapy. Therefore, we strongly recommend against massage manipulation therapy in osteosarcoma patients.
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Affiliation(s)
- I Wayan Arya Mahendra Karda
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Central General Hospital, Faculty of Medicine Universitas Indonesia, Pangeran Diponegoro Street Number 71, Central Jakarta, Jakarta, 10430, Indonesia
| | - Wan Faisham Wan Ismail
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Achmad Fauzi Kamal
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Central General Hospital, Faculty of Medicine Universitas Indonesia, Pangeran Diponegoro Street Number 71, Central Jakarta, Jakarta, 10430, Indonesia.
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3
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Wang B, Chen Y, Qiao Q, Dong L, Xiao C, Qi Z. Evaluation of carotid plaque vulnerability with different echoes by shear wave elastography and CEUS. J Stroke Cerebrovasc Dis 2023; 32:106941. [PMID: 36586243 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Using shear wave elastography (SWE) and contrast enhanced ultrasound (CEUS)to examine carotid plaques with different echoes, and explore a reliable method to quantify characteristics associated with vulnerable carotid plaques. METHODS 2D ultrasound, SWE and CEUS were performed on 244 carotid plaques, and the echoes were evaluated according to the Gray-Weale classification scale and gray-scale median (GSM), and the mean Young's modulus (YM) of the plaque was measured and the intraplaque neovascularization was observed to investigate the relationship between carotid plaque types with different echo characteristics, GSM and the values of each parameter of YM and CEUS. The relationship between GSM and YM and CEUS values was investigated. RESULTS The differences between GSM values (F = 49.742, P < 0.001), with the maximum, mean, and minimum YM values of ultrasound elastography (P < 0.001), and with the number (P < 0.001) and density (P = 0.047) of neovascularization on CEUS were statistically significant for the different echogenic types of plaques, and the lower the echogenicity of the plaque, the lower the GSM values (r = 0.632, P < 0.001), the smaller the YM values (all r > 0, P < 0.001), and the higher the neovascularization number and density values (r < 0, P < 0.001); and there were also statistically significant differences between the above indicators in the vulnerable and stable plaque groups (all P < 0.05). CONCLUSION GSM, SWE, and CEUS techniques can quantitatively evaluate the vulnerability of different echo carotid plaques in a more comprehensive and objective manner, which may help clinical identification of vulnerable plaques, and provide important reference values for early diagnosis and treatment in clinical practice.
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Affiliation(s)
| | | | - Qi Qiao
- First hospital of Qinhuangdao, Hebei, China
| | - Lili Dong
- First hospital of Qinhuangdao, Hebei, China
| | | | - Zhengqin Qi
- First hospital of Qinhuangdao, Hebei, China.
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Bogdanov L, Shishkova D, Mukhamadiyarov R, Velikanova E, Tsepokina A, Terekhov A, Koshelev V, Kanonykina A, Shabaev A, Frolov A, Zagorodnikov N, Kutikhin A. Excessive Adventitial and Perivascular Vascularisation Correlates with Vascular Inflammation and Intimal Hyperplasia. Int J Mol Sci 2022; 23:ijms232012156. [PMID: 36293013 PMCID: PMC9603343 DOI: 10.3390/ijms232012156] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
Albeit multiple studies demonstrated that vasa vasorum (VV) have a crucial importance in vascular pathology, the informative markers and metrics of vascular inflammation defining the development of intimal hyperplasia (IH) have been vaguely studied. Here, we employed two rat models (balloon injury of the abdominal aorta and the same intervention optionally complemented with intravenous injections of calciprotein particles) and a clinical scenario (arterial and venous conduits for coronary artery bypass graft (CABG) surgery) to investigate the pathophysiological interconnections among VV, myeloperoxidase-positive (MPO+) clusters, and IH. We found that the amounts of VV and MPO+ clusters were strongly correlated; further, MPO+ clusters density was significantly associated with balloon-induced IH and increased at calciprotein particle-provoked endothelial dysfunction. Likewise, number and density of VV correlated with IH in bypass grafts for CABG surgery at the pre-intervention stage and were higher in venous conduits which more frequently suffered from IH as compared with arterial grafts. Collectively, our results underline the pathophysiological importance of excessive VV upon the vascular injury or at the exposure to cardiovascular risk factors, highlight MPO+ clusters as an informative marker of adventitial and perivascular inflammation, and propose another mechanistic explanation of a higher long-term patency of arterial grafts upon the CABG surgery.
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Yang R, Yuan J, Chen X, Xie X, Ye Z, Qin C. Vessel wall magnetic resonance imaging of symptomatic middle cerebral artery atherosclerosis: A systematic review and meta-analysis. Clin Imaging 2022; 90:90-96. [DOI: 10.1016/j.clinimag.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
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Jin C, Torii R, Ramasamy A, Tufaro V, Little CD, Konstantinou K, Tan YY, Yap NAL, Cooper J, Crake T, O’Mahony C, Rakhit R, Egred M, Ahmed J, Karamasis G, Räber L, Baumbach A, Mathur A, Bourantas CV. Morphological and Physiological Characteristics of Ruptured Plaques in Native Arteries and Neoatherosclerotic Segments: An OCT-Based and Computational Fluid Dynamics Study. Front Cardiovasc Med 2022; 9:890799. [PMID: 35722127 PMCID: PMC9204481 DOI: 10.3389/fcvm.2022.890799] [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: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intravascular imaging has been used to assess the morphology of lesions causing an acute coronary syndrome (ACS) in native vessels (NV) and identify differences between plaques that ruptured (PR) and caused an event and those that ruptured without clinical manifestations. However, there is no data about the morphological and physiological characteristics of neoatherosclerotic plaques that ruptured (PR-NA) which constitute a common cause of stent failure. Methods We retrospectively analyzed data from patients admitted with an acute myocardial infarction that had optical coherence tomography (OCT) imaging of the culprit vessel before balloon pre-dilation. OCT pullbacks showing PR were segmented at every 0.4 mm. The extent of the formed cavity, lipid and calcific tissue, thrombus, and macrophages were measured, and the fibrous cap thickness (FCT) and the incidence of micro-channels and cholesterol crystals were reported. These data were used to reconstruct a representative model of the native and neoatherosclerotic lesion geometry that was processed with computational fluid dynamics (CFD) techniques to estimate the distribution of the endothelial shear stress and plaque structural stress. Result Eighty patients were included in the present analysis: 56 had PR in NV (PR-NV group) and 24 in NA segments (PR-NA group). The PR-NV group had a larger minimum lumen area (2.93 ± 2.03 vs. 2.00 ± 1.26 mm2, p = 0.015) but similar lesion length and area stenosis compared to PR-NA group. The mean FCT (186 ± 65 vs. 232 ± 80 μm, p = 0.009) and the lipid index was smaller (16.7 ± 13.8 vs. 25.9 ± 14.1, p = 0.008) while the of calcific index (8.3 ± 9.5 vs. 2.2 ± 1.6%, p = 0.002) and the incidence of micro-channels (41.4 vs. 12.5%, p = 0.013) was higher in the PR-NV group. Conversely, there was no difference in the incidence of cholesterol crystals, thrombus burden or the location of the rupture site between groups. CFD analysis revealed higher maximum endothelial shear stress (19.1 vs. 11.0 Pa) and lower maximum plaque structural stress (38.8 vs. 95.1 kPa) in the PR-NA compared to the PR-NV model. Conclusion We reported significant morphological and physiological differences between culprit ruptured plaques in native and stented segments. Further research is needed to better understand the causes of these differences and the mechanisms regulating neoatherosclerotic lesion destabilization.
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Affiliation(s)
- Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Callum D. Little
- Royal Free Hospital, University College London, London, United Kingdom
| | - Klio Konstantinou
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Yi Ying Tan
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Nathan A. L. Yap
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Jackie Cooper
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Tom Crake
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Constantinos O’Mahony
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Roby Rakhit
- Royal Free Hospital, University College London, London, United Kingdom
| | - Mohaned Egred
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Javed Ahmed
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grigoris Karamasis
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Lorenz Räber
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Yale University School of Medicine, New Haven, CT, United States
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- *Correspondence: Christos V. Bourantas,
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Du H, Li J, Yang W, Bos D, Zheng L, Wong LKS, Leung TW, Chen X. Intracranial Arterial Calcification and Intracranial Atherosclerosis: Close but Different. Front Neurol 2022; 13:799429. [PMID: 35211084 PMCID: PMC8861312 DOI: 10.3389/fneur.2022.799429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Intracranial arterial calcification (IAC) may be present in the intimal or medial arterial layer. This study aimed to elucidate the link between the calcification and atherosclerotic disease in the intracranial vasculature. Methods Consecutive patients with acute ischemic stroke were included. Bilateral intracranial segment of the internal carotid artery, M1 segment of the middle cerebral artery, intracranial segment of the vertebral artery, and the basilar artery were visualized by the multi-detector computed tomography (CT) and vessel-wall magnetic resonance imaging (vwMRI) within 14 days after stroke onset. IAC was into the intimal or medial pattern. Subsequently, on the vwMRI, we assessed the luminal stenosis, eccentricity, plaque burden, and intraplaque hemorrhage (IPH) as markers of atherosclerosis at each IAC site. Results Among 69 patients with stroke, IAC was identified in 35% of (161/483) artery segments, of which 61.5% were predominantly intimal calcification and 38.5% were predominantly medial calcification. About 79.8% of intimal calcifications and 64.5% of medial calcifications co-existed with atherosclerotic plaques. Intimal calcification was associated with luminal stenosis (p = 0.003) caused by atherosclerotic lesions. Compared with the medial IAC, intimal IAC was more often accompanied by eccentric plaques (p = 0.02), larger plaque burden (p = 0.001), and IPH (p = 0.001). Conclusion Our multimodal imaging-based comparison study on intracranial arteriosclerosis demonstrated that intimal IAC, compared with medial IAC, was more often accompanied by the luminal stenosis, larger plaque burden, eccentricity, and IPH, providing strong evidence for clinical evaluation on the mechanism, risk, and prognosis of ischemic stroke.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jia Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Clinical Epidemiology, Harvard TH Chan School of Public Health Boston, Cambridge, MA, United States
| | - Lu Zheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lawrence Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Crombag G, Aizaz M, Schreuder F, Benali F, van Dam-Nolen D, Liem M, Lucci C, van der Steen A, Daemen M, Mess W, van der Lugt A, Nederkoorn P, Hendrikse J, Hofman P, van Oostenbrugge R, Wildberger J, Kooi M. Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study. AJNR Am J Neuroradiol 2022; 43:265-271. [PMID: 35121587 PMCID: PMC8985675 DOI: 10.3174/ajnr.a7384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS Eighty-eight symptomatic patients with stroke (<70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P < .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P < .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.
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Affiliation(s)
- G.A.J.C. Crombag
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M. Aizaz
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - F.H.B.M. Schreuder
- Department of Neurology & Donders Institute for Brain Cognition & Behaviour (F.H.B.M.S.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - F. Benali
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | | | - M.I. Liem
- Departments of Neurology (M.I.L., P.J.N.)
| | - C. Lucci
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A.F. van der Steen
- Biomedical Engineering (A.F.v.d.S.), Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M.J.A.P. Daemen
- Pathology (M.J.A.P.D.), Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | | | - A. van der Lugt
- Departments of Radiology and Nuclear Medicine (D.H.K.v.D.-N., A.v.d.L.)
| | | | - J. Hendrikse
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - P.A.M. Hofman
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | - R.J. van Oostenbrugge
- Neurology (R.J.v.O.), Maastricht University Medical Center, Maastricht, the Netherlands,CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - J.E. Wildberger
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M.E. Kooi
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
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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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Sato S, Matsumoto H, Li D, Ohya H, Mori H, Sakai K, Ogura K, Oishi Y, Masaki R, Tanaka H, Kondo S, Tsujita H, Tsukamoto S, Isodono K, Kitamura R, Komori Y, Yoshii N, Sato I, Christodoulou AG, Xie Y, Shinke T. Coronary High-Intensity Plaques at T1-weighted MRI in Stable Coronary Artery Disease: Comparison with Near-Infrared Spectroscopy Intravascular US. Radiology 2021; 302:557-565. [PMID: 34904874 DOI: 10.1148/radiol.211463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background The histologic nature of coronary high-intensity plaques (HIPs) at T1-weighted MRI in patients with stable coronary artery disease remains to be fully understood. Coronary atherosclerosis T1-weighted characterization (CATCH) enables HIP detection by simultaneously acquiring dark-blood plaque and bright-blood anatomic reference images. Purpose To determine if intraplaque hemorrhage (IPH) or lipid is the predominant substrate of HIPs on T1-weighted images by comparing CATCH MRI scans with findings on near-infrared spectroscopy (NIRS) intravascular US (IVUS) images. Materials and Methods This study retrospectively included consecutive patients who underwent CATCH MRI before NIRS IVUS between December 2019 and February 2021 at two facilities. At MRI, HIP was defined as plaque-to-myocardium signal intensity ratio of at least 1.4. The presence of an echolucent zone at IVUS (reported to represent IPH) was recorded. NIRS was used to determine the lipid component of atherosclerotic plaque. Lipid core burden index (LCBI) was calculated as the fraction of pixels with a probability of lipid-core plaque greater than 0.6 within a region of interest. Plaque with maximum LCBI within any 4-mm-long segment (maxLCBI4 mm) greater than 400 was regarded as lipid rich. Multivariable analysis was performed to evaluate NIRS IVUS-derived parameters associated with HIPs. Results There were 205 plaques analyzed in 95 patients (median age, 74 years; interquartile range [IQR], 67-78 years; 75 men). HIPs (n = 42) at MRI were predominantly associated with an echolucent zone at IVUS (79% [33 of 42] vs 8.0% [13 of 163], respectively; P < .001) and a higher maxLCBI4 mm at NIRS (477 [IQR, 258-738] vs 232 [IQR, 59-422], respectively; P < .001) than non-HIPs. In the multivariable model, HIPs were independently associated with an echolucent zone (odds ratio, 24.5; 95% CI: 9.3, 64.7; P < .001), but not with lipid-rich plaque (odds ratio, 2.0; 95% CI: 0.7, 5.4; P = .20). Conclusion The predominant substrate of T1-weighed MRI-defined high-intensity plaques in stable coronary artery disease was intraplaque hemorrhage, not lipid. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Stuber in this issue.
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Affiliation(s)
- Shunya Sato
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hidenari Matsumoto
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Debiao Li
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hidefumi Ohya
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hiroyoshi Mori
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Koshiro Sakai
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Kunihiro Ogura
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Yosuke Oishi
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Ryota Masaki
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hideaki Tanaka
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Seita Kondo
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hiroaki Tsujita
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Shigeto Tsukamoto
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Koji Isodono
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Ryoji Kitamura
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Yoshiaki Komori
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Nobuyuki Yoshii
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Ikumi Sato
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Anthony G Christodoulou
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Yibin Xie
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Toshiro Shinke
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
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Xu X, Hua Y, Liu B, Zhou F, Wang L, Hou W. Correlation Between Calcification Characteristics of Carotid Atherosclerotic Plaque and Plaque Vulnerability. Ther Clin Risk Manag 2021; 17:679-690. [PMID: 34234444 PMCID: PMC8257076 DOI: 10.2147/tcrm.s303485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the relationship between calcification characteristics of carotid atherosclerotic plaque and lipid rich necrotic core (LRNC) and intraplaque hemorrhage (IPH). Methods Patients with severe carotid stenosis undergoing carotid endarterectomy (CEA) were selected. Ultrasound and CT angiography (CTA) were performed to evaluate the calcification characteristics of the plaque before the surgery. Results A total of 142 patients were included and 142 pathological specimens of postoperative plaque were obtained accordingly. There were 78 plaques (54.9%) with LRNC and 41 (28.9%) with IPH. The plaque with LRNC had higher calcification rate (93.6%) compared with the plaque with IPH (87.8%). LRNC was often found in multiple calcification (P = 0.003) and mixed type calcification (P = 0.001). Multiple calcification was more likely to combine with IPH (P = 0.008), while simple basal calcification was not likely to combine IPH (P = 0.002). Smaller granular calcification was more likely to be associated with IPH (P < 0.05). In multivariate regression analysis of IPH and calcification characteristics, simple basal calcification was still a protective factor for IPH (OR, 0.25; 95% CI, 0.09–0.66; P = 0.005), while multiple calcification was closely related to the occurrence of IPH (OR, 3.58; 95% CI, 1.49–8.61; P = 0.004). Conclusion Calcification characteristics of carotid atherosclerotic plaques are closely related to the vulnerability of plaques, especially multiple calcification and mixed type calcification.
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Affiliation(s)
- Xiangli Xu
- Department of Ultrasound, the Second Hospital of Harbin, Harbin, People's Republic of China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fubo Zhou
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lili Wang
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Weihong Hou
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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Influence of Disorders of Fatty Acid Metabolism, Arterial Wall Hypoxia, and Intraplaque Hemorrhages on Lipid Accumulation in Atherosclerotic Vessels. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.2.8] [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
The review describes a number of competing views on the main causes of cholesterol accumulation in atherosclerotic vessels. On the one hand, unregulated cholesterol influx into arterial intima is primarily related to the increasing proportion of atherogenic lipoproteins in the lipoprotein spectrum of blood. On the other hand, the leading role in this process is assigned to the increased permeability of endothelium for atherogenic lipoproteins. The increased ability of arterial intima connective tissue to bind atherogenic blood lipoproteins is also considered to be the leading cause of cholesterol accumulation in the vascular wall. The key role in cholesterol accumulation is also assigned to unregulated (by a negative feedback mechanism) absorption of atherogenic lipoproteins by foam cells. It is suggested that the main cause of abundant cholesterol accumulation in atherosclerotic vessels is significant inflow of this lipid into the vascular wall during vasa vasorum hemorrhages.The article also provides arguments, according to which disorder of fatty acid metabolism in arterial wall cells can initiate accumulation of neutral lipids in them, contribute to the inflammation and negatively affect the mechanical conditions around the vasa vasorum in the arterial walls. As a result, the impact of pulse waves on the luminal surface of the arteries will lead to frequent hemorrhages of these microvessels. At the same time, adaptive-muscular intima hyperplasia, which develops in arterial channel areas subjected to high hemodynamic loads, causes local hypoxia in a vascular wall. As a result, arterial wall cells undergo even more severe lipid transformation. Hypoxia also stimulates vascularization of the arterial wall, which contributes to hemorrhages in it. With hemorrhages, free erythrocyte cholesterol penetrates into the forming atherosclerotic plaque, a part of this cholesterol forms cholesterol esters inside the arterial cells. The saturation of erythrocyte membranes with this lipid in conditions of hypercholesterolemia and atherogenic dyslipoproteinemia contributes to the process of cholesterol accumulation in arteries.
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Paritala PK, Yarlagadda T, Mendieta JB, Wang J, McGahan T, Lloyd T, Yarlagadda PKDV, Li Z. Plaque Longitudinal Heterogeneity in Morphology, Property, and Mechanobiology. Cerebrovasc Dis 2021; 50:510-519. [PMID: 33951645 DOI: 10.1159/000515690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The hemodynamic environment of an atherosclerotic plaque varies along the longitudinal direction. Investigating the changes in plaque morphology and its biomechanical environment along the longitudinal direction and their correlations will enhance our understanding of plaque progression and arterial remodeling. METHODS Six male patients with carotid stenosis >70% were recruited. Multisequence high-resolution MRI was performed at the carotid bifurcation. Carotid endarterectomy was performed following MRI, and the plaque tissue was collected for histological and mechanical testing. Patient-specific biomechanical modeling and simulations were conducted to calculate the mechanical stresses (wall shear stress [WSS] and von Mises stress [VMS]). Changes in plaque cross-sectional morphology, WSS, and VMS as well as their correlations were evaluated. RESULTS Positive correlations were found between % stenosis and % inflammation (MA) (p = 0.019), % lipid area and % MA (p = 0.026), and % calcification area and VMS (p = 0.007). Negative correlations were found between VMS and % stenosis (p = 0.028) and VMS and average WSS (p = 0.034). Moreover, the peak stresses and neovessels were found to be in the shoulder regions. High-stress concentrations were found in the interface regions of the calcification and surrounding tissue, thereby increasing plaque vulnerability. CONCLUSIONS Correlations between the morphology and stresses suggest that arterial remodeling is a dynamic interaction between mechanical environment and plaque progression resulting in plaque heterogeneity. Our finding indicates that plaque heterogeneity is associated with plaque progression and can be combined with mechanical stresses for identifying high-risk plaques.
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Affiliation(s)
- Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tejasri Yarlagadda
- Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tim McGahan
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Prasad K D V Yarlagadda
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia.,School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
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14
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Li Z, Wang Y, Wu X, Liu X, Huang S, He Y, Liu S, Ren L. Studying the Factors of Human Carotid Atherosclerotic Plaque Rupture, by Calculating Stress/Strain in the Plaque, Based on CEUS Images: A Numerical Study. Front Neuroinform 2020; 14:596340. [PMID: 33324188 PMCID: PMC7721669 DOI: 10.3389/fninf.2020.596340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023] Open
Abstract
Carotid plaque neovascularization is one of the major factors for the classification of vulnerable plaque, but the axial force effects of the pulsatile blood flow on the plaque with neovessel and intraplaque hemorrhage was unclear. Together with the severity of stenosis, the fibrous cap thickness, large lipid core, and the neovascularization followed by intraplaque hemorrhage (IPH) have been regarded as high-risk features of plaque rupture. In this work, the effects of these factors were evaluated on the progression and rupture of the carotid atherosclerotic plaques. Five geometries of carotid artery plaque were developed based on contrast-enhanced ultrasound (CEUS) images, which contain two types of neovessel and IPH, and geometry without neovessel and IPH. A one-way fluid-structure interaction model was applied to compute the maximum principal stress and strain in the plaque. For that hyper-elastic and non-linear material, Yeoh 3rd Order strain energy density function was used for components of the plaque. The simulation results indicated that the maximum principal stress of plaque in the carotid artery was higher when the degree of the luminal stenosis increased and the thickness of the fibrous cap decreased. The neovessels within the plaque could introduce a 2.5% increments of deformation in the plaque under the pulsatile blood flow pressure. The IPH also contributed to the increased risk of plaque rupture that a gain of stress was 8.983, 14.526, and 34.47 kPa for the plaque with 50, 65, and 75%, respectively, when comparing stress in the plaque with IPH distributed at the middle to the shoulder of the plaque. In conclusion, neovascularization in the plaque could reduce the stability of the plaque by increasing the stress within the plaque. Also, the risk of plaque rupture increased when large luminal stenosis, thin fibrous cap, and IPH were observed.
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Affiliation(s)
- Zhenzhou Li
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yongfeng Wang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Xinyin Wu
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xin Liu
- Guangdong Academy Research on Virtual Reality (VR) Industry, Foshan University, Foshan, China
| | - Shanshan Huang
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yi He
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Shuyu Liu
- School of Pharmacy, Sun Yat-sen University, Guangzhou, China
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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15
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Mura M, Della Schiava N, Long A, Chirico EN, Pialoux V, Millon A. Carotid intraplaque haemorrhage: pathogenesis, histological classification, imaging methods and clinical value. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1273. [PMID: 33178805 PMCID: PMC7607119 DOI: 10.21037/atm-20-1974] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vulnerable carotid atherosclerotic plaques are characterised by several risk factors, such as inflammation, neovascularization and intraplaque haemorrhage (IPH). Vulnerable plaques can lead to ischemic events such as stroke. Many studies reported a relationship between IPH, plaque rupture, and ischemic stroke. Histology is the gold standard to evaluate IPH, but it required carotid endarterectomy (CEA) surgery to collect the tissue sample. In this context, several imaging methods can be used as a non-invasive way to evaluate plaque vulnerability and detect IPH. Most imaging studies showed that IPH is associated with plaque vulnerability and stroke, with magnetic resonance imaging (MRI) being the most sensitive and specific to detect IPH as a predictor of ischemic events. These conclusions are however still debated because of the limited number of patients included in these studies; further studies are required to better assess risks associated with different IPH stages. Moreover, IPH is implicated in plaque vulnerability with other risk factors which need to be considered to predict ischemic risk. In addition, MRI sequences standardization is required to compare results from different studies and agree on biomarkers that need to be considered to predict plaque rupture. In these circumstances, IPH detection by MRI could be an efficient clinical method to predict stroke. The goal of this review article is to first describe the pathophysiological process responsible for IPH, its histological detection in carotid plaques and its correlation with plaque rupture. The second part will discuss the benefits and limitations of imaging the carotid plaque, and finally the clinical interest of imaging IPH to predict plaque rupture, focusing on MRI-IPH.
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Affiliation(s)
- Mathilde Mura
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France
| | - Nellie Della Schiava
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,Institut National des Sciences Appliquées Lyon, Laboratoire de Génie Electrique et Ferroélectricité EA 682, Villeurbanne, France
| | - Anne Long
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France.,Departement of Internal Medicine and Vascular Medicine, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Erica N Chirico
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vincent Pialoux
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France.,Institut Universitaire de France, Paris, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, University Claude Bernard Lyon 1, CarMeN Laboratory, INSERM U1060, Bron, France
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16
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Murgia A, Erta M, Suri JS, Gupta A, Wintermark M, Saba L. CT imaging features of carotid artery plaque vulnerability. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1261. [PMID: 33178793 PMCID: PMC7607080 DOI: 10.21037/atm-2020-cass-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite steady advances in medical care, cardiovascular disease remains one of the main causes of death and long-term morbidity worldwide. Up to 30% of strokes are associated with the presence of carotid atherosclerotic plaques. While the degree of stenosis has long been recognized as the main guiding factor in risk stratification and therapeutical decisions, recent evidence suggests that features of unstable, or ‘vulnerable’, plaques offer better prognostication capabilities. This paradigmatic shift has motivated researchers to explore the potentialities of non-invasive diagnostic tools to image not only the lumen, but also the vascular wall and the structural characteristics of the plaque. The present review will offer a panoramic on the imaging modalities currently available to characterize carotid atherosclerotic plaques and, in particular, it will focus on the increasingly important role covered by multidetector computed tomographic angiography.
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Affiliation(s)
- Alessandro Murgia
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato (Cagliari), Italy
| | - Marco Erta
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato (Cagliari), Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnosis Division, AtheroPoint(tm), Roseville, CA, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell University, New York, NY, USA
| | - Max Wintermark
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato (Cagliari), Italy
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17
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Porcu M, Mannelli L, Melis M, Suri JS, Gerosa C, Cerrone G, Defazio G, Faa G, Saba L. Carotid plaque imaging profiling in subjects with risk factors (diabetes and hypertension). Cardiovasc Diagn Ther 2020; 10:1005-1018. [PMID: 32968657 DOI: 10.21037/cdt.2020.01.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Carotid artery stenosis (CAS) due to the presence of atherosclerotic plaque (AP) is a frequent medical condition and a known risk factor for stroke, and it is also known from literature that several risk factors promote the AP development, in particular aging, smoke, male sex, hypertension, hyperlipidemia, smoke, diabetes type 1 and 2, and genetic factors. The study of carotid atherosclerosis is continuously evolving: even if the strategies of treatment still depends mainly on the degree of stenosis (DoS) determined by the plaque, in the last years the attention has moved to the study of the plaque components in order to identify the so called "vulnerable" plaque: features like the fibrous cap status and thickness, the volume of the lipid-rich necrotic core and the presence of intraplaque hemorrhage (IPH) are risk factors for plaque rupture, that can be studied with modern imaging techniques. The aim of this review is to give a general overview of the principle histological and imaging features of the subcomponent of carotid AP (CAP), focalizing in particular on the features of CAP of patients affected by hypertension and diabetes (in particular type 2 diabetes mellitus).
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Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| | | | - Marta Melis
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Jasjit S Suri
- Diagnostic and Monitoring Division, AtheroPoint, Roseville, California, USA
| | - Clara Gerosa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giulia Cerrone
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
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18
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Shi Z, Li J, Zhao M, Peng W, Meddings Z, Jiang T, Liu Q, Teng Z, Lu J. Quantitative Histogram Analysis on Intracranial Atherosclerotic Plaques: A High-Resolution Magnetic Resonance Imaging Study. Stroke 2020; 51:2161-2169. [PMID: 32568660 PMCID: PMC7306260 DOI: 10.1161/strokeaha.120.029062] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis is one of the main causes of stroke, and high-resolution magnetic resonance imaging provides useful imaging biomarkers related to the risk of ischemic events. This study aims to evaluate differences in histogram features between culprit and nonculprit intracranial atherosclerosis using high-resolution magnetic resonance imaging. METHODS Two hundred forty-seven patients with intracranial atherosclerosis who underwent high-resolution magnetic resonance imaging sequentially between January 2015 and December 2016 were recruited. Quantitative features, including stenosis, plaque burden, minimum luminal area, intraplaque hemorrhage, enhancement ratio, and dispersion of signal intensity (coefficient of variation), were analyzed based on T2-, T1-, and contrast-enhanced T1-weighted images. Step-wise regression analysis was used to identify key determinates differentiating culprit and nonculprit plaques and to calculate the odds ratios (ORs) with 95% CIs. RESULTS In total, 190 plaques were identified, of which 88 plaques (37 culprit and 51 nonculprit) were located in the middle cerebral artery and 102 (57 culprit and 45 nonculprit) in the basilar artery. Nearly 90% of culprit lesions had a degree of luminal stenosis of <70%. Multiple logistic regression analyses showed that intraplaque hemorrhage (OR, 16.294 [95% CI, 1.043-254.632]; P=0.047), minimum luminal area (OR, 1.468 [95% CI, 1.032-2.087]; P=0.033), and coefficient of variation (OR, 13.425 [95% CI, 3.987-45.204]; P<0.001) were 3 significant features in defining culprit plaques in middle cerebral artery. The enhancement ratio (OR, 9.476 [95% CI, 1.256-71.464]; P=0.029), intraplaque hemorrhage (OR, 2.847 [95% CI, 0.971-10.203]; P=0.046), and coefficient of variation (OR, 10.068 [95% CI, 2.820-21.343]; P<0.001) were significantly associated with plaque type in basilar artery. Coefficient of variation was a strong independent predictor in defining plaque type for both middle cerebral artery and basilar artery with sensitivity, specificity, and accuracy being 0.79, 0.80, and 0.80, respectively. CONCLUSIONS Features characterized by high-resolution magnetic resonance imaging provided complementary values over luminal stenosis in defined lesion type for intracranial atherosclerosis; the dispersion of signal intensity in histogram analysis was a particularly effective predictive parameter.
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Affiliation(s)
- Zhang Shi
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
- Department of Radiology, University of Cambridge, United Kingdom (Z.S., Z.M., Z.T.)
| | - Jing Li
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ming Zhao
- Department of Neurology (M.Z.), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenjia Peng
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zakaria Meddings
- Department of Radiology, University of Cambridge, United Kingdom (Z.S., Z.M., Z.T.)
| | - Tao Jiang
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qi Liu
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, United Kingdom (Z.S., Z.M., Z.T.)
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, China (Z.T.)
| | - Jianping Lu
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
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19
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Paritala PK, Yarlagadda PKDV, Kansky R, Wang J, Mendieta JB, Gu Y, McGahan T, Lloyd T, Li Z. Stress-Relaxation and Cyclic Behavior of Human Carotid Plaque Tissue. Front Bioeng Biotechnol 2020; 8:60. [PMID: 32117939 PMCID: PMC7026010 DOI: 10.3389/fbioe.2020.00060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic plaque rupture is a catastrophic event that contributes to mortality and long-term disability. A better understanding of the plaque mechanical behavior is essential for the identification of vulnerable plaques pre-rupture. Plaque is subjected to a natural dynamic mechanical environment under hemodynamic loading. Therefore, it is important to understand the mechanical response of plaque tissue under cyclic loading conditions. Moreover, experimental data of such mechanical properties are fundamental for more clinically relevant biomechanical modeling and numerical simulations for risk stratification. This study aims to experimentally and numerically characterize the stress-relaxation and cyclic mechanical behavior of carotid plaque tissue. Instron microtester equipped with a custom-developed setup was used for the experiments. Carotid plaque samples excised at endarterectomy were subjected to uniaxial tensile, stress-relaxation, and cyclic loading protocols. Thirty percent of the underlying load level obtained from the uniaxial tensile test results was used to determine the change in mechanical properties of the tissue over time under a controlled testing environment (Control tests). The stress-relaxation test data was used to calibrate the hyperelastic (neo-Hookean, Ogden, Yeoh) and linear viscoelastic (Prony series) material parameters. The normalized relaxation force increased initially and slowly stabilized toward the end of relaxation phase, highlighting the viscoelastic behavior. During the cyclic tests, there was a decrease in the peak force as a function of the cycle number indicating mechanical distension due to repeated loading that varied with different frequencies. The material also accumulated residual deformation, which increased with the cycle number. This trend showed softening behavior of the samples. The results of this preliminary study provide an enhanced understanding of in vivo stress-relaxation and cyclic behavior of the human atherosclerotic plaque tissue.
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Affiliation(s)
- Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Prasad K D V Yarlagadda
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rhys Kansky
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - YuanTong Gu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tim McGahan
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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20
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Porcu M, Anzidei M, Suri JS, A Wasserman B, Anzalone N, Lucatelli P, Loi F, Montisci R, Sanfilippo R, Rafailidis V, Saba L. Carotid artery imaging: The study of intra-plaque vascularization and hemorrhage in the era of the "vulnerable" plaque. J Neuroradiol 2019; 47:464-472. [PMID: 30954549 DOI: 10.1016/j.neurad.2019.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/04/2019] [Accepted: 03/04/2019] [Indexed: 01/01/2023]
Abstract
Intraplaque hemorrhage (IPH) is one of the main factors involved in atherosclerotic plaque (AP) instability. Its recognition is crucial for the correct staging and management of patients with carotid artery plaques to limit ischemic stroke. Imaging plays a crucial role in identifying IPH, even if the great variability of intraplaque vascularization and the limitations of our current imaging technologies make it difficult. The intent of this review is to give a general overview of the main features of intraplaque vascularization and IPH on Ultrasound (US), Computed Tomography (CT), Magnetic Resonance (MR) and Nuclear Medicine, and a brief description on the future prospectives.
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Affiliation(s)
- Michele Porcu
- Department of Medical Imaging, AOU of Cagliari, University of Cagliari, Cagliari, Italy.
| | - Michele Anzidei
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jasjit S Suri
- Monitoring and Diagnostic Division, AtheroPoint, Roseville, CA, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicoletta Anzalone
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Italy
| | - Pierleone Lucatelli
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Loi
- Department of Biomedial Sciences, Unit of Oncology and Molecular Pathology, University of Cagliari, Cagliari, Italy
| | - Roberto Montisci
- Department of Vascular Surgery, AOU of Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Sanfilippo
- Department of Vascular Surgery, AOU of Cagliari, University of Cagliari, Cagliari, Italy
| | - Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloníki, Greece
| | - Luca Saba
- Department of Medical Imaging, AOU of Cagliari, University of Cagliari, Cagliari, Italy
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21
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Kan Y, He W, Ning B, Li H, Wei S, Yu T. The correlation between calcification in carotid plaque and stroke: calcification may be a risk factor for stroke. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:750-758. [PMID: 31933882 PMCID: PMC6945186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/23/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND There are few studies on the relationship between calcified plaques and stroke by ultrasound. We investigated the association between calcification in carotid plaque and stroke by analyzing the different characteristics of calcification and neovascularization distribution in heterogeneous plaques by both two-dimensional and contrast-enhanced ultrasound (CEUS). METHODS A total of 69 patients who were about to undergo carotid endarterectomy were selected between January 2016 and December 2017. Thirty-eight patients with cerebral ischemia were placed in the symptomatic group (amaurosis, TIA and no disability in the previous 6 months), and the other 31 patients, who were asymptomatic, were placed in the asymptomatic group. Two-dimensional ultrasound and CEUS were used to detect the calcification distribution characteristics and neovascularization in the plaques of all subjects. The differences of the calcification location, shape, quantity, and enhancement in the plaques were compared between the two groups. RESULTS There was no significant difference in calcification location between the two groups (P > 0.05). The symptomatic group had more nodular calcification but less strip calcification compared with the asymptomatic group (both P < 0.05). There was no significant difference in mixed morphologic calcification between the two groups (P > 0.05). The symptomatic group had a higher calcification quantity (P < 0.05). The symptomatic group exhibited more fibrous cap fracture and intra-plaque hemorrhage in H&E staining (χ2 = 17.133, P < 0.001, χ2 = 10.003, P = 0.003) and higher CD31 expression (t = 7.584, P = 0.000). CONCLUSIONS The quantity and shape of the calcification, and the presence of neovascularization adjacent to the calcification have certain effects on the stability of plaques. Multiple calcifications, nodular calcification, and neovascularization near calcification may cause plaque rupture and therefore might be risk factors for stroke. Our results suggest that the joint use of two-dimensional ultrasound and CEUS can provide comprehensive information on plaques to assess their stability.
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Affiliation(s)
- Yanmin Kan
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
- Department of Ultrasound, North China University of Science and Technology Affiliated HospitalTangshan, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
| | - Bin Ning
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
| | - Haixin Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
| | - Shiji Wei
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
| | - Tengfei Yu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
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22
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Zhou C, Yuan C, Li R, Wang W, Li C, Zhao X. Association Between Incomplete Circle of Willis and Carotid Vulnerable Atherosclerotic Plaques. Arterioscler Thromb Vasc Biol 2018; 38:2744-2749. [PMID: 30354232 DOI: 10.1161/atvbaha.118.311797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Carotid high-risk plaque, characterized by intraplaque hemorrhage, fibrous cap rupture, and large lipid-rich necrotic core, is associated with cerebrovascular events. This study sought to investigate the relationship between high-risk carotid plaque and an incomplete circle of Willis (COW).
Approach and Results—
Patients were recruited from a multicenter study, Chinese Atherosclerosis Risk Evaluation (CARE-II) and underwent 3-dimensional time-of-flight magnetic resonance angiography for intracranial arteries and 2-dimensional multicontrast magnetic resonance vessel wall imaging for carotid arteries on a 3.0T magnetic resonance scanner. The integrity of the COW in anterior and posterior portions was evaluated. Characteristics of carotid plaques were assessed. Correlation between incomplete COW and carotid plaque features was determined. Of 482 eligible patients, patients with carotid intraplaque hemorrhage showed significantly higher prevalence of an incomplete anterior COW (52.7% versus 38.5%;
P
=0.022) compared with those without. An incomplete anterior COW was associated with intraplaque hemorrhage before (odds ratio, 1.781; 95% CI, 1.083–2.931;
P
=0.023) and after adjusted for clinical risk factors (odds ratio, 1.945; 95% CI, 1.139–3.321;
P
=0.015). The unilateral carotid artery stenosis showed no correlation with incomplete anterior COW and posterior COW (all
P
>0.025). No significant associations were found between other plaque features and any type of incomplete COW (all
P
>0.025).
Conclusions—
An incomplete COW is independently associated with intraplaque hemorrhage of carotid atherosclerotic plaques.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02017756.
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Affiliation(s)
- Changwu Zhou
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
- Department of Radiology, University of Washington, Seattle (C.Y.)
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
| | - Wei Wang
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China (C.L.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
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23
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Fatty Acid Metabolism Disorder as a Factor in Atherogenesis. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background and aims: The study aims to analyze of fatty acid (FA) composition of arteries and blood plasma in atherosclerosis.
Material and method: The blood plasma in patients with coronary atherosclerosis was studied, the blood from healthy volunteers was used as control. There were also analyzed arteries of patients with severe atherosclerotic lesions and arteries of people with significantly less atherosclerotic changes.
Results: The received data indicates that there is a rather active penetration of FA from blood plasma lipoproteins into intima of arteries. Penetration of FA from blood lipoproteins into the depth of atherosclerotic aorta and an atherosclerotic plaque appears to be small and does not effect on their fatty acid composition, which is similar to that of free FA of blood plasma. The evidence of the increased activity of desaturases and fatty acid synthases in atherosclerotic and intact arteries in patients with severe atherosclerotic vascular lesions was obtained. This increase in activity may be related by relatively low content of polyunsaturated linoleic acid in blood plasma in atherosclerosis.
Conclusions: The increased activity of desaturases and fatty acid synthases as well as arterial wall hypoxia must promote accumulation of lipids in vascular wall by increasing the synthesis and inhibition of FA oxidation including free FA coming from blood.
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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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Xu Y, Li D, Yuan C, Zhou Z, He L, Li R, Cui Y, Li Q, Zheng Z, Zhao X. Association of severity between carotid and intracranial artery atherosclerosis. Ann Clin Transl Neurol 2018; 5:843-849. [PMID: 30009201 PMCID: PMC6043773 DOI: 10.1002/acn3.590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/23/2023] Open
Abstract
Objective This study sought to investigate the relationship of atherosclerosis between intracranial and extracranial carotid arteries using three‐dimensional multicontrast magnetic resonance (MR) vessel wall imaging. Methods Patients with recent cerebrovascular symptoms in anterior circulation were recruited and underwent MR vessel wall imaging for intracranial and extracranial carotid arteries. The plaque burden, including maximum wall thickness (Max WT) and stenosis, and presence of intraplaque hemorrhage (IPH) were assessed. The correlation of the plaque characteristics between intracranial and extracranial carotid arteries was determined. Results In total, 107 patients (mean age: 57.0 ± 11.1 years, 69 males) were recruited. In discriminating intracranial severe stenosis (≥50% stenosis), the odds ratio (OR) of Max WT of extracranial carotid arteries was 1.41 (95% confidence interval [CI], 0.94–2.11, P = 0.095) and 1.72 (95% CI, 1.04–2.83, P = 0.034) before and after adjusting for confounding factors, respectively. The OR of stenosis of extracranial carotid arteries with increment of 10% was 1.26 (95% CI, 0.99–1.60, P = 0.054) and 1.37 (95% CI, 1.03–1.82, P = 0.033) before and after adjusting for confounding factors, in discriminating intracranial severe stenosis respectively. Receiver operating characteristic analysis revealed that the area under the curve (AUC) of Max WT, stenosis, and IPH of extracranial carotid artery plaques was 0.641, 0.605, and 0.603 in discriminating intracranial severe stenosis, respectively. After adjusting for confounding factors, the AUC of Max WT, stenosis, and presence of IPH in extracranial carotid artery plaques increased to 0.812, 0.817 and 0.781, respectively. Interpretation Carotid artery plaque burden is significantly associated with severe intracranial artery stenosis, suggesting that extracranial carotid plaque burden might be an independent indicator for severity of intracranial artery atherosclerosis.
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Affiliation(s)
- Yilan Xu
- Department of RadiologyBeijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijingChina
| | - Dongye Li
- Center for Biomedical Imaging ResearchDepartment of Biomedical EngineeringTsinghua University School of MedicineBeijingChina
- Center for Brain Disorders ResearchCapital Medical University and Beijing Institute for Brain DisordersBeijingChina
| | - Chun Yuan
- Center for Biomedical Imaging ResearchDepartment of Biomedical EngineeringTsinghua University School of MedicineBeijingChina
- Department of RadiologyUniversity of WashingtonSeattleWashington
| | - Zechen Zhou
- Philips Research North AmericaCambridgeMassachusetts
| | - Le He
- Center for Biomedical Imaging ResearchDepartment of Biomedical EngineeringTsinghua University School of MedicineBeijingChina
| | - Rui Li
- Center for Biomedical Imaging ResearchDepartment of Biomedical EngineeringTsinghua University School of MedicineBeijingChina
| | - Yuanyuan Cui
- Department of RadiologyPLA General HospitalBeijingChina
| | - Qing Li
- Department of NeurologyPeople's Hospital of Xinjiang Vygur Autonomous RegionUrumqiChina
| | - Zhuozhao Zheng
- Department of RadiologyBeijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijingChina
| | - Xihai Zhao
- Center for Biomedical Imaging ResearchDepartment of Biomedical EngineeringTsinghua University School of MedicineBeijingChina
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26
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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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Yesudasan S, Wang X, Averett RD. Molecular dynamics simulations indicate that deoxyhemoglobin, oxyhemoglobin, carboxyhemoglobin, and glycated hemoglobin under compression and shear exhibit an anisotropic mechanical behavior. J Biomol Struct Dyn 2017; 36:1417-1429. [PMID: 28441918 DOI: 10.1080/07391102.2017.1323674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We developed a new mechanical model for determining the compression and shear mechanical behavior of four different hemoglobin structures. Previous studies on hemoglobin structures have focused primarily on overall mechanical behavior; however, this study investigates the mechanical behavior of hemoglobin, a major constituent of red blood cells, using steered molecular dynamics (SMD) simulations to obtain anisotropic mechanical behavior under compression and shear loading conditions. Four different configurations of hemoglobin molecules were considered: deoxyhemoglobin (deoxyHb), oxyhemoglobin (HbO2), carboxyhemoglobin (HbCO), and glycated hemoglobin (HbA1C). The SMD simulations were performed on the hemoglobin variants to estimate their unidirectional stiffness and shear stiffness. Although hemoglobin is structurally denoted as a globular protein due to its spherical shape and secondary structure, our simulation results show a significant variation in the mechanical strength in different directions (anisotropy) and also a strength variation among the four different hemoglobin configurations studied. The glycated hemoglobin molecule possesses an overall higher compressive mechanical stiffness and shear stiffness when compared to deoxyhemoglobin, oxyhemoglobin, and carboxyhemoglobin molecules. Further results from the models indicate that the hemoglobin structures studied possess a soft outer shell and a stiff core based on stiffness.
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Affiliation(s)
- Sumith Yesudasan
- a School of Chemical, Materials, and Biomedical Engineering , College of Engineering, University of Georgia , 597 D.W. Brooks Drive, Athens , GA 30602 , USA
| | - Xianqiao Wang
- b School of Environmental, Civil, Agricultural and Mechanical Engineering , College of Engineering, University of Georgia , 712G Boyd Graduate Studies Research Center, Athens , GA 30602 , USA
| | - Rodney D Averett
- a School of Chemical, Materials, and Biomedical Engineering , College of Engineering, University of Georgia , 597 D.W. Brooks Drive, Athens , GA 30602 , USA
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28
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Leukocyte trafficking-associated vascular adhesion protein 1 is expressed and functionally active in atherosclerotic plaques. Sci Rep 2016; 6:35089. [PMID: 27731409 PMCID: PMC5059718 DOI: 10.1038/srep35089] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/23/2016] [Indexed: 12/15/2022] Open
Abstract
Given the important role of inflammation and the potential association of the leukocyte trafficking-associated adhesion molecule vascular adhesion protein 1 (VAP-1) with atherosclerosis, this study examined whether functional VAP-1 is expressed in atherosclerotic lesions and, if so, whether it could be targeted by positron emission tomography (PET). First, immunohistochemistry revealed that VAP-1 localized to endothelial cells of intra-plaque neovessels in human carotid endarterectomy samples from patients with recent ischemic symptoms. In low-density lipoprotein receptor-deficient mice expressing only apolipoprotein B100 (LDLR-/-ApoB100/100), VAP-1 was expressed on endothelial cells lining inflamed atherosclerotic lesions; normal vessel walls in aortas of C57BL/6N control mice were VAP-1-negative. Second, we discovered that the focal uptake of VAP-1 targeting sialic acid-binding immunoglobulin-like lectin 9 based PET tracer [68Ga]DOTA-Siglec-9 in atherosclerotic plaques was associated with the density of activated macrophages (r = 0.58, P = 0.022). As a final point, we found that the inhibition of VAP-1 activity with small molecule LJP1586 decreased the density of macrophages in inflamed atherosclerotic plaques in mice. Our results suggest for the first time VAP-1 as a potential imaging target for inflamed atherosclerotic plaques, and corroborate VAP-1 inhibition as a therapeutic approach in the treatment of atherosclerosis.
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29
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Eshtehardi P, Teng Z. Protective or destructive: High wall shear stress and atherosclerosis. Atherosclerosis 2016; 251:501-503. [PMID: 27282831 DOI: 10.1016/j.atherosclerosis.2016.05.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
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30
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Huntzicker S, Shekhar H, Doyley MM. Contrast-Enhanced Quantitative Intravascular Elastography: The Impact of Microvasculature on Model-Based Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1167-81. [PMID: 26924697 PMCID: PMC4811726 DOI: 10.1016/j.ultrasmedbio.2015.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 05/03/2023]
Abstract
Model-based intravascular ultrasound elastography visualizes the stress distribution within vascular tissue-information that clinicians could use to predict the propensity of atherosclerotic plaque rupture. However, there are concerns that clusters of microvessels may reduce the accuracy of the estimated stress distribution. Consequently, we have developed a contrast-enhanced intravascular ultrasound system to investigate how plaque microvasculature affects the performance of model-based elastography. In simulations, diameters of 200, 400 and 800 μm were used, where the latter diameter represented a cluster of microvessels. In phantoms, we used a microvessel with a diameter of 750 μm. Peak stress errors of 3% and 38% were incurred in the fibrous cap when stress recovery was performed with and without a priori information about microvessel geometry. The results indicate that incorporating geometric information about plaque microvasculature obtained with contrast-enhanced ultrasound imaging improves the accuracy of estimates of the stress distribution within the fibrous cap precisely.
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Affiliation(s)
- Steven Huntzicker
- Department of Electrical & Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA
| | - Himanshu Shekhar
- Department of Electrical & Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA
| | - Marvin M Doyley
- Department of Electrical & Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA.
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31
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Xu C, Yuan C, Stutzman E, Canton G, Comess KA, Beach KW. Quest for the Vulnerable Atheroma: Carotid Stenosis and Diametric Strain--A Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:699-716. [PMID: 26705891 PMCID: PMC4744121 DOI: 10.1016/j.ultrasmedbio.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 10/05/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
The Bernoulli effect may result in eruption of a vulnerable carotid atheroma, causing a stroke. We measured electrocardiography (ECG)-registered QRS intra-stenotic blood velocity and atheroma strain dynamics in carotid artery walls using ultrasonic tissue Doppler methods, providing displacement and time resolutions of 0.1 μm and 3.7 ms. Of 22 arteries, 1 had a peak systolic velocity (PSV) >280 cm/s, 4 had PSVs between 165 and 280 cm/s and 17 had PSVs <165 cm/s. Eight arteries with PSVs <65 cm/s and 4 of 9 with PSVs between 65 and 165 cm/s had normal systolic diametric expansion (0% and 7%) and corresponding systolic wall thinning. The remaining 10 arteries had abnormal systolic strain dynamics, 2 with diametric reduction (>-0.05 mm), 2 with extreme wall expansion (>0.1 mm), 2 with extreme wall thinning (>-0.1 mm) and 4 with combinations. Decreases in systolic diameter and/or extreme systolic arterial wall thickening may indicate imminent atheroma rupture.
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Affiliation(s)
- Canxing Xu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, Washington, USA; Department of Radiology, Vascular Imaging Laboratory, University of Washington, Seattle, Washington, USA
| | - Edward Stutzman
- D. E. Strandness, Jr. Vascular Laboratory, University of Washington Medical Center, Seattle, Washington, USA
| | - Gador Canton
- Department of Radiology, Vascular Imaging Laboratory, University of Washington, Seattle, Washington, USA
| | | | - Kirk W Beach
- Department of Bioengineering, University of Washington, Seattle, Washington, USA; Department of Radiology, Vascular Imaging Laboratory, University of Washington, Seattle, Washington, USA; Department of Surgery, University of Washington, Seattle, Washington, USA.
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32
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Abstract
Atherosclerosis remains a major cause of morbidity and mortality worldwide, and a thorough understanding of the underlying pathophysiological mechanisms is crucial for the development of new therapeutic strategies. Although atherosclerosis is a systemic inflammatory disease, coronary atherosclerotic plaques are not uniformly distributed in the vascular tree. Experimental and clinical data highlight that biomechanical forces, including wall shear stress (WSS) and plaque structural stress (PSS), have an important role in the natural history of coronary atherosclerosis. Endothelial cell function is heavily influenced by changes in WSS, and longitudinal animal and human studies have shown that coronary regions with low WSS undergo increased plaque growth compared with high WSS regions. Local alterations in WSS might also promote transformation of stable to unstable plaque subtypes. Plaque rupture is determined by the balance between PSS and material strength, with plaque composition having a profound effect on PSS. Prospective clinical studies are required to ascertain whether integrating mechanical parameters with medical imaging can improve our ability to identify patients at highest risk of rapid disease progression or sudden cardiac events.
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33
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Nieuwstadt HA, Fekkes S, Hansen HHG, de Korte CL, van der Lugt A, Wentzel JJ, van der Steen AFW, Gijsen FJH. Carotid plaque elasticity estimation using ultrasound elastography, MRI, and inverse FEA - A numerical feasibility study. Med Eng Phys 2015; 37:801-7. [PMID: 26130603 DOI: 10.1016/j.medengphy.2015.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/02/2015] [Accepted: 06/07/2015] [Indexed: 12/13/2022]
Abstract
The material properties of atherosclerotic plaques govern the biomechanical environment, which is associated with rupture-risk. We investigated the feasibility of noninvasively estimating carotid plaque component material properties through simulating ultrasound (US) elastography and in vivo magnetic resonance imaging (MRI), and solving the inverse problem with finite element analysis. 2D plaque models were derived from endarterectomy specimens of nine patients. Nonlinear neo-Hookean models (tissue elasticity C1) were assigned to fibrous intima, wall (i.e., media/adventitia), and lipid-rich necrotic core. Finite element analysis was used to simulate clinical cross-sectional US strain imaging. Computer-simulated, single-slice in vivo MR images were segmented by two MR readers. We investigated multiple scenarios for plaque model elasticity, and consistently found clear separations between estimated tissue elasticity values. The intima C1 (160 kPa scenario) was estimated as 125.8 ± 19.4 kPa (reader 1) and 128.9 ± 24.8 kPa (reader 2). The lipid-rich necrotic core C1 (5 kPa) was estimated as 5.6 ± 2.0 kPa (reader 1) and 8.5 ± 4.5 kPa (reader 2). A scenario with a stiffer wall yielded similar results, while realistic US strain noise and rotating the models had little influence, thus demonstrating robustness of the procedure. The promising findings of this computer-simulation study stimulate applying the proposed methodology in a clinical setting.
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Affiliation(s)
- H A Nieuwstadt
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
| | - S Fekkes
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H H G Hansen
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C L de Korte
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A van der Lugt
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - J J Wentzel
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - A F W van der Steen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands; Department of Imaging Science and Technology, Delft University of Technology, Delft, The Netherlands
| | - F J H Gijsen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
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Makris GC, Teng Z, Patterson AJ, Lin JM, Young V, Graves MJ, Gillard JH. Advances in MRI for the evaluation of carotid atherosclerosis. Br J Radiol 2015; 88:20140282. [PMID: 25826233 DOI: 10.1259/bjr.20140282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Carotid artery atherosclerosis is an important source of mortality and morbidity in the Western world with significant socioeconomic implications. The quest for the early identification of the vulnerable carotid plaque is already in its third decade and traditional measures, such as the sonographic degree of stenosis, are not selective enough to distinguish those who would really benefit from a carotid endarterectomy. MRI of the carotid plaque enables the visualization of plaque composition and specific plaque components that have been linked to a higher risk of subsequent embolic events. Blood suppressed T1 and T2 weighted and proton density-weighted fast spin echo, gradient echo and time-of-flight sequences are typically used to quantify plaque components such as lipid-rich necrotic core, intraplaque haemorrhage, calcification and surface defects including erosion, disruption and ulceration. The purpose of this article is to review the most important recent advances in MRI technology to enable better diagnostic carotid imaging.
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Affiliation(s)
- G C Makris
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Z Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - A J Patterson
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - J-M Lin
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - V Young
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - M J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - J H Gillard
- Department of Radiology, University of Cambridge, Cambridge, UK
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35
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Lu J, Duan W, Qiao A. Finite element analysis of mechanics of neovessels with intraplaque hemorrhage in carotid atherosclerosis. Biomed Eng Online 2015; 14 Suppl 1:S3. [PMID: 25603398 PMCID: PMC4306113 DOI: 10.1186/1475-925x-14-s1-s3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Intraplaque hemorrhage is a widely known factor facilitating plaque instability. Neovascularization of plaque can be regarded as a compensatory response to the blood supply in the deep intimal and medial areas of the artery. Due to the physiological function, the deformation of carotid atherosclerotic plaque would happen under the action of blood pressure and blood flow. Neovessels are subject to mechanical loading and likely undergo deformation. The rupture of neovessels may deteriorate the instability of plaque. This study focuses on the local mechanical environments around neovessels and investigates the relationship between the biomechanics and the morphological specificity of neovessels. Methods Stress and stretch were used to evaluate the rupture risk of the neovessels in plaque. Computational structural analysis was performed based on two human carotid plaque slice samples. Two-dimensional models containing neovessels and other components were built according to the plaque slice samples. Each component was assumed to be non-linear isotropic, piecewise homogeneous and incompressible. Different mechanical boundary conditions, i.e. static pressures, were imposed in the carotid lumen and neovessels lumen respectively. Finite element method was used to simulate the mechanical conditions in the atherosclerotic plaque. Results Those neovessels closer to the carotid lumen undergo larger stress and stretch. With the same distance to the carotid lumen, the longer the perimeter of neovessels is, the larger stress and the deformation of the neovessels will be. Under the same conditions, the neovessels with larger curvature suffer greater stress and stretch. Neovessels surrounded by red blood cells undergo a much larger stretch. Conclusions Local mechanical conditions may result in the hemorrhage of neovessels and accelerate the rupture of plaque. The mechanical environments of the neovessel are related to its shape, curvature, distance to the carotid lumen and the material properties of plaque.
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36
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Fukumitsu R, Minami M, Yoshida K, Nagata M, Yasui M, Higuchi S, Fujikawa R, Ikedo T, Yamagata S, Sato Y, Arai H, Yokode M, Miyamoto S. Expression of Vasohibin-1 in Human Carotid Atherosclerotic Plaque. J Atheroscler Thromb 2015; 22:942-8. [DOI: 10.5551/jat.29074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ryu Fukumitsu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Manabu Minami
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Manabu Nagata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Mika Yasui
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine
| | - Sei Higuchi
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine
| | - Risako Fujikawa
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine
| | - Taichi Ikedo
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital
| | - Yasufumi Sato
- Department of Vascular Biology, Institute of Development, Aging, and Cancer, Tohoku University
| | - Hidenori Arai
- Department of Human Health and Sciences, Kyoto University Graduate School of Medicine
| | - Masayuki Yokode
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
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37
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Material properties of components in human carotid atherosclerotic plaques: a uniaxial extension study. Acta Biomater 2014; 10:5055-5063. [PMID: 25200842 PMCID: PMC4226324 DOI: 10.1016/j.actbio.2014.09.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/31/2014] [Accepted: 09/01/2014] [Indexed: 12/17/2022]
Abstract
Computational modelling to calculate the mechanical loading within atherosclerotic plaques has been shown to be complementary to defining anatomical plaque features in determining plaque vulnerability. However, its application has been partially impeded by the lack of comprehensive knowledge about the mechanical properties of various tissues within the plaque. Twenty-one human carotid plaques were collected from endarterectomy. The plaque was cut into rings, and different type of atherosclerotic tissues, including media, fibrous cap (FC), lipid and intraplaque haemorrhage/thrombus (IPH/T) was dissected for uniaxial extension testing. In total, 65 media strips from 17 samples, 59 FC strips from 14 samples, 38 lipid strips from 11 samples, and 21 IPH/T strips from 11 samples were tested successfully. A modified Mooney–Rivlin strain energy density function was used to characterize the stretch–stress relationship. The stiffnesses of media and FC are comparable, as are lipid and IPH/T. However, both media and FC are stiffer than either lipid or IPH/T. The median values of incremental Young’s modulus of media, FC, lipid and IPH/T at λ = 1 are 290.1, 244.5, 104.4, 52.9, respectively; they increase to 1019.5, 817.4, 220.7 and 176.9 at λ = 1.1; and 4302.7, 3335.0, 533.4 and 268.8 at λ = 1.15 (unit, kPa; λ, stretch ratio). The material constants of each tissue type are suggested to be: media, c1 = 0.138 kPa, D1 = 3.833 kPa and D2 = 18.803; FC, c1 = 0.186 kPa, D1 = 5.769 kPa and D2 = 18.219; lipid, c1 = 0.046 kPa, D1 = 4.885 kPa and D2 = 5.426; and IPH/T, c1 = 0.212 kPa, D1 = 4.260 kPa and D2 = 5.312. It is concluded that all soft atherosclerotic tissues are non-linear, and both media and FC are stiffer than either lipid or IPH/T.
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38
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Dimensionality reduction by supervised neighbor embedding using laplacian search. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:594379. [PMID: 24963339 PMCID: PMC4055433 DOI: 10.1155/2014/594379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/28/2014] [Indexed: 11/18/2022]
Abstract
Dimensionality reduction is an important issue for numerous applications including biomedical images analysis and living system analysis. Neighbor embedding, those representing the global and local structure as well as dealing with multiple manifolds, such as the elastic embedding techniques, can go beyond traditional dimensionality reduction methods and find better optima. Nevertheless, existing neighbor embedding algorithms can not be directly applied in classification as suffering from several problems: (1) high computational complexity, (2) nonparametric mappings, and (3) lack of class labels information. We propose a supervised neighbor embedding called discriminative elastic embedding (DEE) which integrates linear projection matrix and class labels into the final objective function. In addition, we present the Laplacian search direction for fast convergence. DEE is evaluated in three aspects: embedding visualization, training efficiency, and classification performance. Experimental results on several benchmark databases present that the proposed DEE exhibits a supervised dimensionality reduction approach which not only has strong pattern revealing capability, but also brings computational advantages over standard gradient based methods.
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39
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Wang JY, Wu PK, Chen PCH, Yen CC, Hung GY, Chen CF, Hung SC, Tsai SF, Liu CL, Chen TH, Chen WM. Manipulation therapy prior to diagnosis induced primary osteosarcoma metastasis--from clinical to basic research. PLoS One 2014; 9:e96571. [PMID: 24804772 PMCID: PMC4013034 DOI: 10.1371/journal.pone.0096571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Osteosarcoma (OS) patients who suffer manipulation therapy (MT) prior to diagnosis resulted in poor prognosis with increasing metastasis or recurrence rate. The aim of the study is to establish an in vivo model to identify the effects of MT on OS. The enrolled 235 OS patients were followed up in this study. In vivo nude mice model with tibia injection of GFP-labeled human OS cells were randomly allocated into MT(+) that with repeated massage on tumor site twice a week and no treatment as MT(-) group. The five-year survival, metastasis and recurrence rates were recorded in clinical subjects. X-ray plainfilm, micro-PET/CT scan, histopathology, serum metalloproteinase 2 (MMP2), metalloproteinase 9 (MMP9) level and human kinase domain insert receptor (KDR) pattern were assayed in mice model. The results showed that patient with MT decreased 5-year survival and higher recurrence or metastasis rate. Compatible with clinical findings, the decreased body weight (30.5 ± 0.65 g) and an increased tumor volume (8.3 ± 1.18 mm3) in MT(+) mice were observed. The increasing signal intensity over lymph node region of hind limb by micro-PET/CT and the tumor cells were detected in lung and bilateral lymph nodes only in MT(+) group. MMP2 (214 ± 9.8 ng/ml) and MMP9 (25.5 ± 1.81 ng/ml) were higher in MT(+) group than in MT(-) group (165 ± 7.8 ng/ml and 16.9 ± 1.40 ng/ml, individually) as well as KDR expression. Taking clinical observations and in vivo evidence together, MT treatment leads to poor prognosis of primary osteosarcoma; physicians should pay more attention on patients who seek MT before diagnosis.
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Affiliation(s)
- Jir-You Wang
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan
| | - Paul Chih-Hsueh Chen
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chuen-Chuan Yen
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Giun-Yi Hung
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Chieh Hung
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Fen Tsai
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Chien-Lin Liu
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan
| | - Tain-Hsiung Chen
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery and Institute of Clinical Medicine School, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Teng Z, Brown AJ, Calvert PA, Parker RA, Obaid DR, Huang Y, Hoole SP, West NE, Gillard JH, Bennett MR. Coronary Plaque Structural Stress Is Associated With Plaque Composition and Subtype and Higher in Acute Coronary Syndrome. Circ Cardiovasc Imaging 2014; 7:461-70. [DOI: 10.1161/circimaging.113.001526] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Atherosclerotic plaques underlying most myocardial infarctions have thin fibrous caps and large necrotic cores; however, these features alone do not reliably identify plaques that rupture. Rupture occurs when plaque structural stress (PSS) exceeds mechanical strength. We examined whether PSS could be calculated in vivo based on virtual histology (VH) intravascular ultrasound and whether PSS varied according to plaque composition, subtype, or clinical presentation.
Methods and Results—
A total of 4429 VH intravascular ultrasound frames from 53 patients were analyzed, identifying 99 584 individual plaque components. PSS was calculated by finite element analysis in whole vessels, in individual plaques, and in higher-risk regions (plaque burden ≥70%, mean luminal area ≤4 mm
2
, noncalcified VH-defined thin-cap fibroatheroma). Plaque components including total area/arc of calcification (
R
2
=0.33;
P
<0.001 and
R
2
=0.28;
P
<0.001) and necrotic core (
R
2
=0.18;
P
<0.001 and
R
2
=0.15;
P
<0.001) showed complex, nonlinear relationships with PSS. PSS was higher in noncalcified VH-defined thin-cap fibroatheroma compared with thick-cap fibroatheromas (median [Q1–Q3], 8.44 [6.97–10.64] versus 7.63 [6.37–9.68];
P
=0.002). PSS was also higher in patients with an acute coronary syndrome, where mean luminal area ≤4 mm
2
(8.24 [7.06–9.93] versus 7.72 [6.33–9.34];
P
=0.03), plaque burden ≥70% (9.18 [7.44–10.88] versus 7.93 [6.16–9.46];
P
=0.02), and in noncalcified VH-defined thin-cap fibroatheroma (9.23 [7.33–11.44] versus 7.65 [6.45–8.62];
P
=0.02). Finally, PSS increased the positive predictive value for VH intravascular ultrasound to identify clinical presentation.
Conclusions—
Finite element analysis modeling demonstrates that structural stress is highly variable within plaques, with increased PSS associated with plaque composition, subtype, and higher-risk regions in patients with acute coronary syndrome. PSS may represent a novel tool to analyze the dynamic behavior of coronary plaques with the potential to improve prediction of plaque rupture.
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Affiliation(s)
- Zhongzhao Teng
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Adam J. Brown
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Patrick A. Calvert
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Richard A. Parker
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Daniel R. Obaid
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Yuan Huang
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Stephen P. Hoole
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Nick E.J. West
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Jonathan H. Gillard
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
| | - Martin R. Bennett
- From the Department of Radiology (Z.T., Y.H., J.H.G.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (A.J.B., P.A.C., D.R.O., M.R.B.), and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK (R.A.P.); and Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK (S.P.H., N.E.J.W.)
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Selwaness M, van den Bouwhuijsen Q, Mattace-Raso FU, Verwoert GC, Hofman A, Franco OH, Witteman JC, van der Lugt A, Vernooij MW, Wentzel JJ. Arterial Stiffness Is Associated With Carotid Intraplaque Hemorrhage in the General Population. Arterioscler Thromb Vasc Biol 2014; 34:927-32. [DOI: 10.1161/atvbaha.113.302603] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
The relation between arterial stiffness and atherosclerosis, and specifically the influence of arterial stiffness on plaque composition, is largely unknown. In a population-based study, we investigated the association between arterial stiffness and the presence and composition of carotid atherosclerotic plaques.
Approach and Results—
Arterial stiffness was measured in 6527 participants (67.0±8.6 years) using aortic pulse wave velocity (PWV). Presence of carotid atherosclerotic plaques was assessed with ultrasound. Subsequently, 1059 subjects with carotid plaques (>2.5 mm) underwent MRI to assess plaque composition (presence of intraplaque hemorrhage, lipid, and calcification). Generalized estimation equation analyses adjusted for age, sex, mean arterial pressure, heart rate, carotid wall thickening, pulse pressure, and traditional cardiovascular risk factors were used to study the association between PWV and the presence and composition of carotid atherosclerotic plaques. In multivariable analysis, higher PWV was independently related to higher prevalence of carotid atherosclerotic plaque on ultrasound (odds ratio for highest quartile of PWV compared with lowest quartile, 1.24 [95% confidence interval, 1.02–1.51]). Furthermore, higher PWV was associated with intraplaque hemorrhage (age- and sex-adjusted odds ratio per SD increase in PWV, 1.20 [1.04–1.38] and calcification, 1.18 [1.03–1.35]), but not with lipid. After adjustment for cardiovascular risk factors, PWV remained significantly associated with intraplaque hemorrhage (1.20 [1.01–1.43]). Additional adjustment for pulse pressure did not materially affect the effect estimate (1.19 [1.00–1.42]).
Conclusions—
Higher PWV is associated with presence and composition of carotid atherosclerotic plaques, in particular with intraplaque hemorrhage. These findings provide further clues for understanding the development of vulnerable atherosclerotic plaque.
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Affiliation(s)
- Mariana Selwaness
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Quirijn van den Bouwhuijsen
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Francesco U.S. Mattace-Raso
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Germaine C. Verwoert
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Oscar H. Franco
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Jacqueline C.M. Witteman
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Aad van der Lugt
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Meike W. Vernooij
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Jolanda J. Wentzel
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
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42
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Nieuwstadt HA, Speelman L, Breeuwer M, van der Lugt A, van der Steen AFW, Wentzel JJ, Gijsen FJH. The Influence of Inaccuracies in Carotid MRI Segmentation on Atherosclerotic Plaque Stress Computations. J Biomech Eng 2014; 136:021015. [DOI: 10.1115/1.4026178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/09/2013] [Indexed: 11/08/2022]
Abstract
Biomechanical finite element analysis (FEA) based on in vivo carotid magnetic resonance imaging (MRI) can be used to assess carotid plaque vulnerability noninvasively by computing peak cap stress. However, the accuracy of MRI plaque segmentation and the influence this has on FEA has remained unreported due to the lack of a reliable submillimeter ground truth. In this study, we quantify this influence using novel numerical simulations of carotid MRI. Histological sections from carotid plaques from 12 patients were used to create 33 ground truth plaque models. These models were subjected to numerical computer simulations of a currently used clinically applied 3.0 T T1-weighted black-blood carotid MRI protocol (in-plane acquisition voxel size of 0.62 × 0.62 mm2) to generate simulated in vivo MR images from a known underlying ground truth. The simulated images were manually segmented by three MRI readers. FEA models based on the MRI segmentations were compared with the FEA models based on the ground truth. MRI-based FEA model peak cap stress was consistently underestimated, but still correlated (R) moderately with the ground truth stress: R = 0.71, R = 0.47, and R = 0.76 for the three MRI readers respectively (p < 0.01). Peak plaque stretch was underestimated as well. The peak cap stress in thick-cap, low stress plaques was substantially more accurately and precisely predicted (error of −12 ± 44 kPa) than the peak cap stress in plaques with caps thinner than the acquisition voxel size (error of −177 ± 168 kPa). For reliable MRI-based FEA to compute the peak cap stress of carotid plaques with thin caps, the current clinically used in-plane acquisition voxel size (∼0.6 mm) is inadequate. FEA plaque stress computations would be considerably more reliable if they would be used to identify thick-cap carotid plaques with low stresses instead.
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43
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Teng Z, Sadat U, Brown AJ, Gillard JH. Plaque hemorrhage in carotid artery disease: pathogenesis, clinical and biomechanical considerations. J Biomech 2014; 47:847-58. [PMID: 24485514 PMCID: PMC3994507 DOI: 10.1016/j.jbiomech.2014.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 12/21/2022]
Abstract
Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Adam J Brown
- Department of Cardiovascular Medicine, University of Cambridge, UK
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44
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Mercer JR. Mitochondrial bioenergetics and therapeutic intervention in cardiovascular disease. Pharmacol Ther 2014; 141:13-20. [DOI: 10.1016/j.pharmthera.2013.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/18/2013] [Indexed: 11/15/2022]
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45
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Saba L, Anzidei M, Marincola BC, Piga M, Raz E, Bassareo PP, Napoli A, Mannelli L, Catalano C, Wintermark M. Imaging of the carotid artery vulnerable plaque. Cardiovasc Intervent Radiol 2013; 37:572-85. [PMID: 23912494 DOI: 10.1007/s00270-013-0711-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Abstract
Atherosclerosis involving the carotid arteries has a high prevalence in the population worldwide. This condition is significant because accidents of the carotid artery plaque are associated with the development of cerebrovascular events. For this reason, carotid atherosclerotic disease needs to be diagnosed and those determinants that are associated to an increased risk of stroke need to be identified. The degree of stenosis typically has been considered the parameter of choice to determine the therapeutical approach, but several recently published investigations have demonstrated that the degree of luminal stenosis is only an indirect indicator of the atherosclerotic process and that direct assessment of the plaque structure and composition may be key to predict the development of future cerebrovascular ischemic events. The concept of "vulnerable plaque" was born, referring to those plaque's parameters that concur to the instability of the plaque making it more prone to the rupture and distal embolization. The purpose of this review is to describe the imaging characteristics of "vulnerable carotid plaques."
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554, 09045, Monserrato, Cagliari, Italy,
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46
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Fast discriminative stochastic neighbor embedding analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:106867. [PMID: 23853667 PMCID: PMC3703401 DOI: 10.1155/2013/106867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 03/22/2013] [Indexed: 11/18/2022]
Abstract
Feature is important for many applications in biomedical signal analysis and living system analysis. A fast discriminative stochastic neighbor embedding analysis (FDSNE) method for feature extraction is proposed in this paper by improving the existing DSNE method. The proposed algorithm adopts an alternative probability distribution model constructed based on its K-nearest neighbors from the interclass and intraclass samples. Furthermore, FDSNE is extended to nonlinear scenarios using the kernel trick and then kernel-based methods, that is, KFDSNE1 and KFDSNE2. FDSNE, KFDSNE1, and KFDSNE2 are evaluated in three aspects: visualization, recognition, and elapsed time. Experimental results on several datasets show that, compared with DSNE and MSNP, the proposed algorithm not only significantly enhances the computational efficiency but also obtains higher classification accuracy.
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Teng Z, Sadat U, Wang W, Bahaei NS, Chen S, Young VE, Graves MJ, Gillard JH. Intraplaque stretch in carotid atherosclerotic plaque--an effective biomechanical predictor for subsequent cerebrovascular ischemic events. PLoS One 2013; 8:e61522. [PMID: 23626694 PMCID: PMC3634006 DOI: 10.1371/journal.pone.0061522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/11/2013] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Stretch is a mechanical parameter, which has been proposed previously to affect the biological activities in different tissues. This study explored its utility in determining plaque vulnerability. METHODS One hundred and six patients with mild to moderate carotid stenosis were recruited in this study (53 symptomatic and 53 asymptomatic). High resolution, multi-sequence magnetic resonance (MR) imaging was performed to delineate various plaque components. Finite element method was used to predict high stretch concentration within the plaque. RESULTS During a two-year follow-up, 11 patients in symptomatic group and 3 in asymptomatic group experienced recurrent cerebrovascular events. Plaque stretch at systole and stretch variation during one cardiac cycle was greater in symptomatic group than those in the asymptomatic. Within the symptomatic group, a similar trend was observed in patients with recurrent events compared to those without. CONCLUSION Plaques with high stretch concentration and large stretch variation are associated with increased risk of future cerebrovascular events.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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Nonlinear radon transform using Zernike moment for shape analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:208402. [PMID: 23818937 PMCID: PMC3681207 DOI: 10.1155/2013/208402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/22/2013] [Indexed: 11/17/2022]
Abstract
We extend the linear Radon transform to a nonlinear space and propose a method by applying the nonlinear Radon transform to Zernike moments to extract shape descriptors. These descriptors are obtained by computing Zernike moment on the radial and angular coordinates of the pattern image's nonlinear Radon matrix. Theoretical and experimental results validate the effectiveness and the robustness of the method. The experimental results show the performance of the proposed method in the case of nonlinear space equals or outperforms that in the case of linear Radon.
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Bayes clustering and structural support vector machines for segmentation of carotid artery plaques in multicontrast MRI. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2012:549102. [PMID: 23365619 PMCID: PMC3536030 DOI: 10.1155/2012/549102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 11/19/2012] [Indexed: 11/18/2022]
Abstract
Accurate segmentation of carotid artery plaque in MR images is not only a key part but also an essential step for in vivo plaque analysis. Due to the indistinct MR images, it is very difficult to implement the automatic segmentation. Two kinds of classification models, that is, Bayes clustering and SSVM, are introduced in this paper to segment the internal lumen wall of carotid artery. The comparative experimental results show the segmentation performance of SSVM is better than Bayes.
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A rate-distortion-based merging algorithm for compressed image segmentation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:648320. [PMID: 23118800 PMCID: PMC3478748 DOI: 10.1155/2012/648320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022]
Abstract
Original images are often compressed for the communication applications. In order to avoid the burden of decompressing computations, it is thus desirable to segment images in the compressed domain directly. This paper presents a simple rate-distortion-based scheme to segment images in the JPEG2000 domain. It is based on a binary arithmetic code table used in the JPEG2000 standard, which is available at both encoder and decoder; thus, there is no need to transmit the segmentation result. Experimental results on the Berkeley image database show that the proposed algorithm is preferable in terms of the running time and the quantitative measures: probabilistic Rand index (PRI) and boundary displacement error (BDE).
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