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Cress HJ, Mitchell CC, Wilbrand SM, Wesley UV, Morel Valdés GM, Hess T, Varghese T, Maybock J, Metoxen M, Riesenberg A, Vandenberg C, Blohowiak CJ, Kennard J, Danforth D, Dempsey RJ. Methods in Stroke Prevention in the Wisconsin Native American Population. Neuroepidemiology 2024; 58:300-309. [PMID: 38295773 DOI: 10.1159/000536426] [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: 09/11/2023] [Accepted: 01/09/2024] [Indexed: 08/07/2024] Open
Abstract
Native American individuals are more frequently affected by cerebrovascular diseases including stroke and vascular cognitive decline. The aim of this study was to determine stroke risk factors that are most prevalent in Wisconsin Native Americans and to examine how education at the community and individual level as well as intensive health wellness coaching may influence modification of stroke risk factors. Additionally, we will investigate the role novel stroke biomarkers may play in stroke risk in this population. This paper details the aims and methods employed in the "Stroke Prevention in the Wisconsin Native American Population" (clinicaltrials.gov identifier: NCT04382963) study including participant health assessments, clinical ultrasound exam of the carotid arteries, cognitive testing battery, and structure and execution of the coaching program.
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Affiliation(s)
- Hannah J Cress
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carol C Mitchell
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stephanie M Wilbrand
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Umadevi V Wesley
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gloria M Morel Valdés
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy Hess
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jenna Maybock
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Melissa Metoxen
- Native American Center for Health Professions, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | | | - Jay Kennard
- Oneida Comprehensive Health Division, Oneida, Wisconsin, USA
| | - Debra Danforth
- Oneida Comprehensive Health Division, Oneida, Wisconsin, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Gui C, Cao C, Zhang X, Zhang J, Ni G, Ming D. Radiomics and artificial neural networks modelling for identification of high-risk carotid plaques. Front Cardiovasc Med 2023; 10:1173769. [PMID: 37485276 PMCID: PMC10358979 DOI: 10.3389/fcvm.2023.1173769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Objective In this study, we aimed to investigate the classification of symptomatic plaques by evaluating the models generated via two different approaches, a radiomics-based machine learning (ML) approach, and an end-to-end learning approach which utilized deep learning (DL) techniques with several representative model frameworks. Methods We collected high-resolution magnetic resonance imaging (HRMRI) data from 104 patients with carotid artery stenosis, who were diagnosed with either symptomatic plaques (SPs) or asymptomatic plaques (ASPs), in two medical centers. 74 patients were diagnosed with SPs and 30 patients were ASPs. Sampling Perfection with Application-optimized Contrasts (SPACE) by using different flip angle Evolutions was used for MRI imaging. Repeated stratified five-fold cross-validation was used to evaluate the accuracy and receiver operating characteristic (ROC) of the trained classifier. The two proposed approaches were investigated to train the models separately. The difference in the model performance of the two proposed methods was quantitatively evaluated to find a better model to differentiate between SPs and ASPs. Results 3D-SE-Densenet-121 model showed the best performance among all prediction models (AUC, accuracy, precision, sensitivity, and F1-score of 0.9300, 0.9308, 0.9008, 0.8588, and 0.8614, respectively), which were 0.0689, 0.1119, 0.1043, 0.0805, and 0.1089 higher than the best radiomics-based ML model (MLP). Decision curve analysis showed that the 3D-SE-Densenet-121 model delivered more net benefit than the best radiomics-based ML model (MLP) with a wider threshold probability. Conclusion The DL models were able to accurately differentiate between symptomatic and asymptomatic carotid plaques with limited data, which outperformed radiomics-based ML models in identifying symptomatic plaques.
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Affiliation(s)
- Chengzhi Gui
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | | | - Xin Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Jiaxin Zhang
- School of Medical Science and Engineering, Tianjin University, Tianjin, China
| | - Guangjian Ni
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
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Sohn B, Won SY. Quality assessment of stroke radiomics studies: Promoting clinical application. Eur J Radiol 2023; 161:110752. [PMID: 36878154 DOI: 10.1016/j.ejrad.2023.110752] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE To evaluate the quality of radiomics studies on stroke using a radiomics quality score (RQS), Minimum Information for Medial AI reporting (MINIMAR) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) to promote clinical application. METHODS PubMed MEDLINE and Embase were searched to identify radiomics studies on stroke. Of 464 articles, 52 relevant original research articles were included. The RQS, MINIMAR and TRIPOD were scored to evaluate the quality of the studies by neuroradiologists. RESULTS Only four studies (7.7 %) performed external validation. The mean RQS was 3.2 of 36 (8.9 %), and the basic adherence rate was 24.9 %. The adherence rate was low for conducting phantom study (1.9 %), stating comparison to 'gold standard' (1.9 %), offering potential clinical utility (13.5 %) and performing cost-effectiveness analysis (1.9 %). None of the studies performed a test-retest, stated biologic correlation, conducted prospective studies, or opened codes and data to the public, resulting in low RQS. The total MINIMAR adherence rate was 47.4 %. The overall adherence rate for TRIPOD was 54.6 %, with low scores for reporting the title (2.0 %), key elements of the study setting (6.1 %), and explaining the sample size (2.0 %). CONCLUSIONS The overall radiomics reporting quality and reporting of published radiomics studies on stoke was suboptimal. More thorough validation and open data are needed to increase clinical applicability of radiomics studies.
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Affiliation(s)
- Beomseok Sohn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - So Yeon Won
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Zhang R, Zhang Q, Ji A, Lv P, Acosta-Cabronero J, Fu C, Ding J, Guo D, Teng Z, Lin J. Prediction of new cerebral ischemic lesion after carotid artery stenting: a high-resolution vessel wall MRI-based radiomics analysis. Eur Radiol 2022; 33:4115-4126. [PMID: 36472695 DOI: 10.1007/s00330-022-09302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Carotid artery stenting (CAS) is an established treatment for local stenosis. The most common complication is new ipsilateral ischemic lesions (NIILs). This study aimed to develop models considering lesion morphological and compositional features, and radiomics to predict NIILs. MATERIALS AND METHODS One hundred and forty-six patients who underwent brain MRI and high-resolution vessel wall MR imaging (hrVWI) before and after CAS were retrospectively recruited. Lumen and outer wall boundaries were segmented on hrVWI as well as atherosclerotic components. A traditional model was constructed with patient clinical information, and lesion morphological and compositional features. Least absolute shrinkage and selection operator algorithm was performed to determine key radiomics features for reconstructing a radiomics model. The model in predicting NIILs was trained and its performance was tested. RESULTS Sixty-one patients were NIIL-positive and eighty-five negative. Volume percentage of intraplaque hemorrhage (IPH) and patients' clinical presentation (symptomatic/asymptomatic) were risk factors of NIILs. The traditional model considering these two features achieved an area under the curve (AUC) of 0.778 and 0.777 in the training and test cohorts, respectively. Twenty-two key radiomics features were identified and the model based on these features achieved an AUC of 0.885 and 0.801 in the two cohorts. The AUCs of the combined model considering IPH volume percentage, clinical presentation, and radiomics features were 0.893 and 0.842 in the training and test cohort respectively. CONCLUSIONS Compared with traditional features (clinical and compositional features), the combination of traditional and radiomics features improved the power in predicting NIILs after CAS. KEY POINTS • Volume percentage of IPH and symptomatic events were independent risk factors of new ipsilateral ischemic lesions (NIILs). • Radiomics features derived from carotid artery high-resolution vessel wall imaging had great potential in predicting NIILs after CAS. • The combination model with radiomics and traditional features further improved the diagnostic performance than traditional features alone.
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Affiliation(s)
- Ranying Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, China
| | - Aihua Ji
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | | | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK.
- Nanjing Jingsan Medical Science and Technology, Nanjing, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China.
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Cilla S, Macchia G, Lenkowicz J, Tran EH, Pierro A, Petrella L, Fanelli M, Sardu C, Re A, Boldrini L, Indovina L, De Filippo CM, Caradonna E, Deodato F, Massetti M, Valentini V, Modugno P. CT angiography-based radiomics as a tool for carotid plaque characterization: a pilot study. Radiol Med 2022; 127:743-753. [DOI: 10.1007/s11547-022-01505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022]
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Wang X, Luo P, Du H, Li S, Wang Y, Guo X, Wan L, Zhao B, Ren J. Ultrasound Radiomics Nomogram Integrating Three-Dimensional Features Based on Carotid Plaques to Evaluate Coronary Artery Disease. Diagnostics (Basel) 2022; 12:diagnostics12020256. [PMID: 35204347 PMCID: PMC8871132 DOI: 10.3390/diagnostics12020256] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to explore the feasibility of ultrasound radiomics analysis before invasive coronary angiography (ICA) for evaluating the severity of coronary artery disease (CAD) quantified by the SYNTAX score (SS). This study included 105 carotid plaques from 105 patients (64 low-SS patients, 41 intermediate-high-SS patients). The clinical characteristics and three-dimensional ultrasound (3D-US) features before ICA were assessed. Ultrasound images of carotid plaques were used for radiomics analysis. Least absolute shrinkage and selection operator (LASSO) regression, which generated several nonzero coefficients, was used to select features that could predict intermediate-high SS. Based on those coefficients, the radiomics score (Rad-score) was calculated. The selected clinical characteristics, 3D-US features, and Rad-score were finally integrated into a radiomics nomogram. Among the clinical characteristics and 3D-US features, high-density lipoprotein (HDL), apolipoprotein B (Apo B), and plaque volume were identified as predictors for distinguishing between low SS and intermediate-high SS. During the radiomics process, 8 optimal radiomics features most capable of identifying intermediate-high SS were selected from 851 candidate radiomics features. The differences in Rad-score between the training and the validation set were significant (p = 0.016 and 0.006). The radiomics nomogram integrating HDL, Apo B, plaque volume, and Rad-score showed excellent results in the training set (AUC, 0.741 (95% confidence interval (CI): 0.646–0.835)) and validation set (AUC, 0.939 (95% CI: 0.860–1.000)), with good calibration (mean absolute errors of 0.028 and 0.059 in training and validation sets, respectively). Decision curve analysis showed that the radiomics nomogram could identify patients who could obtain the most benefit. We concluded that the radiomics nomogram based on carotid plaque ultrasound has favorable value for the noninvasive prediction of intermediate-high SS. This radiomics nomogram has potential value for the risk stratification of CAD before ICA and provides clinicians with a noninvasive diagnostic tool.
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Affiliation(s)
- Xiaoting Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Peng Luo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Huaan Du
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.D.); (B.Z.)
| | - Shiyu Li
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Yi Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Xun Guo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Li Wan
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Binyi Zhao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.D.); (B.Z.)
| | - Jianli Ren
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
- Correspondence:
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Huang Z, Cheng XQ, Liu HY, Bi XJ, Liu YN, Lv WZ, Xiong L, Deng YB. Relation of Carotid Plaque Features Detected with Ultrasonography-Based Radiomics to Clinical Symptoms. Transl Stroke Res 2021; 13:970-982. [PMID: 34741749 DOI: 10.1007/s12975-021-00963-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022]
Abstract
Carotid plaque is one of the predominant causes of stroke. We sought to build a nomogram using ultrasonography (US)-based radiomics and clinical features for identification of symptomatic carotid plaques. We prospectively enrolled 548 patients (mean age ± standard deviation, 63 ± 10 years; 373 men) were randomly divided into training and test cohorts. Clinical and conventional US features of carotid plaques were used to generate a clinical and conventional US model. US-based radiomics model was constructed by extracting radiomics features from grayscale and strain elasticity images. Multivariate logistic regression was performed using the radiomics scores together with clinical and conventional US data, and a final nomogram was subsequently developed. The performance of the final nomogram was assessed with respect to discrimination and clinical usefulness in the training of the test cohorts and contrast-enhanced US test cohort. All the radiomics scores were significantly higher in patients with symptomatic carotid plaques. The US-based radiomics model [area under the curve (AUC) = 0.930 and 0.922 for training and test cohorts, respectively] and final nomogram (AUC = 0.927 and 0.919, respectively) outperformed the clinical and conventional US model (AUC = 0.723 and 0.580, respectively). The decision curve analysis indicated that the final nomogram was clinically useful. In patients undergoing the contrast-enhanced US, the prevalence of plaque enhancement was higher in high-risk patients than in low-risk patients based on the final nomogram-score (P = 0.008). Nomogram has a high diagnostic performance for identification of symptomatic carotid plaques.
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Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, China
| | - Xue-Qing Cheng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, China
| | - Hong-Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, China
| | - Xiao-Jun Bi
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, China
| | - Ya-Ni Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, 13 Daxueyuan Road, Wuhan, 430030, China
| | - Li Xiong
- Department of Cardiovascular Ultrasound, Zhongnan Hospital, Wuhan University, 169 East Lake Road, Wuhan, 430071, China.
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, China.
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Amniotic fluid segmentation based on pixel classification using local window information and distance angle pixel. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2021.107196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Zhang R, Zhang Q, Ji A, Lv P, Zhang J, Fu C, Lin J. Identification of high-risk carotid plaque with MRI-based radiomics and machine learning. Eur Radiol 2020; 31:3116-3126. [PMID: 33068185 DOI: 10.1007/s00330-020-07361-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/01/2020] [Accepted: 03/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to build a high-risk plaque MRI-based model (HRPMM) using radiomics features and machine learning for differentiating symptomatic from asymptomatic carotid plaques. MATERIALS AND METHODS One hundred sixty-two patients with carotid stenosis were randomly divided into training and test cohorts. Multi-contrast MRI including time of flight (TOF), T1- and T2-weighted imaging, and contrast-enhanced imaging was done. Radiological characteristics of the carotid plaques were recorded and calculated to build a traditional model. After extracting the radiomics features on these images, we constructed HRPMM with least absolute shrinkage and selection operator algorithm in the training cohort and evaluated its performance in the test cohort. A combined model was also built using both the traditional and radiomics features. The performance of all the models in the identification of high-risk carotid plaque was compared. RESULTS Intraplaque hemorrhage and lipid-rich necrotic core were independently associated with clinical symptoms and were used to build the traditional model, which achieved an area under the curve (AUC) of 0.825 versus 0.804 in the training and test cohorts. The HRPMM and the combined model achieved an AUC of 0.988 versus 0.984 and of 0.989 versus 0.986 respectively in the two cohorts. Both the radiomics model and combined model outperformed the traditional model, whereas the combined model showed no significant difference with the HRPMM. CONCLUSIONS Our MRI-based radiomics model can accurately distinguish symptomatic from asymptomatic carotid plaques. It is superior to the traditional model in the identification of high-risk plaques. KEY POINTS • Carotid plaque multi-contrast MRI stores other valuable information to be further exploited by radiomics analysis. • Radiomics analysis can accurately distinguish symptomatic from asymptomatic carotid plaques. • The radiomics model is superior to the traditional model in the identification of high-risk plaques.
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Affiliation(s)
- Ranying Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, China
| | - Aihua Ji
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Jingjing Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Gaoxin C. Ave, 2nd, Hi-Tech Industrial Park, Shenzhen, 518057, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China.
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Osipova O, Popova I, Starodubtsev V, Bugurov S, Karpenko A. Is it possible to prevent cerebral embolization by improving the design and technology of carotid stent implantation? Expert Rev Cardiovasc Ther 2020; 18:891-904. [PMID: 33021842 DOI: 10.1080/14779072.2020.1833718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The prevention of atherosclerotic plaque fragmentation during carotid artery stenting is a fundamental problem in decreasing the risk of disability of patients. The goal of this review is to clarify whether the stent design can have a decisive impact on the rate of intraoperative and postoperative complications. AREAS COVERED Different designs of the carotid stents are briefed and the advantages and disadvantages of different stent designs are discussed as well as the results of their clinical use. Various solutions are presented to reduce cerebral embolism during carotid artery stenting. EXPERT OPINION There is no conclusive evidence for the benefits of closed cell and hybrid stents. The stent design cannot completely resolve the problem of cerebral embolism. Most of the events of cerebral microembolism occur at the stages of stent delivery rather than protrusion of an atherosclerotic plaque in the long-term follow-up. Most likely, minimization of the risks for periprocedural and postprocedural strokes requires not only the new solutions in stent design as well as the corresponding delivery systems and brain embolic protection systems, but also the new strategies of preprocedural drug stabilization of the atherosclerotic plaque in the carotid artery. Abbreviations: CAS, carotid artery stenting; CE, carotid endarterectomy; DW-MRI, diffusion-weighted magnetic resonance imaging; ECA, external carotid artery; ICA, internal carotid artery; IVUS, intravascular ultrasound examination; OCT, optical coherence tomography.
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Affiliation(s)
- Olesia Osipova
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation , Novosibirsk, Russian Federation
| | - Irina Popova
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation , Novosibirsk, Russian Federation
| | - Vladimir Starodubtsev
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation , Novosibirsk, Russian Federation
| | - Savr Bugurov
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation , Novosibirsk, Russian Federation
| | - Andrey Karpenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation , Novosibirsk, Russian Federation
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Wajda J, Świat M, Owczarek AJ, Holecki M, Duława J, Brzozowska A, Olszanecka-Glinianowicz M, Chudek J. Osteoprotegerin Assessment Improves Prediction of Mortality in Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:1160-1167. [PMID: 30658955 DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 01/01/2019] [Accepted: 01/06/2019] [Indexed: 12/20/2022] Open
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Carotid artery plaque echomorphology and its association with histopathologic characteristics. J Vasc Surg 2018; 68:1772-1780. [DOI: 10.1016/j.jvs.2018.01.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/27/2018] [Indexed: 12/27/2022]
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Steinbuch J, Schreuder FHBM, Reesink KD, Hoeks APG, Mess WH. Orthogonal B-Mode Evaluation of Common Carotid Artery Plaques Reveals the Absence of Outward Remodeling. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:986-994. [PMID: 29477746 DOI: 10.1016/j.ultrasmedbio.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
To properly assess morphologic and dynamic parameters of arteries and plaques, we propose the concept of orthogonal distance measurements, that is, measurements made perpendicular to the local lumen axis rather than along the ultrasound beam (vertical direction for a linear array). The aim of this study was to compare orthogonal and vertical artery and lumen diameters at the site of a plaque in the common carotid artery (CCA). Moreover, we investigated the interrelationship of orthogonal diameters and plaque size and the association of artery parameters with plaque echogenicity. In 29 patients, we acquired a longitudinal B-mode ultrasound recording of plaques at the posterior CCA wall. After semi-automatic segmentation of end-diastolic frames, diameters were extracted orthogonally along the lumen axis. To establish inter-observer variability of diameters obtained at the location of maximal plaque thickness, a second observer repeated the analysis (subset N = 21). Orthogonal adventitia-adventitia and lumen diameters could be determined with good precision (coefficient of variation: 1%-5%. However, the precision of the change in lumen diameter from diastole to systole (distension) at the site of the plaque was poor (21%-50%). The orthogonal lumen diameter was significantly smaller than the vertical lumen diameter (p <0.001). Surprisingly, the plaques did not cause outward remodeling, that is, a local increase in adventitia-adventitia distance at the site of the plaque. The intra- and inter-observer precision of diastolic-systolic plaque compression was poor and of the same order as the standard deviation of plaque compression. The orthogonal relative lumen distension was significantly lower for echogenic plaques, indicating a higher stiffness, than for echolucent plaques (p <0.01). In conclusion, we illustrated the feasibility of extracting orthogonal CCA and plaque dimensions, albeit that the proposed approach is inadequate to quantify plaque compression.
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Affiliation(s)
- J Steinbuch
- Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - F H B M Schreuder
- Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands; Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - K D Reesink
- Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - A P G Hoeks
- Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - W H Mess
- Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands.
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14
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Mitchell CC, Korcarz CE, Tattersall MC, Gepner AD, Young RL, Post WS, Kaufman JD, McClelland RL, Stein JH. Carotid artery ultrasound texture, cardiovascular risk factors, and subclinical arterial disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Br J Radiol 2018; 91:20170637. [PMID: 29308915 DOI: 10.1259/bjr.20170637] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This pilot study determined if the ultrasound texture feature "contrast" was associated with cardiovascular disease (CVD) risk factors and subclinical arterial disease. METHODS We evaluated ultrasound images of the right common carotid artery (CCA) from a convenience sample of 151 participants and examined relationships between contrast, CVD risk factors, carotid intima-media thickness (IMT) and coronary artery calcium (CAC). Grey level difference statistics algorithms were used to evaluate the texture feature "contrast" from carotid ultrasound images. Right CCA IMT measurements were made in triplicate in the distal 1 cm segment of the far wall of the artery and CAC score was measured using the Agatston scoring method. RESULTS In individual models that included age, sex and race, grey level difference statistics contrast (outcome) was associated independently with age [beta (standard error) = -0.87 (0.38) per year; p = 0.02], C-reactive protein [-2.22 (0.96) per mg dl-1; p = 0.02], high-density lipoprotein cholesterol [0.61 (0.24) per mg dl-1; p = 0.01] and CCA IMT [-0.06 (0.02) microns; p = 0.001]. Other CVD risk factors and CAC were not associated independently with contrast. CONCLUSION These findings support the potential use of the ultrasound texture contrast for evaluating arterial injury and CVD risk. Advances in knowledge: This paper contributes to the literature in that it describes how the greyscale texture feature "contrast" is related to CVD risk factors.
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Affiliation(s)
- Carol C Mitchell
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health , Madison, WI , USA
| | - Claudia E Korcarz
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health , Madison, WI , USA
| | - Matthew C Tattersall
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health , Madison, WI , USA
| | - Adam D Gepner
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health , Madison, WI , USA
| | - Rebekah L Young
- 2 Department of Biostatistics, University of Washington , Seattle, WA , USA
| | - Wendy S Post
- 3 Department of Medicine, Division of Cardiology , Johns Hopkins Hospital , Baltimore, MD , USA
| | - Joel D Kaufman
- 4 Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington , Seattle, WA , USA
| | - Robyn L McClelland
- 2 Department of Biostatistics, University of Washington , Seattle, WA , USA
| | - James H Stein
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health , Madison, WI , USA
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15
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Calogero E, Fabiani I, Pugliese NR, Santini V, Ghiadoni L, Di Stefano R, Galetta F, Sartucci F, Penno G, Berchiolli R, Ferrari M, Cioni D, Napoli V, De Caterina R, Di Bello V, Caramella D. Three-Dimensional Echographic Evaluation of Carotid Artery Disease. J Cardiovasc Echogr 2018; 28:218-227. [PMID: 30746325 PMCID: PMC6341847 DOI: 10.4103/jcecho.jcecho_57_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The introduction of three-dimensional echography (3D echo) in vascular field is not recent, but it still remains a seldom-used technique because of the costs of ultrasound probe and the need of dedicated laboratories. Therefore, despite significant prognostic implications, the high diagnostic accuracy in plaque definition, and the relative ease of use, 3D echo in vascular field is a niche technique. The purpose of this review is mainly clinical and intends to demonstrate the potential strength of a 3D approach, including technical aspects, in order to present to clinicians and imagers the appealing aspects of a noninvasive and radiation-free methodology with relevant diagnostic and prognostic correlates in the assessment of carotid atherosclerosis. A comprehensive literature search (since 1990s to date) using the PubMed, MEDLINE, and Cochrane libraries databases has been conducted. Articles written in English have been assessed, including reviews, clinical trials, meta-analyses, and interventional/observational studies. Manual cross-referencing was also performed, and relevant references from selected articles were reviewed. The search was limited to studies conducted in humans. Search terms, retrieved also with PubMed Advanced search and AND/OR Boolean operators (mainly in title and abstract), included three-dimensional, echo, stroke/transient ischemic attack, predictors, carotid, imaging, and biomarkers.
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Affiliation(s)
- Enrico Calogero
- Department of Medical, Surgical, Molecular and Critical Area Pathology, Pisa University, Pisa, Italy.,Department of Cardiac, Thoracic and Vascular, Pisa University, Pisa, Italy
| | - Iacopo Fabiani
- Department of Medical, Surgical, Molecular and Critical Area Pathology, Pisa University, Pisa, Italy.,Department of Cardiac, Thoracic and Vascular, Pisa University, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Medical, Surgical, Molecular and Critical Area Pathology, Pisa University, Pisa, Italy.,Department of Cardiac, Thoracic and Vascular, Pisa University, Pisa, Italy
| | - Veronica Santini
- Department of Clinical and Experimental Medicine, Pisa University, Pisa, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, Pisa University, Pisa, Italy
| | - Rossella Di Stefano
- Department of Medical, Surgical, Molecular and Critical Area Pathology, Pisa University, Pisa, Italy.,Department of Cardiac, Thoracic and Vascular, Pisa University, Pisa, Italy
| | - Fabio Galetta
- Department of Clinical and Experimental Medicine, Pisa University, Pisa, Italy
| | - Ferdinando Sartucci
- Department of Clinical and Experimental Medicine, Pisa University, Pisa, Italy
| | - Giuseppe Penno
- Department of Clinical and Experimental Medicine, Pisa University, Pisa, Italy
| | - Raffaella Berchiolli
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | - Mauro Ferrari
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | - Dania Cioni
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | - Vinicio Napoli
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | - Raffaele De Caterina
- Department of Medical, Surgical, Molecular and Critical Area Pathology, Pisa University, Pisa, Italy.,Department of Cardiac, Thoracic and Vascular, Pisa University, Pisa, Italy
| | - Vitantonio Di Bello
- Department of Medical, Surgical, Molecular and Critical Area Pathology, Pisa University, Pisa, Italy.,Department of Cardiac, Thoracic and Vascular, Pisa University, Pisa, Italy
| | - Davide Caramella
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
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16
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Abstract
Measurement of plaque burden is different from measurement of carotid intima-media thickness (IMT). Carotid total plaque area is a stronger predictor of cardiovascular risk than IMT, and in contrast to progression of IMT, which does not predict cardiovascular events, progression of total plaque area and total plaque volume strongly predict cardiovascular events. Measurement of plaque burden is useful in genetic research, and in evaluation of new therapies for atherosclerosis. Perhaps more importantly, it can be used for management of patients. A strategy called "treating arteries instead of treating risk factors" markedly reduces risk among patients with asymptomatic carotid stenosis.
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Affiliation(s)
- J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario N6G 2V4, Canada.
| | - Grace Parraga
- Imaging Research Laboratories, Department of Medical Biophysics, Robarts Research Institute, Western University, London, Ontario, Canada
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17
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A Review on Carotid Ultrasound Atherosclerotic Tissue Characterization and Stroke Risk Stratification in Machine Learning Framework. Curr Atheroscler Rep 2016; 17:55. [PMID: 26233633 DOI: 10.1007/s11883-015-0529-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular diseases (including stroke and heart attack) are identified as the leading cause of death in today's world. However, very little is understood about the arterial mechanics of plaque buildup, arterial fibrous cap rupture, and the role of abnormalities of the vasa vasorum. Recently, ultrasonic echogenicity characteristics and morphological characterization of carotid plaque types have been shown to have clinical utility in classification of stroke risks. Furthermore, this characterization supports aggressive and intensive medical therapy as well as procedures, including endarterectomy and stenting. This is the first state-of-the-art review to provide a comprehensive understanding of the field of ultrasonic vascular morphology tissue characterization. This paper presents fundamental and advanced ultrasonic tissue characterization and feature extraction methods for analyzing plaque. Additionally, the paper shows how the risk stratification is achieved using machine learning paradigms. More advanced methods need to be developed which can segment the carotid artery walls into multiple regions such as the bulb region and areas both proximal and distal to the bulb. Furthermore, multimodality imaging is needed for validation of such advanced methods for stroke and cardiovascular risk stratification.
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18
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Kyriacou E, Vogazianos P, Christodoulou C, Loizou C, Panayides AS, Petroudi S, Pattichis M, Pantziaris M, Nicolaides A, Pattichis CS. Prediction of the time period of stroke based on ultrasound image analysis of initially asymptomatic carotid plaques. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:334-7. [PMID: 26736267 DOI: 10.1109/embc.2015.7318367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Non-invasive ultrasound imaging of carotid plaques can provide information on the characteristics of the arterial wall including the size, morphology and texture of the atherosclerotic plaques. Several studies were carried out that demonstrated the usefulness of these feature sets for differentiating between asymptomatic and symptomatic plaques and their corresponding cerebrovascular risk stratification. The aim of this study was to develop predictive modelling for estimating the time period of a stroke event by determining the risk for short term (less or equal to three years) or long term (more than three years) events. Data from 108 patients that had a stroke event have been used. The information collected included clinical and ultrasound imaging data. The prediction was performed at base line where patients were still asymptomatic. Several image texture analysis and clinical features were used in order to create a classification model. The different features were statistically analyzed and we conclude that image texture analysis features extracted using Spatial Gray Level Dependencies method had the best statistical significance. Several predictive models were derived based on Binary Logistic Regression (BLR) and Support Vector Machines (SVM) modelling. The best results were obtained with the SVM modelling models with an average correct classifications score of 77±7% for differentiating between stroke event occurrences within 3 years versus more than 3 years. Further work is needed in investigating additional multiscale texture analysis features as well as more modelling techniques on more subjects.
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19
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Kadoglou N, Sfyroeras G, Spathis A, Gkekas C, Gastounioti A, Mantas G, Nikita K, Karakitsos P, Liapis C. Galectin-3, Carotid Plaque Vulnerability, and Potential Effects of Statin Therapy. Eur J Vasc Endovasc Surg 2015; 49:4-9. [DOI: 10.1016/j.ejvs.2014.10.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
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20
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Pazinato DV, Stein BV, de Almeida WR, Werneck RDO, Mendes Júnior PR, Penatti OAB, Torres RDS, Menezes FH, Rocha A. Pixel-Level Tissue Classification for Ultrasound Images. IEEE J Biomed Health Inform 2014; 20:256-67. [PMID: 25561598 DOI: 10.1109/jbhi.2014.2386796] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pixel-level tissue classification for ultrasound images, commonly applied to carotid images, is usually based on defining thresholds for the isolated pixel values. Ranges of pixel values are defined for the classification of each tissue. The classification of pixels is then used to determine the carotid plaque composition and, consequently, to determine the risk of diseases (e.g., strokes) and whether or not a surgery is necessary. The use of threshold-based methods dates from the early 2000s but it is still widely used for virtual histology. METHODOLOGY/PRINCIPAL FINDINGS We propose the use of descriptors that take into account information about a neighborhood of a pixel when classifying it. We evaluated experimentally different descriptors (statistical moments, texture-based, gradient-based, local binary patterns, etc.) on a dataset of five types of tissues: blood, lipids, muscle, fibrous, and calcium. The pipeline of the proposed classification method is based on image normalization, multiscale feature extraction, including the proposal of a new descriptor, and machine learning classification. We have also analyzed the correlation between the proposed pixel classification method in the ultrasound images and the real histology with the aid of medical specialists. CONCLUSIONS/SIGNIFICANCE The classification accuracy obtained by the proposed method with the novel descriptor in the ultrasound tissue images (around 73%) is significantly above the accuracy of the state-of-the-art threshold-based methods (around 54%). The results are validated by statistical tests. The correlation between the virtual and real histology confirms the quality of the proposed approach showing it is a robust ally for the virtual histology in ultrasound images.
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21
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Kotze CW, Rudd JH, Ganeshan B, Menezes LJ, Brookes J, Agu O, Yusuf SW, Groves AM. CT signal heterogeneity of abdominal aortic aneurysm as a possible predictive biomarker for expansion. Atherosclerosis 2014; 233:510-517. [DOI: 10.1016/j.atherosclerosis.2014.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 12/18/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
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22
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Thornhill RE, Lum C, Jaberi A, Stefanski P, Torres CH, Momoli F, Petrcich W, Dowlatshahi D. Can shape analysis differentiate free-floating internal carotid artery thrombus from atherosclerotic plaque in patients evaluated with CTA for stroke or transient ischemic attack? Acad Radiol 2014; 21:345-54. [PMID: 24507422 DOI: 10.1016/j.acra.2013.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/22/2013] [Accepted: 11/08/2013] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Patients presenting with transient ischemic attack or stroke may have symptom-related lesions on acute computed tomography angiography (CTA) such as free-floating intraluminal thrombus (FFT). It is difficult to distinguish FFT from carotid plaque, but the distinction is critical as management differs. By contouring the shape of these vascular lesions ("virtual endarterectomy"), advanced morphometric analysis can be performed. The objective of our study is to determine whether quantitative shape analysis can accurately differentiate FFT from atherosclerotic plaque. MATERIALS AND METHODS We collected 23 consecutive cases of suspected carotid FFT seen on CTA (13 men, 65 ± 10 years; 10 women, 65.5 ± 8.8 years). True-positive FFT cases (FFT+) were defined as filling defects resolving with anticoagulant therapy versus false-positives (FFT-), which remained unchanged. Lesion volumes were extracted from CTA images and quantitative shape descriptors were computed. The five most discriminative features were used to construct receiver operator characteristic (ROC) curves and to generate three machine-learning classifiers. Average classification accuracy was determined by cross-validation. RESULTS Follow-up imaging confirmed sixteen FFT+ and seven FFT- cases. Five shape descriptors delineated FFT+ from FFT- cases. The logistic regression model produced from combining all five shape features demonstrated a sensitivity of 87.5% and a specificity of 71.4% with an area under the ROC curve = 0.85 ± 0.09. Average accuracy for each classifier ranged from 65.2%-76.4%. CONCLUSIONS We identified five quantitative shape descriptors of carotid FFT. This shape "signature" shows potential for supplementing conventional lesion characterization in cases of suspected FFT.
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Affiliation(s)
- Rebecca E Thornhill
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Cheemun Lum
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Arash Jaberi
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Pawel Stefanski
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Carlos H Torres
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Franco Momoli
- Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - William Petrcich
- Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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23
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Truijman MTB, Kooi ME, van Dijk AC, de Rotte AAJ, van der Kolk AG, Liem MI, Schreuder FHBM, Boersma E, Mess WH, van Oostenbrugge RJ, Koudstaal PJ, Kappelle LJ, Nederkoorn PJ, Nederveen AJ, Hendrikse J, van der Steen AFW, Daemen MJAP, van der Lugt A. Plaque at RISK (PARISK): Prospective Multicenter Study to Improve Diagnosis of High-Risk Carotid Plaques. Int J Stroke 2013; 9:747-54. [DOI: 10.1111/ijs.12167] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Patients with symptomatic carotid artery stenosis are at high risk for recurrent stroke. To date, the decision to perform carotid endarterectomy in patients with a recent cerebrovascular event is mainly based on degree of stenosis of the ipsilateral carotid artery. However, additional atherosclerotic plaque characteristics might be better predictors of stroke, allowing for more precise selection of patients for carotid endarterectomy. Aims and hypothesis We investigate the hypothesis that the assessment of carotid plaque characteristics with magnetic resonance imaging, multidetector-row computed tomography angiography, ultrasonography, and transcranial Doppler, either alone or in combination, may improve identification of a subgroup of patients with <70% carotid artery stenosis with an increased risk of recurrent stroke. Methods The Plaque At RISK (PARISK) study is a prospective multicenter cohort study of patients with recent (<3 months) neurological symptoms due to ischemia in the territory of the carotid artery and < 70% ipsilateral carotid artery stenosis who are not scheduled for carotid endarterectomy or stenting. At baseline, 300 patients will undergo magnetic resonance imaging, multidetector-row computed tomography angiography, and ultrasonography examination of the carotid arteries. In addition, magnetic resonance imaging of the brain, ambulatory transcranial Doppler recording of the middle cerebral artery and blood withdrawal will be performed. After two-years, imaging will be repeated in 150 patients. All patients undergo a follow-up brain magnetic resonance imaging, and there will be regular clinical follow-up until the end of the study. Study outcomes The combined primary end-point contains ipsilateral recurrent ischemic stroke or transient ischemic attack or new ipsilateral ischemic brain lesions on follow-up brain magnetic resonance imaging.
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Affiliation(s)
- M. T. B. Truijman
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M. E. Kooi
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A. C. van Dijk
- Department of Radiology, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A. A. J. de Rotte
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A. G. van der Kolk
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. I. Liem
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - F. H. B. M. Schreuder
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E. Boersma
- Department of Cardiology, University Medical Center, Rotterdam, The Netherlands
| | - W. H. Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R. J. van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P. J. Koudstaal
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - L. J. Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P. J. Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - A. J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - J. Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - M. J. A. P. Daemen
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - A. van der Lugt
- Department of Radiology, University Medical Center, Rotterdam, The Netherlands
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Menezes FH, Silveira TDC, Silveira SAF, Salles-Cunha SX, Metze K, Menezes ASCD. Comparacoes preliminares entre a histologia virtual ultrassonografica in vivo e os achados histopatologicos da placa carotidea produto de endarterectomia. J Vasc Bras 2013. [DOI: 10.1590/jvb.2013.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: A doença aterosclerótica da carótida extracraniana é uma das principais causas evitáveis de acidente vascular cerebral isquêmico (AVCi), sendo este a segunda causa mais comum de morte nos países desenvolvidos. Nos grandes estudos sobre a cirurgia carotídea, a indicação estava embasada fundamentalmente no grau de estenose arterial. Analisar somente o grau de estenose, entretanto, não revela todas as características da placa, na medida em que a morfologia e a composição da placa complementam a avaliação da doença carotídea avançada e são fundamentais para a análise e o acompanhamento da maioria das placas carotídeas tratadas clinicamente. OBJETIVO: Correlacionar a caracterização dos componentes da placa de ateroma pela histologia virtual ultrassonográfica (HVUS) com a histologia. MÉTODOS: As imagens pré-operatórias obtidas por ultrassonografia transcutânea de 12 placas de ateroma de bifurcação carotídea foram submetidas a um programa de computador, o qual correlacionou os níveis de cinza com os prováveis componentes da placa da bifurcação carotídea (HVUS). Estes achados foram correlacionados com o exame anatomopatológico das placas coletadas pela cirurgia de endarterectomia. RESULTADOS: O coeficiente de correlação de Pearson para os conteúdos de lipídeos e músculo/tecido fibroso foram, respectivamente, R=0,83 para gordura e R=0,91 para músculo/tecido fibroso. Quanto ao cálcio e ao sangue, foram R=0,05 e R=0,19, respectivamente. CONCLUSÕES: O presente trabalho corrobora a literatura demonstrando que a histologia virtual computadorizada baseada em ultrassonografia transcutânea apresenta boa correlação com os achados da histologia quanto ao conteúdo da placa. Maiores estudos para a padronização da técnica e o aperfeiçoamento do programa de análise permitirão maior uso clínico deste método.
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25
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Martinez-Sanchez P, Alexandrov AV. Ultrasonography of carotid plaque for the prevention of stroke. Expert Rev Cardiovasc Ther 2013; 11:1425-40. [PMID: 23980574 DOI: 10.1586/14779072.2013.816475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A carotid ultrasonography is a non-invasive technique that provides an accurate and reliable characterization of the broad spectrum of carotid arteriosclerosis, from the intima-media thickness to the atherosclerotic plaque. Carotid ultrasonography has become a useful tool for identifying patients at high risk of stroke and selecting those who can benefit most from revascularization therapies such as carotid endarterectomy and stenting. In addition to the degree of stenosis, plaque echomorphology has emerged in recent years as an important contributory factor to stroke risk. Changes in plaque echogenicity, as measured by the quantitative computer-assisted ultrasonography index, could be a marker of plaque instability as well as an indicator of plaque remodeling, thereby providing the means for monitoring anti-atherosclerosis drugs such as statins.
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Affiliation(s)
- Patricia Martinez-Sanchez
- Department of Neurology and Stroke Center, IdiPAZ Health Research Institute, La Paz University Hospital, Autonomous University of Madrid, Spain
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Doonan RJ, Dawson AJ, Kyriacou E, Nicolaides AN, Corriveau MM, Steinmetz OK, Mackenzie KS, Obrand DI, Daskalopoulos ME, Daskalopoulou SS. Association of ultrasonic texture and echodensity features between sides in patients with bilateral carotid atherosclerosis. Eur J Vasc Endovasc Surg 2013; 46:299-305. [PMID: 23849798 DOI: 10.1016/j.ejvs.2013.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/20/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Our objective was to estimate the correlation of echodensity and textural features, using ultrasound and digital image analysis, between plaques in patients with bilateral carotid stenosis. DESIGN Cross-sectional observational study. METHODS Patients undergoing carotid endarterectomy were recruited from Vascular Surgery at the Royal Victoria and Jewish General hospitals in Montreal, Canada. Bilateral pre-operative carotid ultrasound and digital image analysis was performed to extract echodensity and textural features using a commercially available Plaque Texture Analysis software (LifeQMedical Ltd). Principal component analysis (PCA) was performed. Partial correlation coefficients for PCA and individual imaging variables between surgical and contralateral plaques were calculated with adjustment for age, sex, contralateral stenosis, and statin use. RESULTS In the whole group (n = 104), the six identified PCA variables and 42/50 individual imaging variables were moderately correlated (r = .211-.641). Correlations between sides were increased in patients with ≥50% contralateral stenosis and symptomatic patients. CONCLUSION Textural and echodensity features of carotid plaques were similar between two sides in patients with bilateral stenosis, supporting the notion that plaque instability is determined by systemic factors. Patients with unstable features of one plaque should perhaps be monitored more closely or treated more aggressively for their contralateral stenosis, particularly if this is hemodynamically significant.
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Affiliation(s)
- R J Doonan
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Östling G, Persson M, Hedblad B, Gonçalves I. Comparison of grey scale median (GSM) measurement in ultrasound images of human carotid plaques using two different softwares. Clin Physiol Funct Imaging 2013; 33:431-5. [PMID: 23701450 DOI: 10.1111/cpf.12049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/15/2013] [Indexed: 11/30/2022]
Abstract
Grey scale median (GSM) measured on ultrasound images of carotid plaques has been used for several years now in research to find the vulnerable plaque. Centres have used different software and also different methods for GSM measurement. This has resulted in a wide range of GSM values and cut-off values for the detection of the vulnerable plaque. The aim of this study was to compare the values obtained with two different softwares, using different standardization methods, for the measurement of GSM on ultrasound images of carotid human plaques. GSM was measured with Adobe Photoshop(®) and with Artery Measurement System (AMS) on duplex ultrasound images of 100 consecutive medium- to large-sized carotid plaques of the Beta-blocker Cholesterol-lowering Asymptomatic Plaque Study (BCAPS). The mean values of GSM were 35·2 ± 19·3 and 55·8 ± 22·5 for Adobe Photoshop(®) and AMS, respectively. Mean difference was 20·45 (95% CI: 19·17-21·73). Although the absolute values of GSM differed, the agreement between the two measurements was good, correlation coefficient 0·95. A chi-square test revealed a kappa value of 0·68 when studying quartiles of GSM. The intra-observer variability was 1·9% for AMS and 2·5% for Adobe Photoshop. The difference between softwares and standardization methods must be taken into consideration when comparing studies. To avoid these problems, researcher should come to a consensus regarding software and standardization method for GSM measurement on ultrasound images of plaque in the arteries.
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Affiliation(s)
- Gerd Östling
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
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28
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Kyriacou EC, Petroudi S, Pattichis CS, Pattichis MS, Griffin M, Kakkos S, Nicolaides A. Prediction of high-risk asymptomatic carotid plaques based on ultrasonic image features. ACTA ACUST UNITED AC 2012; 16:966-73. [PMID: 22481831 DOI: 10.1109/titb.2012.2192446] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Carotid plaques have been associated with ipsilateral neurological symptoms. High-resolution ultrasound can provide information not only on the degree of carotid artery stenosis but also on the characteristics of the arterial wall including the size and consistency of atherosclerotic plaques. The aim of this study is to determine whether the addition of ultrasonic plaque texture features to clinical features in patients with asymptomatic internal carotid artery stenosis (ACS) improves the ability to identify plaques that will produce stroke. 1121 patients with ACS have been scanned with ultrasound and followed for a mean of 4 years. It is shown that the combination of texture features based on second-order statistics spatial gray level dependence matrices (SGLDM) and clinical factors improves stroke prediction (by correctly predicting 89 out of the 108 cases that were symptomatic). Here, the best classification results of 77 ±1.8% were obtained from the use of the SGLDM texture features with support vector machine classifiers. The combination of morphological features with clinical features gave slightly worse classification results of 76 ±2.6% . These findings need to be further validated in additional prospective studies.
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Graf IM, Kim S, Wang B, Smalling R, Emelianov S. Noninvasive detection of intimal xanthoma using combined ultrasound, strain rate and photoacoustic imaging. ULTRASONICS 2012; 52:435-41. [PMID: 22078093 DOI: 10.1016/j.ultras.2011.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 09/29/2011] [Accepted: 10/10/2011] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND MOTIVATION The structure, composition and mechanics of carotid artery are good indicators of early progressive atherosclerotic lesions. The combination of three imaging modalities (ultrasound, strain rate and photoacoustic imaging) which could provide corroborative information about the named arterial properties could enhance the characterization of intimal xanthoma. METHODS The experiments were performed using a New Zealand white rabbit model of atherosclerosis. The aorta excised from an atherosclerotic rabbit was scanned ex vivo using the three imaging techniques: (1) ultrasound imaging of the longitudinal section: standard ultrasound B-mode (74Hz frame rate); (2) strain rate imaging: the artery was flushed with blood and a 1.5Hz physiologic pulsation was induced, while the ultrasound data were recorded at higher frame rate (296Hz); (3) photoacoustic imaging: the artery was irradiated with nanosecond pulsed laser light of low fluence in the 1210-1230nm wavelength range and the photoacoustic data was recorded at 10Hz frame rate. Post processing algorithms based on cross-correlation and optical absorption variation were implemented to derive strain rate and spectroscopic photoacoustic images, respectively. RESULTS Based on the spatio-temporal variation in displacement of different regions within the arterial wall, strain rate imaging reveals differences in tissue mechanical properties. Additionally, spectroscopic photoacoustic imaging can spatially resolve the optical absorption properties of arterial tissue and identify the location of lipid pools. CONCLUSIONS The study demonstrates that ultrasound, strain rate and photoacoustic imaging can be used to simultaneously evaluate the structure, the mechanics and the composition of atherosclerotic lesions to improve the assessment of plaque vulnerability.
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Affiliation(s)
- Iulia M Graf
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712, USA
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30
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Magnetic propulsion and ultrasound tracking of endovascular devices. J Robot Surg 2011; 6:5-12. [DOI: 10.1007/s11701-011-0332-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
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31
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Three-dimensional ultrasound imaging for the evaluation of carotid atherosclerosis. Atherosclerosis 2011; 219:377-83. [DOI: 10.1016/j.atherosclerosis.2011.05.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 11/19/2022]
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32
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Kakkos SK, Nicolaides AN, Kyriacou E, Daskalopoulou SS, Sabetai MM, Pattichis CS, Geroulakos G, Griffin MB, Thomas D. Computerized Texture Analysis of Carotid Plaque Ultrasonic Images Can Identify Unstable Plaques Associated With Ipsilateral Neurological Symptoms. Angiology 2011; 62:317-28. [DOI: 10.1177/0003319710384397] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We estimated the value of objective, computerized texture analysis of ultrasonic images in distinguishing carotid plaques associated with neurological ipsilateral symptoms (amaurosis fugax [AmF; n = 30], transient ischemic attack [TIA; n = 52], and stroke [n = 55]) from asymptomatic plaques (n = 51). We performed 3 case-control studies (1/symptom with asymptomatic plaques as control). On logistic regression, AmF was independently associated with severity of stenosis, percentage of pixels with gray levels 0 to 10 (PPCS1; measure of echolucency), and spatial gray level dependence matrices (SGLDM) information measure of correlation (IMC-1; texture); TIAs with PPCS1 (echolucency), SGLDM correlation, and skewness (both texture); and stroke with PPCS1, SGLDM correlation, and percentage of pixels with gray levels 11 to 20 (PPCS2; echolucency). The area under the curve of the regression-derived predicted probability for AmF, TIA, and stroke was 0.92, 0.82, and 0.85, respectively (all P < .001). Texture analysis can identify carotid plaques associated with a neurological event, improving the diagnostic value of echolucency measures. Texture analyses could be applied to natural history studies.
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Affiliation(s)
| | | | - Efthyvoulos Kyriacou
- Department of Computer Science and Engineering, Frederick University, Limassol, Cyprus, Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | - Stella S. Daskalopoulou
- Department of Vascular Surgery, Imperial College London, London, UK, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | | | - George Geroulakos
- Department of Vascular Surgery, Imperial College London, London, UK,
| | - Maura B. Griffin
- The Vascular Noninvasive Screening and Diagnostic Centre, London, UK
| | - Dafydd Thomas
- Department of Neurology, St Mary's Hospital, London, UK
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Kyriacou E, Nicolaides A, Pattichis CS, Petroudi S, Pattichis M, Griffin M, Kakkos S, Makris G. First and second order statistical texture features in carotid plaque image analysis: preliminary results from ongoing research. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:6655-6658. [PMID: 22255865 DOI: 10.1109/iembs.2011.6091641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Carotid plaques have been associated with ipsilateral neurological symptoms. High-resolution ultrasound can provide information not only on the degree of carotid artery stenosis but also on the characteristics of the arterial wall including the size and consistency of atherosclerotic plaques. The aim of this study was to determine cerebrovascular risk stratification based on ultrasonic plaque texture features and clinical features in patients with asymptomatic internal carotid artery (ICA) stenosis. It is shown that cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features with very satisfactory results. However, these findings need to be validated in additional prospective studies in patients having current medical intervention.
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Makris GC, Nicolaides AN, Xu XY, Geroulakos G. Introduction to the biomechanics of carotid plaque pathogenesis and rupture: review of the clinical evidence. Br J Radiol 2010; 83:729-35. [PMID: 20647514 PMCID: PMC3473420 DOI: 10.1259/bjr/49957752] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 11/26/2009] [Indexed: 11/05/2022] Open
Abstract
The management of patients with asymptomatic carotid disease is currently under debate and new methods are warranted for better risk stratification. The role of the biomechanical properties of the atherosclerotic arterial wall together with the effect of different stress types in plaque destabilisation has only been recently investigated. PubMed and Scopus databases were reviewed. There is preliminary clinical evidence demonstrating that the analysis of the combined effect of the various types of biomechanical stress acting on the carotid plaque may help us to identify the vulnerable plaque. At present, MRI and two-dimensional ultrasound are combined with fluid-structure interaction techniques to produce maps of the stress variation within the carotid wall, with increased cost and complexity. Stress wall analysis can be a useful tool for carotid plaque evaluation; however, further research and a multidisciplinary approach are deemed as necessary for further development in this direction.
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Affiliation(s)
- G C Makris
- Vascular Surgery Department, Ealing Hospital, NHS Trust, London, UK.
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35
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Awad J, Krasinski A, Parraga G, Fenster A. Texture analysis of carotid artery atherosclerosis from three-dimensional ultrasound images. Med Phys 2010; 37:1382-91. [PMID: 20443459 DOI: 10.1118/1.3301592] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To quantitatively evaluate local carotid arterial statin effects in 3D US images using multiclassifier image texture analysis tools. METHODS Texture analysis tools were used to evaluate the effect of 80 mg atorvastatin administered daily to patients with carotid stenosis compared to those treated with placebo. Using three-dimensional carotid ultrasound images, 270 texture features from seven texture techniques were extracted from manually segmented carotid arteries based on the intima-media boundary [vessel wall (VW)]. Individual texture features were compared to the previously determined changes in VW volume (VWV) using the distance between classes, the Wilcoxon rank sum test, and accuracy of the classifiers. Texture features that resulted in maximal classification accuracy from each texture technique were selected using Pudil's sequential floating forward selection (SFFS) as a method of ranking each technique. Finally, SFFS-selected texture features from all texture techniques were used in combination with 24 classifier fusion techniques to improve classification accuracy. RESULTS Using the measurement of change in VWV, the distance between classes (DBC), Wilcoxon rank sum (WRS) p-value, and median accuracy measures (ACC) were 0.3798, 0.076, and 54.50%, respectively. Texture features improved the detection of statin-related changes using DBC to 0.5199, using WRS to 0.002, and ACC to 63.87%, respectively. The texture techniques that most differentiated between atorvastatin and placebo classes were Fourier power spectrum and Laws texture energy measures. The average classification accuracy between atorvastatin and placebo classes was improved from 57.22 +/- 12.11% using VWV to 97.87 +/- 3.93% using specific texture features. Furthermore, the use of specific texture features resulted in the average area under the receiver-operator characteristic curve (AUC) a value of 0.9988 +/- 0.0069 compared to 0.617 +/- 0.15 using carotid VWV. CONCLUSIONS Based on DBC, WRS, ACC, and AUC texture features derived from 3D carotid ultrasound were observed to be more sensitive in detecting statin-related changes in carotid atherosclerosis than VWV suggesting that texture classifiers can be used to detect changes in carotid atherosclerosis after therapy.
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Affiliation(s)
- Joseph Awad
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8, Canada.
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36
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Kyriacou EC, Pattichis C, Pattichis M, Loizou C, Christodoulou C, Kakkos SK, Nicolaides A. A review of noninvasive ultrasound image processing methods in the analysis of carotid plaque morphology for the assessment of stroke risk. ACTA ACUST UNITED AC 2010; 14:1027-38. [PMID: 20378477 DOI: 10.1109/titb.2010.2047649] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Noninvasive ultrasound imaging of carotid plaques allows for the development of plaque-image analysis methods associated with the risk of stroke. This paper presents several plaque-image analysis methods that have been developed over the past years. The paper begins with a review of clinical methods for visual classification that have led to standardized methods for image acquisition, describes methods for image segmentation and denoising, and provides an overview of the several texture-feature extraction and classification methods that have been applied. We provide a summary of emerging trends in 3-D imaging methods and plaque-motion analysis. Finally, we provide a discussion of the emerging trends and future directions in our concluding remarks.
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Affiliation(s)
- Efthyvoulos C Kyriacou
- Department of Computer Science and Engineering, Frederick University, CY-3080 Limassol, Cyprus.
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37
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Russell D, Wijeyaratne S, Gough M. Relationship of Carotid Plaque Echomorphology to Presenting Symptom. Eur J Vasc Endovasc Surg 2010; 39:134-8. [DOI: 10.1016/j.ejvs.2009.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 11/02/2009] [Indexed: 11/29/2022]
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Nybo M, Johnsen SP, Dethlefsen C, Overvad K, Tjønneland A, Jørgensen JOL, Rasmussen LM. Lack of Observed Association between High Plasma Osteoprotegerin Concentrations and Ischemic Stroke Risk in a Healthy Population. Clin Chem 2008; 54:1969-74. [DOI: 10.1373/clinchem.2008.110593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: Several studies suggest that osteoprotegerin (OPG) concentrations may be associated with the risk of ischemic stroke, but no large prospective studies have been conducted. We conducted a nested case-control study within a large cohort to elucidate a possible relation.
Methods: The study was done within a follow-up study including 57 053 men and women. Baseline data included OPG concentrations, lifestyle factors, and medical history. Median length of follow-up was 3.1 years. We assessed the relationship between OPG and stroke risk using conditional logistic regression to adjust for known risk factors (smoking, blood pressure, cholesterol, diabetes, body mass index, alcohol use, polyunsaturated fatty acids, and education).
Results: We identified 254 cases with verified incident acute ischemic stroke and 254 age- and sex-matched controls. Median plasma OPG concentration among cases was 1.84 μg/L (25th–75th percentile 1.45–2.30 μg/L) compared with 1.87 μg/L (1.49–2.27 μg/L) in the control group. The adjusted odds ratio was 0.87 (95% CI 0.46–1.63) comparing participants in the highest quartile of OPG concentrations with those in the lowest quartile.
Conclusions: These findings provide no support for the hypothesis that plasma OPG concentrations are associated with an increased risk of ischemic stroke. This result could indicate a different pathogenic process in stroke development from that in ischemic heart disease, where OPG is a strong predictor.
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Affiliation(s)
- Mads Nybo
- Department of Biochemistry, Pharmacology and Genetics, Odense University Hospital, Odense, Denmark
| | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Claus Dethlefsen
- Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Denmark
| | - Kim Overvad
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
- Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Denmark
- Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Denmark
| | - Anne Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | | | - Lars Melholt Rasmussen
- Department of Biochemistry, Pharmacology and Genetics, Odense University Hospital, Odense, Denmark
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Ricotta JJ, Pagan J, Xenos M, Alemu Y, Einav S, Bluestein D. Cardiovascular disease management: the need for better diagnostics. Med Biol Eng Comput 2008; 46:1059-68. [PMID: 19002517 DOI: 10.1007/s11517-008-0416-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 10/09/2008] [Indexed: 11/30/2022]
Abstract
Current diagnostic testing for cardiovascular pathology usually rests on either physiological or anatomic measurement. Multiple tests must then be combined to arrive at a conclusion regarding treatment of a specific pathology. Much of the diagnostic decisions currently made are based on rough estimates of outcomes, often derived from gross anatomic observations or extrapolation of physical laws. Thus, intervention for carotid and coronary disease is based on estimates of diameter stenosis, despite data to suggest that plaque character and lesion anatomy are important determinants of outcome. Similarly, abdominal aortic aneurysm (AAA) intervention is based on maximal aneurysm diameter without regard for arterial wall composition or individual aneurysm geometry. In other words, our current diagnostic tests do not reflect the sophistication of our current knowledge of vascular disease. Using a multimodal approach, computer modeling has the potential to predict clinical outcomes based on a variety of factors including arterial wall composition, surface anatomy and hemodynamic forces. We term this more sophisticated approach "patient specific diagnostics", in which the computer models are reconstructed from patient specific clinical visualizing modalities, and material properties are extracted from experimental measurements of specimens and incorporated into the modeling using advanced material models (including nonlinear anisotropic models) and performed as dynamic simulations using the FSI (fluid structure interaction) approach. Such an approach is sorely needed to improve the effectiveness of interventions. This article will review ongoing work in "patient specific diagnostics" in the areas of carotid, coronary and aneurismal disease. We will also suggest how this approach may be applicable to management of aortic dissection. New diagnostic methods should allow better patient selection, targeted intervention and modeling of the results of different therapies.
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Affiliation(s)
- John J Ricotta
- Division of Vascular Surgery, Department of Surgery, Health Sciences Center T-19, Stony Brook University Medical Center, Stony Brook, NY 11794-8191, USA.
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Kadoglou NPE, Gerasimidis T, Golemati S, Kapelouzou A, Karayannacos PE, Liapis CD. The relationship between serum levels of vascular calcification inhibitors and carotid plaque vulnerability. J Vasc Surg 2008; 47:55-62. [PMID: 18178454 DOI: 10.1016/j.jvs.2007.09.058] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/20/2007] [Accepted: 09/20/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Osteopontin (OPN) and osteoprotegerin (OPG) are well-known vascular calcification inhibitors, which have been recently demonstrated to correlate with inflammation and cardiovascular events incidence. The aim of this cross-sectional study is to survey whether OPN and OPG are involved in carotid plaque vulnerability. For this reason, we assessed serum OPN and OPG levels in patients with carotid stenosis, and we explored their relationship with carotid plaque echogenicity and subsequent cerebrovascular ischemic events. METHODS A total of 164 Whites were selected from a large cohort of 297 subjects to participate. In particular, 114 patients (61 men, 53 women), aged 55 to 80, had recently-diagnosed ICA stenosis higher than 50%. A group of 50 age-, sex-, and body mass index (BMI)-matched healthy individuals served as healthy controls. Patients with renal failure, hypothyroidism, osteoporosis, and lipid-lowering therapy were excluded. Images of both carotids were obtained from all participants using a high-resolution color duplex ultrasound and the gray-scale median (GSM) score was calculated. Brain computed tomography (CT), and magnetic resonance imaging (MRI) scans when CT was questionable, were performed on all patients with carotid stenosis. Clinical parameters, lipid and glycemic indexes, hsCRP, fibrinogen, white blood cells (WBC) count, OPN, and OPG were measured. Independent t test, one-way ANOVA, Pearson correlation, and multiple regression analysis were used for statistical analysis. RESULTS Among patients with carotid stenosis, 60 had history of ipsilateral stroke or TIA and positive CT or MRI findings (group A), while 54 had no neurological symptoms and negative CT and MRI scan (group B). Overall, patients with carotid stenosis showed worse lipid profile and increased waist circumference, blood pressure, hsCRP, fibrinogen, WBC count, OPN, and OPG levels compared with healthy subjects (group C) (P <.05). Statistical analysis revealed that group A had significantly lower levels of GSM than group B (57.41 +/- 38.19 vs 76.32 +/- 36.72; P = .008) and higher levels of hsCRP, OPN, and OPG than groups B and C (P < .05). Concerning the latter, biochemical markers group B showed only elevated OPG levels compared with group C (P = .038). Notably, GSM was considerably associated with serum OPN and OPG and waist circumference in patients with carotid atherosclerosis in univariate (r = -0.333; P = .032, r = -0.575; P < .001, r = -0.590; P =.006, respectively) and multiple regression analysis (R(2) = 0.445; P =.006). CONCLUSIONS The present study demonstrated elevated serum OPN and OPG levels in patients with carotid stenosis and documented an independent association between these biochemical markers, GSM and carotid-induced symptomatology. Therefore bone-matrix proteins combined with GSM could be potential markers for vulnerable carotid plaques.
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Affiliation(s)
- Nikolaos P E Kadoglou
- Department of Vascular Surgery, Medical School, University of Athens, 124 Vosporou Street, Athens, Greece.
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Gray-scale median of the atherosclerotic plaque can predict success of lumen re-entry during subintimal femoral-popliteal angioplasty. J Vasc Surg 2008; 47:109-15; discussion 115-6. [DOI: 10.1016/j.jvs.2007.09.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/07/2007] [Accepted: 09/13/2007] [Indexed: 11/19/2022]
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