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Gifani M, Eddins DJ, Kosuge H, Zhang Y, Paluri SLA, Larson T, Leeper N, Herzenberg LA, Gambhir SS, McConnell MV, Ghosn EEB, Smith BR. Ultra-selective carbon nanotubes for photoacoustic imaging of inflamed atherosclerotic plaques. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2101005. [PMID: 34733130 PMCID: PMC8559995 DOI: 10.1002/adfm.202101005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Indexed: 05/29/2023]
Abstract
Disruption of vulnerable atherosclerotic plaques often leads to myocardial infarction and stroke, the leading causes of morbidity and mortality in the United States. A diagnostic method that detects high-risk atherosclerotic plaques at early stages could prevent these sequelae. The abundance of immune cells in the arterial wall, especially inflammatory Ly-6Chi monocytes and foamy macrophages, is indicative of plaque inflammation, and may be associated with plaque vulnerability. Hence, we sought to develop a new method that specifically targets these immune cells to offer clinically-relevant diagnostic information about cardiovascular disease. We combine ultra-selective nanoparticle targeting of Ly-6Chi monocytes and foamy macrophages with clinically-viable photoacoustic imaging (PAI) in order to precisely and specifically image inflamed plaques ex vivo in a mouse model that mimics human vulnerable plaques histopathologically. Within the plaques, high-dimensional single-cell flow cytometry (13-parameter) showed that our nanoparticles were almost-exclusively taken up by the Ly-6Chi monocytes and foamy macrophages that heavily infiltrate plaques. PAI identified inflamed atherosclerotic plaques that display ~6-fold greater signal compared to controls (P<0.001) six hours after intravenous injection of ultra-selective carbon nanotubes, with in vivo corroboration via optical imaging. Our highly selective strategy may provide a targeted, non-invasive imaging strategy to accurately identify and diagnose inflamed atherosclerotic lesions.
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Affiliation(s)
- Mahsa Gifani
- Department of Biomedical Engineering, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Devon J. Eddins
- Departments of Medicine and Pediatrics, Lowance Center for Human Immunology, Emory University, Atlanta, GA 30322, USA
| | - Hisanori Kosuge
- Division of Cardiovascular Medicine and Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yapei Zhang
- Department of Biomedical Engineering, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Sesha L. A. Paluri
- Department of Biomedical Engineering, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Timothy Larson
- Departments of Radiology, Bioengineering, and Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - Nicholas Leeper
- Division of Cardiovascular Medicine and Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Sanjiv Sam Gambhir
- Departments of Radiology, Bioengineering, and Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - Michael V. McConnell
- Division of Cardiovascular Medicine and Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eliver E. B. Ghosn
- Departments of Medicine and Pediatrics, Lowance Center for Human Immunology, Emory University, Atlanta, GA 30322, USA
| | - Bryan Ronain Smith
- Department of Biomedical Engineering, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Departments of Radiology, Bioengineering, and Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
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2
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Cao Y, Xiao X, Liu Z, Yang M, Sun D, Guo W, Cui L, Zhang P. Detecting vulnerable plaque with vulnerability index based on convolutional neural networks. Comput Med Imaging Graph 2020; 81:101711. [PMID: 32155412 DOI: 10.1016/j.compmedimag.2020.101711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/29/2020] [Accepted: 02/16/2020] [Indexed: 10/25/2022]
Abstract
Plaque rupture and subsequent thrombosis are major processes of acute cardiovascular events. The Vulnerability Index is a very important indicator of whether a plaque is ruptured, and these easily ruptured or fragile plaques can be detected early. The higher the general vulnerability index, the higher the instability of the plaque. Therefore, determining a clear vulnerability index classification point can effectively reduce unnecessary interventional therapy. However, the current critical value of the vulnerability index has not been well defined. In this study, we proposed a neural network-based method to determine the critical point of vulnerability index that distinguishes vulnerable plaques from stable ones. Firstly, based on MatConvNet, the intravascular ultrasound images under different vulnerability index labels are classified. Different vulnerability indexes can obtain different accuracy rates for the demarcation points. The corresponding data points are fitted to find the existing relationship to judge the highest classification. In this way, the vulnerability index corresponding to the highest classification accuracy rate is judged. Then the article is based on the same experiment of different components of the aortic artery in the artificial neural network, and finally the vulnerability index corresponding to the highest classification accuracy can be obtained. The results show that the best vulnerability index point is 1.716 when the experiment is based on the intravascular ultrasound image, and the best vulnerability index point is 1.607 when the experiment is based on the aortic artery component data. Moreover, the vulnerability index and classification accuracy rate has a periodic relationship within a certain range, and finally the highest AUC is 0.7143 based on the obtained vulnerability index point on the verification set. In this paper, the convolution neural network is used to find the best vulnerability index classification points. The experimental results show that this method has the guiding significance for the classification and diagnosis of vulnerable plaques, further reduce interventional treatment of cardiovascular disease.
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Affiliation(s)
- Yankun Cao
- The Rsearch Center of Intelligent Medical Information Processing, School of Information Science and Engineering, Shandong University, Qingdao 266237, China; Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
| | - Xiaoyan Xiao
- Department of Nephrology, Qilu Hospital of Shandong University, No.107 Wenhuaxi Road, Jinan 250012, China
| | - Zhi Liu
- The Rsearch Center of Intelligent Medical Information Processing, School of Information Science and Engineering, Shandong University, Qingdao 266237, China; Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China.
| | - Meijun Yang
- The Rsearch Center of Intelligent Medical Information Processing, School of Information Science and Engineering, Shandong University, Qingdao 266237, China
| | - Dianmin Sun
- Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong, China
| | - Wei Guo
- Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
| | - Lizhen Cui
- Joint SDU-NTU Centre for Artificial Intelligence Research (C-FAIR), Shandong University, Jinan 250101, China
| | - Pengfei Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese National Health Commission, Department of Cardiology, Qilu Hospital of Shandong University. N0.107 Wenhuaxi Road, Jinan, Shanodng Province, China.
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3
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Xu M, Hu X, Wang L, Zhang W, Wu L, Li J, Chen Y, Zhang P, Su H, Han Y, Zhang C, Zhang M, Zhang Y. Plasma biomarkers and plaque strain predict long-term cardiovascular events in patients with acute coronary syndrome. SCIENCE CHINA-LIFE SCIENCES 2019; 63:269-278. [PMID: 31278618 DOI: 10.1007/s11427-019-9557-7] [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: 01/30/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
Abstract
To test whether circulating and intracoronary biomarkers and coronary plaque strain have additive values to Global Registry of Acute Coronary Events (GRACE) score for predicting long-term cardiovascular events in ACS patients. One hundred ACS patients were enrolled and the GRACE score and plasma levels and intracoronary gradients of a number of biomarkers were measured. Coronary plaque burden and morphology in non-critical stenotic plaques were determined by intravascular ultrasound (IVUS) technique, and the maximal shear strain (SSmax) and maximal area strain (ASmax) were determined by intravascular ultrasound elastography (IVUSE) technique. Patients were followed for cardiovascular events and the predictive values of clinical characteristics, plasma biomarkers and plaque parameters were compared with GRACE score, and the incremental values of these measurements to the GRACE score were assessed. GRACE score, plasma biomarkers and plaque strain were independent predictors of cardiovascular events. Combination of GRACE score, plasma biomarkers and plaque strains significantly improved the predictive value of the GRACE score alone with the receiver-operating characteristic area increased from 0.457 to 0.667 (P=0.014). The combination of circulating and intracoronary biomarkers, plaque strain and GRACE score provides a better predictive tool than GRACE score alone in patients with ACS.
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Affiliation(s)
- Mingjun Xu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xiaobo Hu
- Department of Intensive Care Unit, Shandong Provincial Hospital affiliated to Shandong University, Jinan, 250012, China
| | - Lin Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Wei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Lindi Wu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Jifu Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yuguo Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Pengfei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Haijun Su
- School of Mathematics, Shandong University, Jinan, 250012, China
| | - Yaling Han
- Department of Cardiology, Shenyang Military Region General Hospital, Shenyang, 110016, China
| | - Cheng Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Yun Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
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4
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Ma AJ, Zhu XY, Yang SN, Pan XD, Wang T, Wang Y, Xiao X, Liu SH. Associations of CXCL16, miR‑146a and miR‑146b in atherosclerotic apolipoprotein E‑knockout mice. Mol Med Rep 2018; 18:2995-3002. [PMID: 30015963 DOI: 10.3892/mmr.2018.9270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/14/2018] [Indexed: 11/06/2022] Open
Abstract
Atherosclerosis is the primary cause of cardiovascular and cerebrovascular diseases. Recent studies have revealed that C‑X‑C motif chemokine ligand 16 (CXCL16), microRNA (miR)‑146a and miR‑146b may have important roles in atherosclerotic diseases. However, the associations of CXCL16, miR‑146a and miR‑146b in atherosclerotic diseases in vivo remain unclear. Previous studies have demonstrated that miR‑146a and miR‑146b may negatively regulate the toll like receptor (TLR4)/nuclear factor (NF)‑κB signaling pathway to repress the inflammatory response. The present study investigated the associations of CXCL16, miR‑146a and miR‑146b in atherosclerotic apolipoprotein E (ApoE)‑/‑ mice in vivo. The expression levels of CXCL16, TLR4/NF‑κB signaling pathway, miR‑146a and miR‑146b in the control and atherosclerotic ApoE‑/‑ mice were investigated via reverse transcription‑quantitative polymerase chain reaction and western blot analysis. The present study demonstrated that the expression of CXCL16 was significantly upregulated in atherosclerotic ApoE‑/‑ mice compared with control ApoE‑/‑ mice. The expression levels of TRL4, interleukin‑1 receptor‑associated kinase 1, tumor necrosis factor receptor associated factor 6, NF‑κB, tumor necrosis factor‑α and interleukin‑1β were also significantly upregulated in atherosclerotic ApoE‑/‑ mice compared with control mice. However, the present study revealed that the expression levels of miR‑146a and miR‑146b were significantly downregulated in atherosclerotic ApoE‑/‑ mice compared with control ApoE‑/‑ mice. Overall, the results of the present study suggested that CXCL16 may regulate the TRL4/NF‑κB/CXCL16 signaling pathway, and that miR‑146a and miR‑146b may negatively regulate CXCL16 via this pathway in atherosclerosis in vivo.
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Affiliation(s)
- Ai-Jun Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Xiao-Yan Zhu
- Department of Critical Care Medicine, The Affiliated Hiser Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Shao-Nan Yang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Xu-Dong Pan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Ting Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Yuan Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Xing Xiao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
| | - Shi-Hai Liu
- Medical Animal Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266033, P.R. China
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5
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Li Z, Wang L, Hu X, Zhang P, Chen Y, Liu X, Xu M, Su H, Zhang M. Intravascular ultrasound elastography analysis of the elastic mechanical properties of atherosclerotic plaque. Int J Cardiovasc Imaging 2017; 33:1663-1671. [PMID: 28500378 DOI: 10.1007/s10554-017-1156-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/03/2017] [Indexed: 12/16/2022]
Abstract
To assess the elastic mechanical properties of atherosclerotic plaque with different morphological properties by intravascular ultrasound elastography (IVUSE). 30 purebred New Zealand rabbits were fed a high-cholesterol diet; the abdominal aorta endothelium was balloon-injured after 2 weeks; at week 12, 2 plaques with moderate echo from each rabbit were chosen for in situ imaging, and 2 consecutive frames near the end-diastole images in situ were used to construct an IVUS elastogram. Shear strain (SS) and area strain (AS) were greater for eccentric than centripetal plaque (SS: 2.65(2.45)% vs. 1.79 ± 0.97%, p < 0.05; AS: 4.81(4.99)% vs. 3.23 ± 1.75%, p < 0.05) but were lower with low than high plaque burden (SS: 2.14 ± 0.37% vs. 3.40 ± 0.34%, p < 0.05; AS: 3.88 ± 0.60% vs. 5.81 ± 0.54%, p < 0.05). SS and AS were significantly greater for plaque with negative than no remodeling (SS: 3.98 ± 1.53% vs. 1.82(1.40)%, p < 0.017; AS: 6.94 ± 2.24% vs. 2.59(2.87)%, p < 0.017) and were found correlated with eccentric index and plaque burden (R2 = 0.365 and R2 = 0.359, both p < 0.05). Plaques associated with eccentricity, high plaque burden and negative remodeling showed greater strain than those with centripetalism, low plaque burden and positive remodeling. Eccentric index and plaque burden may be useful to predict the elastic stability of plaque.
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Affiliation(s)
- Zhaohuan Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China.,School of Mathematics, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Lin Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Xiaobo Hu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Pengfei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yifei Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Xinxin Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Mingjun Xu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China.,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Haijun Su
- School of Mathematics, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107#, Wenhua West Road, Jinan, 250012, Shandong, People's Republic of China. .,Cardiovascular Ultrasound and Non-invasive Cardiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China.
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Mahmood B, Ewertsen C, Carlsen J, Nielsen MB. Ultrasound Vascular Elastography as a Tool for Assessing Atherosclerotic Plaques - A Systematic Literature Review. Ultrasound Int Open 2016; 2:E106-E112. [PMID: 27896334 DOI: 10.1055/s-0042-115564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/05/2016] [Indexed: 02/02/2023] Open
Abstract
Atherosclerosis is a widespread disease that accounts for nearly 3-quarters of deaths due to cardiovascular disease. Ultrasound elastography might be able to reliably identify characteristics associated with vulnerable plaques. There is a need for the evaluation of elastography and its ability to distinguish between vulnerable and stable plaques. The aim of this paper is to provide an overview of the literature on vascular elastography. A systematic search of the available literature for studies using elastography for assessing atherosclerotic plaques was conducted using the MEDLINE, Embase, Cochrane Library and Web of Science databases. A standardized template was used to extract relevant data following the PRISMA 2009 checklist. 20 articles were included in this paper. The studies were heterogeneous. All studies reported that elastography was a feasible technique and provided additional information compared to B-mode ultrasound alone. Most studies reported higher strain values for vulnerable plaques. Ultrasound elastography has potential as a clinical tool in the assessment of atherosclerotic plaques. Elastography is able to distinguish between different plaque types, but there is considerable methodological variation between studies. There is a need for larger studies in a clinical setting to determine the full potential of elastography.
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Affiliation(s)
- B Mahmood
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - C Ewertsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - J Carlsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - M B Nielsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
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7
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Effect of rosuvastatin on atherosclerotic plaque stability: An intravascular ultrasound elastography study. Atherosclerosis 2016; 248:27-35. [DOI: 10.1016/j.atherosclerosis.2016.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/04/2016] [Accepted: 02/23/2016] [Indexed: 11/21/2022]
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8
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Liu F, Yong Q, Zhang Q, Liu P, Yang Y. Real-time tissue elastography for the detection of vulnerable carotid plaques in patients undergoing endarterectomy: a pilot study. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:705-712. [PMID: 25619789 DOI: 10.1016/j.ultrasmedbio.2014.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/19/2014] [Accepted: 10/18/2014] [Indexed: 06/04/2023]
Abstract
We examined the utility of ultrasonic real-time tissue elastography (RTE) and conventional B-mode ultrasound (US) in the detection of vulnerable carotid atherosclerotic plaques. This prospective study comprised 19 patients scheduled for carotid endarterectomy. Results obtained from pre-operative RTE and B-mode US and post-operative pathology were compared. RTE encoded low, average and high deformability as blue, green and red, respectively. Tissue hardness was scored on a 5-point scale, and relative strains were calculated. The relative strain was 1.12 ± 0.14 for fibrous plaques (n = 4), 0.28 ± 0.07 for atherosclerotic plaques (n = 5), 0.47 ± 0.31 for intraplaque hemorrhage/thrombosis (n = 5) and 0.98 ± 1.04 for complex plaques (n = 5). The sensitivity, specificity and accuracy of detection of vulnerable plaques were 25%, 100% and 84.2% for B-mode US, 50%, 100% and 89.4% for RTE and 62.5%, 100% and 94.7% for the combination. Ultrasonic RTE is a potential candidate for a non-invasive and effective approach to identify vulnerable atherosclerotic plaques in the carotid artery.
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Affiliation(s)
- Fengju Liu
- Department of Ultrasound, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Qiang Yong
- Department of Ultrasound, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Qinyi Zhang
- Stroke Center, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yuguang Yang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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9
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Mercure E, Destrempes F, Roy Cardinal MH, Porée J, Soulez G, Ohayon J, Cloutier G. A local angle compensation method based on kinematics constraints for non-invasive vascular axial strain computations on human carotid arteries. Comput Med Imaging Graph 2014; 38:123-36. [DOI: 10.1016/j.compmedimag.2013.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 06/28/2013] [Accepted: 08/07/2013] [Indexed: 11/16/2022]
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10
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Teng Z, Sadat U, Brown AJ, Gillard JH. Plaque hemorrhage in carotid artery disease: pathogenesis, clinical and biomechanical considerations. J Biomech 2014; 47:847-58. [PMID: 24485514 PMCID: PMC3994507 DOI: 10.1016/j.jbiomech.2014.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 12/21/2022]
Abstract
Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Adam J Brown
- Department of Cardiovascular Medicine, University of Cambridge, UK
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11
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Teng Z, Sadat U, Wang W, Bahaei NS, Chen S, Young VE, Graves MJ, Gillard JH. Intraplaque stretch in carotid atherosclerotic plaque--an effective biomechanical predictor for subsequent cerebrovascular ischemic events. PLoS One 2013; 8:e61522. [PMID: 23626694 PMCID: PMC3634006 DOI: 10.1371/journal.pone.0061522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/11/2013] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Stretch is a mechanical parameter, which has been proposed previously to affect the biological activities in different tissues. This study explored its utility in determining plaque vulnerability. METHODS One hundred and six patients with mild to moderate carotid stenosis were recruited in this study (53 symptomatic and 53 asymptomatic). High resolution, multi-sequence magnetic resonance (MR) imaging was performed to delineate various plaque components. Finite element method was used to predict high stretch concentration within the plaque. RESULTS During a two-year follow-up, 11 patients in symptomatic group and 3 in asymptomatic group experienced recurrent cerebrovascular events. Plaque stretch at systole and stretch variation during one cardiac cycle was greater in symptomatic group than those in the asymptomatic. Within the symptomatic group, a similar trend was observed in patients with recurrent events compared to those without. CONCLUSION Plaques with high stretch concentration and large stretch variation are associated with increased risk of future cerebrovascular events.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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Le Floc’h S, Cloutier G, Saijo Y, Finet G, Yazdani SK, Deleaval F, Rioufol G, Pettigrew RI, Ohayon J. A four-criterion selection procedure for atherosclerotic plaque elasticity reconstruction based on in vivo coronary intravascular ultrasound radial strain sequences. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38. [PMID: 23196202 PMCID: PMC4722089 DOI: 10.1016/j.ultrasmedbio.2012.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Plaque elasticity (i.e., modulogram) and morphology are good predictors of plaque vulnerability. Recently, our group developed an intravascular ultrasound (IVUS) elasticity reconstruction method which was successfully implemented in vitro using vessel phantoms. In vivo IVUS modulography, however, remains a major challenge as the motion of the heart prevents accurate strain field estimation. We therefore designed a technique to extract accurate strain fields and modulograms from recorded IVUS sequences. We identified a set of four criteria based on tissue overlapping, RF-correlation coefficient between two successive frames, performance of the elasticity reconstruction method to recover the measured radial strain, and reproducibility of the computed modulograms over the cardiac cycle. This four-criterion selection procedure (4-CSP) was successfully tested on IVUS sequences obtained in twelve patients referred for a directional coronary atherectomy intervention. This study demonstrates the potential of the IVUS modulography technique based on the proposed 4-CSP to detect vulnerable plaques in vivo.
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Affiliation(s)
- Simon Le Floc’h
- Laboratory TIMC-IMAG/DyCTiM, UJF, CNRS UMR 5525, Grenoble, France
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Yoshifumi Saijo
- Department of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Gérard Finet
- Department of Hemodynamics and Interventional Cardiology, Hospices Civiles de Lyon and Claude Bernard University Lyon 1, INSERM Unit 886, Lyon, France
| | | | - Flavien Deleaval
- Laboratory TIMC-IMAG/DyCTiM, UJF, CNRS UMR 5525, Grenoble, France
| | - Gilles Rioufol
- Department of Hemodynamics and Interventional Cardiology, Hospices Civiles de Lyon and Claude Bernard University Lyon 1, INSERM Unit 886, Lyon, France
| | - Roderic I. Pettigrew
- Laboratory of Integrative Cardiovascular Imaging Science, NIDDK, NIH, Bethesda, Maryland, USA
| | - Jacques Ohayon
- Laboratory TIMC-IMAG/DyCTiM, UJF, CNRS UMR 5525, Grenoble, France
- University of Savoie, Polytech Annecy-Chambéry, Le Bourget du Lac, France
- Address for correspondence, Professor Jacques Ohayon, Laboratory TIMC-DynaCell, UJF, CNRS UMR 5525, InS, Grenoble, France., Fax number: (33) 456 52 00 22, Telephone number: (33) 456 52 0124,
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