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Non-invasive volumetric assessment of aortic atheroma: a core laboratory validation using computed tomography angiography. Int J Cardiovasc Imaging 2015; 32:121-9. [PMID: 25962864 DOI: 10.1007/s10554-015-0674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/06/2015] [Indexed: 01/16/2023]
Abstract
Aortic atherosclerosis has been linked with worse peri- and post-procedural outcomes following a range of aortic procedures. Yet, there are currently no standardized methods for non-invasive volumetric pan-aortic plaque assessment. We propose a novel means of more accurately assessing plaque volume across whole aortic segments using computed tomography angiography (CTA) imaging. Sixty patients who underwent CTA prior to trans-catheter aortic valve implantation were included in this analysis. Specialized software analysis (3mensio Vascular™, Pie Medical, Maastricht, Netherlands) was used to reconstruct images using a centerline approach, thus creating true cross-sectional aortic images, akin to those images produced with intravascular ultrasonography. Following aortic segmentation (from the aortic valve to the renal artery origin), atheroma areas were measured across multiple contiguous evenly spaced (10 mm) cross-sections. Percent atheroma volume (PAV), total atheroma volume (TAV) and calcium score were calculated. In our populations (age 79.9 ± 8.5 years, male 52 %, diabetes 27 %, CAD 84 %, PVD 20 %), mean ± SD number of cross sections measured for each patient was 35.1 ± 3.5 sections. Mean aortic PAV and TAV were 33.2 ± 2.51 % and 83,509 ± 17,078 mm(3), respectively. Median (IQR) calcium score was 1.5 (0.7-2.5). Mean (SD) inter-observer coefficient of variation and agreement for plaque area among 4 different analysts was 14.1 (5.4), and the mean (95 % CI) Lin's concordance correlation coefficient was 0.79 (0.62-0.89), effectively simulating a Core Laboratory scenario. We provide an initial validation of cross-sectional volumetric aortic atheroma assessment using CTA. This proposed methodology highlights the potential for utilizing non-invasive aortic plaque imaging for risk prediction across a range of clinical scenarios.
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Burtea C, Ballet S, Laurent S, Rousseaux O, Dencausse A, Gonzalez W, Port M, Corot C, Elst LV, Muller RN. Development of a Magnetic Resonance Imaging Protocol for the Characterization of Atherosclerotic Plaque by Using Vascular Cell Adhesion Molecule-1 and Apoptosis-Targeted Ultrasmall Superparamagnetic Iron Oxide Derivatives. Arterioscler Thromb Vasc Biol 2012; 32:e36-48. [DOI: 10.1161/atvbaha.112.245415] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective—
Acute ischemic events are often caused by the disruption of lipid-rich plaques, which are frequently not angiographically visible. Vascular cell adhesion molecule-1 and apoptotic cell-targeted peptides studied during our previous work were conjugated to ultrasmall superparamagnetic iron oxide (USPIO) (USPIO-R832 for vascular cell adhesion molecule-1 targeting; USPIO-R826 for apoptosis targeting) and assessed by magnetic resonance imaging.
Methods and Results—
Apolipoprotein E knockout mice were injected with 0.1 mmol Fe/kg body weight and were imaged on a 4.7-T Bruker magnetic resonance imaging until 24 hours after contrast agent administration. Aortic samples were then harvested and examined by histochemistry, and the magnetic resonance images and histological micrographs were analyzed with ImageJ software. The plaques enhanced by USPIO-R832 contained macrophages concentrated in the cap and a large necrotic core, whereas USPIO-R826 produced a negative enhancement of plaques rich in macrophages and neutral fats concentrated inside the plaque. Both USPIO derivatives colocalized with their target on histological sections and were able to detect plaques with a vulnerable morphology, but each one is detecting a specific environment.
Conclusion—
Our vascular cell adhesion molecule-1 and apoptotic cell targeted USPIO derivatives seem to be highly promising tools for atherosclerosis imaging contributing to the detection of vulnerable plaques. They are able to attain their target in low doses and as fast as 30 minutes after administration.
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Affiliation(s)
- Carmen Burtea
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Sébastien Ballet
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Sophie Laurent
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Olivier Rousseaux
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Anne Dencausse
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Walter Gonzalez
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Marc Port
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Claire Corot
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Luce Vander Elst
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
| | - Robert N. Muller
- From the Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium (C.B., S.L., L.V.E., R.N.M.); and Biological Research (S.B., A.D., W.G.), Chemical Discovery (O.R., M.P.), Research Director (C.C.), Guerbet, Research Center, Aulnay-sous-Bois, France
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Parmar JP, Rogers WJ, Mugler JP, Baskurt E, Altes TA, Nandalur KR, Stukenborg GJ, Phillips CD, Hagspiel KD, Matsumoto AH, Dake MD, Kramer CM. Magnetic resonance imaging of carotid atherosclerotic plaque in clinically suspected acute transient ischemic attack and acute ischemic stroke. Circulation 2010; 122:2031-8. [PMID: 21041694 DOI: 10.1161/circulationaha.109.866053] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Carotid atherosclerotic plaque rupture is thought to cause transient ischemic attack (TIA) and ischemic stroke (IS). Pathological hallmarks of these plaques have been identified through observational studies. Although generally accepted, the relationship between cerebral thromboembolism and in situ atherosclerotic plaque morphology has never been directly observed noninvasively in the acute setting. METHODS AND RESULTS Consecutive acutely symptomatic patients referred for stroke protocol magnetic resonance imaging/angiography underwent additional T1- and T2-weighted carotid bifurcation imaging with the use of a 3-dimensional technique with blood signal suppression. Two blinded reviewers performed plaque gradings according to the American Heart Association classification system. Discharge outcomes and brain magnetic resonance imaging results were obtained. Image quality for plaque characterization was adequate in 86 of 106 patients (81%). Eight TIA/IS patients with noncarotid pathogenesis were excluded, yielding 78 study patients (38 men and 40 women with a mean age of 64.3 years, SD 14.7) with 156 paired watershed vessel/cerebral hemisphere observations. Thirty-seven patients had 40 TIA/IS events. There was a significant association between type VI plaque (demonstrating cap rupture, hemorrhage, and/or thrombosis) and ipsilateral TIA/IS (P<0.001). A multiple logistic regression model including standard Framingham risk factors and type VI plaque was constructed. Type VI plaque was the dominant outcome-associated observation achieving significance (P<0.0001; odds ratio, 11.66; 95% confidence interval, 5.31 to 25.60). CONCLUSIONS In situ type VI carotid bifurcation region plaque identified by magnetic resonance imaging is associated with ipsilateral acute TIA/IS as an independent identifier of events, thereby supporting the dominant disease pathophysiology.
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Affiliation(s)
- Jaywant P Parmar
- Department of Radiology, University of Virginia Health System, Charlottesville, USA.
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Capmany RP, Ibañez MO, Pesquer XJ. Complex atheromatosis of the aortic arch in cerebral infarction. Curr Cardiol Rev 2010; 6:184-93. [PMID: 21804777 PMCID: PMC2994110 DOI: 10.2174/157340310791658712] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/10/2010] [Accepted: 05/25/2010] [Indexed: 12/13/2022] Open
Abstract
In many stroke patients it is not possible to establish the etiology of stroke. However, in the last two decades, the use of transesophageal echocardiography in patients with stroke of uncertain etiology reveals atherosclerotic plaques in the aortic arch, which often protrude into the lumen and have mobile components in a high percentage of cases. Several autopsy series and retrospective studies of cases and controls have shown an association between aortic arch atheroma and arterial embolism, which was later confirmed by prospectively designed studies. The association with ischemic stroke was particularly strong when atheromas were located proximal to the ostium of the left subclavian artery, when the plaque was ≥ 4 mm thick and particularly when mobile components are present. In these cases, aspirin might not prevent adequately new arterial ischemic events especially stroke. Here we review the evidence of aortic arch atheroma as an independent risk factor for stroke and arterial embolism, including clinical and pathological data on atherosclerosis of the thoracic aorta as an embolic source. In addition, the impact of complex plaques (≥ 4 mm thick, or with mobile components) on increasing the risk of stroke is also reviewed. In non-randomized retrospective studies anticoagulation was superior to antiplatelet therapy in patients with stroke and aortic arch plaques with mobile components. In a retrospective case-control study, statins significantly reduced the relative risk of new vascular events. However, given the limited data available and its retrospective nature, randomized prospective studies are needed to establish the optimal secondary prevention therapeutic regimens in these high risk patients.
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Affiliation(s)
- Ramón Pujadas Capmany
- Department of Cardiology, Hospital Universitari del Sagrat Cor, Address: Viladomat 288, E-08027 Barcelona, Spain
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Chiesa G, Rigamonti E, Monteggia E, Parolini C, Marchesi M, Miragoli L, Grotti A, Maggioni F, Lorusso V, Sirtori CR. Evaluation of a soft atherosclerotic lesion in the rabbit aorta by an invasive IVUS method versus a non-invasive MRI technology. Atherosclerosis 2004; 174:25-33. [PMID: 15135247 DOI: 10.1016/j.atherosclerosis.2004.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Revised: 01/05/2004] [Accepted: 01/22/2004] [Indexed: 10/26/2022]
Abstract
The intravascular ultrasound (IVUS) modality has rapidly gained acceptance for the measurement of arterial plaque thickness and for anatomical characterization. In view, however, of the growing interest in the direct assessment of plaque size after therapeutic modalities directly reducing plaque burden, a non-invasive method such as magnetic resonance imaging (MRI) may be of help for repeated evaluations. The two methods were compared directly on a focal plaque developed at the abdominal aortic level by a combination of local electric lesion followed by a hypercholesterolemic diet. The plaque was fully characterized histopathologically at intervals up to 120 days from lesion induction, and maximal plaque formation was detected at 90 days from electrical injury. Plaques could be well assessed by IVUS at each time point analyzed and data correlated very well to histopathologic findings (r = 0.969, P = 0.0014). The MRI technology provided reliable determinations only at 90 days after lesion induction, i.e. at maximal plaque formation, with excellent correspondence to IVUS determinations (r = 0.989, P = 0.0111). Altogether these findings indicate that the non-invasive MRI technology, when applied to the analysis of arterial plaques of adequate size, can be used successfully for plaque determination, with results comparable to the invasive IVUS technique.
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Affiliation(s)
- G Chiesa
- Department of Pharmacological Sciences, University of Milan, via Balzaretti 9, 20133 Milan, Italy
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