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Khorasanizadeh F, Azizi N, Cannella R, Brancatelli G. An exploration of radiological signs in post-intervention liver complications. Eur J Radiol 2024; 180:111668. [PMID: 39180784 DOI: 10.1016/j.ejrad.2024.111668] [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: 04/09/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024]
Abstract
The advent and progression of radiological techniques in the past few decades have revolutionized the diagnostic and therapeutic landscape for liver diseases. These minimally invasive interventions, ranging from biopsies to complex therapeutic procedures like transjugular intrahepatic portosystemic shunt placement and transarterial embolization, offer substantial benefits for the treatment of patients with liver diseases. They provide accurate tissue diagnosis, allow real-time visualization, and render targeted treatment for hepatic lesions with enhanced precision. Despite their advantages, these procedures are not without risks, with the potential for complications that can significantly impact patient outcomes. It is imperative for radiologists to recognize the signs of these complications promptly to mitigate further health deterioration. Ultrasound, CT, and MRI are widely utilized examinations for monitoring the complications. This article presents an overarching review of the most commonly encountered hepatobiliary complications post-radiological interventions, emphasizing their imaging characteristics to improve patient post-procedure management.
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Affiliation(s)
- Faezeh Khorasanizadeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Narges Azizi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Roberto Cannella
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
| | - Giuseppe Brancatelli
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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2
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Grazzini G, Pradella S, Rossi A, Basile RP, Ruggieri M, Galli D, Palmisano A, Palumbo P, Esposito A, Miele V. Practical Guide to Interpreting Cardiac Magnetic Resonance in Patients with Cardiac Masses. J Cardiovasc Dev Dis 2023; 10:229. [PMID: 37367394 DOI: 10.3390/jcdd10060229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
It is common for a cardiac mass to be discovered accidentally during an echocardiographic examination. Following the relief of a cardiac mass, being able to evaluate and characterize it using non-invasive imaging methods is critical. Echocardiography, computed tomography (CT), cardiac magnetic resonance imaging (CMR), and positron emission tomography (PET) are the main imaging modalities used to evaluate cardiac masses. Although multimodal imaging often allows for a better assessment, CMR is the best technique for the non-invasive characterization of tissues, as the different MR sequences help in the diagnosis of cardiac masses. This article provides detailed descriptions of each CMR sequence employed in the evaluation of cardiac masses, underlining the potential information it can provide. The description in the individual sequences provides useful guidance to the radiologist in performing the examination.
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Affiliation(s)
- Giulia Grazzini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Alice Rossi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Rocco Pio Basile
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Matteo Ruggieri
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Galli
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Anna Palmisano
- Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20100 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100 L'Aquila, Italy
| | - Antonio Esposito
- Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20100 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
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3
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Vazquez-Prada KX, Moonshi SS, Wu Y, Akther F, Tse BWC, Sokolowski KA, Peter K, Wang X, Xu G, Ta HT. A Spiky Silver-Iron Oxide Nanoparticle for Highly Efficient Targeted Photothermal Therapy and Multimodal Imaging of Thrombosis. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2205744. [PMID: 36634995 DOI: 10.1002/smll.202205744] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Thrombosis and its complications are responsible for 30% of annual deaths. Limitations of methods for diagnosing and treating thrombosis highlight the need for improvements. Agents that provide simultaneous diagnostic and therapeutic activities (theranostics) are paramount for an accurate diagnosis and rapid treatment. In this study, silver-iron oxide nanoparticles (AgIONPs) are developed for highly efficient targeted photothermal therapy and imaging of thrombosis. Small iron oxide nanoparticles are employed as seeding agents for the generation of a new class of spiky silver nanoparticles with strong absorbance in the near-infrared range. The AgIONPs are biofunctionalized with binding ligands for targeting thrombi. Photoacoustic and fluorescence imaging demonstrate the highly specific binding of AgIONPs to the thrombus when functionalized with a single chain antibody targeting activated platelets. Photothermal thrombolysis in vivo shows an increase in the temperature of thrombi and a full restoration of blood flow for targeted group but not in the non-targeted group. Thrombolysis from targeted groups is significantly improved (p < 0.0001) in comparison to the standard thrombolytic used in the clinic. Assays show no apparent side effects of AgIONPs. Altogether, this work suggests that AgIONPs are potential theranostic agents for thrombosis.
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Affiliation(s)
- Karla X Vazquez-Prada
- Queensland Micro- and Nanotechnology, Griffith University, Nathan, Queensland, 4111, Australia
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Shehzahdi S Moonshi
- Queensland Micro- and Nanotechnology, Griffith University, Nathan, Queensland, 4111, Australia
| | - Yuao Wu
- Queensland Micro- and Nanotechnology, Griffith University, Nathan, Queensland, 4111, Australia
| | - Fahima Akther
- Queensland Micro- and Nanotechnology, Griffith University, Nathan, Queensland, 4111, Australia
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Brian W C Tse
- Translational Research Institute, Woolloongabba, Queensland, 4102, Australia
| | - Kamil A Sokolowski
- Translational Research Institute, Woolloongabba, Queensland, 4102, Australia
| | - Karlheinz Peter
- Baker Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia
- Department of Medicine, Monash University, 27 Rainforest Walk, Clayton, VIC, 3800, Australia
| | - Xiaowei Wang
- Baker Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia
| | - Gordon Xu
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Hang Thu Ta
- Queensland Micro- and Nanotechnology, Griffith University, Nathan, Queensland, 4111, Australia
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, St Lucia, Queensland, 4072, Australia
- School of Environment and Science, Griffith University, Nathan, Queensland, 4111, Australia
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4
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Morphological and Compositional Features of Chronic Internal Carotid Artery Occlusion in MR Vessel Wall Imaging Predict Successful Endovascular Recanalization. Diagnostics (Basel) 2023; 13:diagnostics13010147. [PMID: 36611438 PMCID: PMC9818158 DOI: 10.3390/diagnostics13010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Background: We sought to determine if the morphological and compositional features of chronic internal carotid artery occlusion (CICAO), as assessed by MR vessel wall imaging (MR-VWI), initially predict successful endovascular recanalization. Methods: Consecutive patients with CICAO scheduled for endovascular recanalization were recruited. MR-VWI was performed within 1 week prior to surgery for evaluating the following features: proximal stump morphology, extent of occlusion, occlusion with collapse, arterial tortuosity, the presence of hyperintense signals (HIS) and calcification in the occluded C1 segment. Multivariate logistic regression was used to identify features associated with technical success and construct a prediction model. Results: Eighty-three patients were recruited, of which fifty-seven (68.7%) were recanalized successfully. The morphological and compositional characteristics of CICAO were associated with successful recanalization, including occlusions limited to C1 and extensive HIS, as well as the absence of extensive calcification, absence of high tortuosity, and absence of artery collapse. The MR CICAO score that comprised the five predictors showed a high predictive ability (area under the curve: 0.888, p < 0.001). Conclusion: the MR-VWI characteristics of CICAO predicted the technical success of endovascular recanalization and may be leveraged for identifying patients with a high probability of successful recanalization.
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5
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Fibrin-Targeted Nanoparticles for Finding, Visualizing and Characterizing Blood Clots in Acute Ischemic Stroke. Pharmaceutics 2022; 14:pharmaceutics14102156. [PMID: 36297588 PMCID: PMC9606925 DOI: 10.3390/pharmaceutics14102156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
Abstract
Recanalization of the occluded artery is the gold standard treatment for acute ischemic stroke, which includes enzymatic fibrinolytic treatment with the use of recombinant tissue plasminogen activators (rtPAs) to disrupt the occluding clot, the use of mechanical thrombectomy to physically remove the clot, or a combination of both. Fibrin is one of the main components of blood clots causing ischemic stroke and is the target of rtPA upon activation of plasminogen in the clot. In addition, fibrin content also influences the efficacy of mechanical thrombectomy. Current imaging methods can successfully identify occlusions in large vessels; however, there is still a need for contrast agents capable of visualizing small thrombi in ischemic stroke patients. In this work, we describe the synthesis and the in vitro characterization of a new diagnostic nanoparticle, as well as the in vivo evaluation in an animal model of thromboembolic stroke. Gd-labeled KCREKA peptides were synthesized and attached onto the surface of PEGylated superparamagnetic nanoparticles. Magnetic resonance imaging (MRI) of blood clots was performed in vitro and in vivo in animal models of thromboembolic stroke. KCREKA-NPs were synthesized by attaching the peptide to the amino (N) termini of the PEG-NPs. The sizes of the nanoparticles, measured via DLS, were similar for both KCREKA-NPs and PEG-NPs (23 ± 4 nm, PDI = 0.11 and 25 ± 8 nm, PDI = 0.24, respectively). In the same line, r2 relaxivities were also similar for the nanoparticles (149 ± 2 mM Fe s−1 and 151 ± 5 mM Fe s−1), whereas the r1 relaxivity was higher for KCREKA-NPs (1.68 ± 0.29 mM Fe s−1 vs. 0.69 ± 0.3 mM Fe s−1). In vitro studies showed that blood clots with low coagulation times were disrupted by rtPA, whereas aged clots were almost insensitive to the presence of rtPA. MRI in vitro studies showed a sharp decrease in the T1 × T2 signals measured for aged clots incubated with KCREKA-NPs compared with fresh clots (47% [22, 80] to 26% [15, 51]). Furthermore, the control blood showed a higher value of the T1 × T2 signal (39% [20, 61]), being the blood clots with low coagulation times the samples with the lowest values measured by MRI. In vivo studies showed a significant T1 × T2 signal loss in the clot region of 24% after i.v. injection of KCREKA-NPs. The thrombus age (2.5% ± 6.1% vs. 81.3% ± 19.8%, p < 0.01) confirmed our ability to identify in vivo fresh blood clots. In this study, we developed and tested a dual MRI nanoparticle, acting as T1 and T2 contrast agents in MRI analyses. The developed KCREKA-NPs showed affinity for the fibrin content of blood clots, and the MRI signals provided by the nanoparticles showed significant differences depending on the clot age. The developed KCREKA-NPs could be used as a tool to predict the efficacy of a recanalization treatment and improve the triage of ischemic stroke patients.
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Alkarithi G, Duval C, Shi Y, Macrae FL, Ariëns RAS. Thrombus Structural Composition in Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2021; 41:2370-2383. [PMID: 34261330 PMCID: PMC8384252 DOI: 10.1161/atvbaha.120.315754] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thrombosis is a major complication of cardiovascular disease, leading to myocardial infarction, acute ischemic stroke, or venous thromboembolism. Thrombosis occurs when a thrombus forms inside blood vessels disrupting blood flow. Developments in thrombectomy to remove thrombi from vessels have provided new opportunities to study thrombus composition which may help to understand mechanisms of disease and underpin improvements in treatments. We aimed to review thrombus compositions, roles of components in thrombus formation and stability, and methods to investigate thrombi. Also, we summarize studies on thrombus structure obtained from cardiovascular patients and animal models. Thrombi are composed of fibrin, red blood cells, platelets, leukocytes, and neutrophil extracellular traps. These components have been analyzed by several techniques, including scanning electron microscopy, laser scanning confocal microscopy, histochemistry, and immunohistochemistry; however, each technique has advantages and limitations. Thrombi are heterogenous in composition, but overall, thrombi obtained from myocardial infarction are composed of mainly fibrin and other components, including platelets, red blood cells, leukocytes, and cholesterol crystals. Thrombi from patients with acute ischemic stroke are characterized by red blood cell- and platelet-rich regions. Thrombi from patients with venous thromboembolism contain mainly red blood cells and fibrin with some platelets and leukocytes. Thrombus composition from patients with myocardial infarction is influenced by ischemic time. Animal thrombosis models are crucial to gain further mechanistic information about thrombosis and thrombus structure, with thrombi being similar in composition compared with those from patients. Further studies on thrombus composition and function are key to improve treatment and clinical outcome of thrombosis.
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Affiliation(s)
- Ghadir Alkarithi
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.).,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia (G.A.)
| | - Cédric Duval
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Yu Shi
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Fraser L Macrae
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Robert A S Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
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7
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Song SY, Dornbos D, Lan D, Jiao BL, Wan SL, Guo YB, Ding YC, Yang Q, Ji XM, Meng R. High-Resolution Magnetic Resonance Black Blood Thrombus Imaging and Serum D-Dimer in the Confirmation of Acute Cortical Vein Thrombosis. Front Neurol 2021; 12:680040. [PMID: 34234736 PMCID: PMC8255931 DOI: 10.3389/fneur.2021.680040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebral cortical vein thrombosis (CCVT) is often misdiagnosed because of its non-specific diagnostic symptoms. Here, we analyzed a cohort of patients with CCVT in hopes of improving understandings and treatments of the disease. A total of 23 patients with CCVT (confirmed with high-resolution imaging), who had been diagnosed between 2017 and 2019, were enrolled in this cohort study. Baseline demographics, clinical manifestations, laboratory data, radiological findings, treatment, and outcomes were collected and analyzed. Fourteen females and nine males were enrolled (mean age: 32.7 ± 11.9 years), presenting in the acute (within 7 days, n = 9), subacute (8–30 days, n = 7), and chronic (over 1 month, n = 7) stages. Headaches (65.2%) and seizures (39.1%) were the most common symptoms. Abnormally elevated plasma D-dimers were observed in the majority of acute stage patients (87.5%). The diagnostic accuracy of contrast-enhanced magnetic resonance venography (CE-MRV) and high-resolution magnetic resonance black-blood thrombus imaging (HR-MRBTI) in detecting CCVT were 57.1 and 100.0%, respectively. All patients had good functional outcomes after 6-month of standard anticoagulation (mRS 0–1) treatment. However, four CCVT patients that had cases involving multiple veins showed symptom relief after batroxobin therapy (p = 0.030). HR-MRBTI may be a fast and accurate tool for non-invasive CCVT diagnosis. HR-MRBTI combined with D-dimer can also precisely identify the pathological stage of CCVT. Batroxobin may safely accelerate cortical venous recanalization in combination with anticoagulation. Follow-up studies with larger sample sizes are suggested to evaluate the safety and efficacy of batroxobin for treating CCVT.
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Affiliation(s)
- Si-Ying Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - David Dornbos
- Department of Neurological Surgery, Semmes-Murphey Clinic and University of Tennessee Health Science Center, Memphis, TN, United States
| | - Duo Lan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bao-Lian Jiao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shu-Ling Wan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi-Bing Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-Chuan Ding
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Qi Yang
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xun-Ming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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8
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Hajhosseiny R, Prieto C, Qi H, Phinikaridou A, Botnar RM. Thrombosis and Embolism. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Restrepo R, Pevsner R, Pelaez L, Plut D, Lee EY. Three Distinct Vascular Anomalies Involving Skeletal Muscle: Simplifying the Approach for the General Radiologist. Radiol Clin North Am 2020; 58:603-618. [PMID: 32276706 DOI: 10.1016/j.rcl.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Venous malformations and hemangiomas of the skeletal muscle are separate entities with different clinical presentation, histology, and imaging findings. Recent advances in the field of vascular anomalies and current efforts in the unification of terminology by the International Society for the Study of Vascular Anomalies are pivotal in understanding and differentiating intramuscular venous malformations and intramuscular capillary-type hemangioma. Fibroadipose vascular anomaly is another recently defined vascular anomaly affecting the skeletal muscle, with a distinct clinical presentation, histology, and imaging appearance. These 3 distinct vascular anomalies are reviewed and their histologic features, clinical presentation, imaging appearance, and treatment are discussed.
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Affiliation(s)
- Ricardo Restrepo
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Rachel Pevsner
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Liset Pelaez
- Department of Pathology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Domen Plut
- Department of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre, Ljubljana, Zaloska cesta 7, Ljubljana 1000, Slovenia
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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10
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Li X, Chen Y, Liu J, Xu L, Li Y, Liu D, Sun Z, Wen Z. Cardiac magnetic resonance imaging of primary cardiac tumors. Quant Imaging Med Surg 2020; 10:294-313. [PMID: 31956550 DOI: 10.21037/qims.2019.11.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac magnetic resonance (CMR) offers superior advantages in cardiac imaging due to supplying a greater field of view, excellent soft-tissue imaging, and multiplanar imaging capabilities. CMR imaging can evaluate the characteristics of cardiac tumors by visualizing the relationship between the tumor and surrounding tissues, and plays a vital role in assisting the formulation of the surgical plan, the assessment of tumor progression, and the monitoring of postoperative tumor recurrence and metastasis. In this review, we present the clinical manifestations and imaging features of different cardiac tumors. The superior performance of CMR in preoperative diagnosis, surgical treatment, and postoperative follow-up of patients with heart tumors are also highlighted.
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Affiliation(s)
- Xiaodan Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yan Chen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jiayi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yu Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Dongting Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
| | - Zhaoying Wen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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11
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Yu Y, Yu M, Liu J, Ding N, Huang J, Wan D, Zhao Y, Ma Z. In vivo monitoring of thrombosis in mice by optical coherence tomography. JOURNAL OF BIOPHOTONICS 2019; 12:e201900105. [PMID: 31339664 DOI: 10.1002/jbio.201900105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study is to establish a novel method for continuously monitoring thrombus progression with various outcome measures and to assess the efficacy of antithrombotic drugs in murine thrombosis model in mice. In the study, thrombus was induced in the femoral vein of mice by FeCl3 and monitored over time by spectral-domain optical coherence tomography (OCT). Three-dimensional images of thrombi with or without heparin as an antithrombotic agent were obtained from OCT angiography. In addition, several parameters of thrombi were analyzed and compared between control and anticoagulant groups. By using OCT, we were able to trace thrombus generation in the same mouse in real time. We found that in our model heparin reduced thrombus size by ~60% and thrombus cross-sectional area by 50%. OCT results also show that both time to thrombus size (>0.02mm3 ) and time to occlusion (>30%) were significantly reduced after heparin addition. This study demonstrates that OCT reliably monitors thrombus generation and progression from various aspects including thrombus size. This enables us to measure the kinetic of thrombosis more accurately, and effectively evaluate the efficacy and activities of antithrombotic drugs. This model may represent a useful tool in antithrombotic drug discoveries in preclinical studies.
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Affiliation(s)
- Yao Yu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Menghan Yu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Jian Liu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Ning Ding
- School of Sino-Dutch Biomedical and Information Engineering, Northeastern University, Shenyang, China
| | - Jiangmei Huang
- Department of Pathology, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Dong Wan
- School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Yuliang Zhao
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Zhenhe Ma
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
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12
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Bacigaluppi M, Semerano A, Gullotta GS, Strambo D. Insights from thrombi retrieved in stroke due to large vessel occlusion. J Cereb Blood Flow Metab 2019; 39:1433-1451. [PMID: 31213164 PMCID: PMC6681524 DOI: 10.1177/0271678x19856131] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The recent advances of endovascular procedures to treat stroke due to large cerebral vessel occlusion have made it possible to analyze the retrieved thrombus material. Analysis of cerebral thrombi is emerging as a relevant opportunity to complement the diagnostic workup of etiology, to develop new lytic approaches and to optimize the acute treatment of stroke due to large vessel occlusion. Nonetheless, retrieved thrombi are frequently discarded since their informative potential is often neglected and standards are missing. This review provides an overview of the current knowledge and expanding research relating to thrombus composition analysis in large vessel occlusions. We first discuss the heterogeneity of thrombogenic factors that underlie the thrombotic formation in stroke and its implications to identify stroke etiology and thrombus age. Further, we show that understanding structural characteristics of thrombus is pivotal for the development of new-targeted lytic therapies as well as to improve, through thrombus modeling, the development of thrombectomy devices. Finally, we discuss the on-going attempts to identify a signature of thrombus composition indirectly through imaging and peripheral blood biomarkers, which might in future assist treatment decision-making as well as secondary prevention. Thrombus analysis might contribute to the advancement and optimization of personalized stroke treatments.
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Affiliation(s)
- Marco Bacigaluppi
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Aurora Semerano
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Giorgia Serena Gullotta
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Davide Strambo
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy.,2 Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Yusof NNM, McCann A, Little PJ, Ta HT. Non-invasive imaging techniques for the differentiation of acute and chronic thrombosis. Thromb Res 2019; 177:161-171. [PMID: 30921535 DOI: 10.1016/j.thromres.2019.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 02/07/2023]
Abstract
Thrombosis is the localized clotting of blood that can occur in both the arterial and venous circulation. It is a key factor in the pathogenesis of acute coronary syndrome, myocardial infarction and stroke and the primary cause of deep vein thrombosis and pulmonary embolism. Rapid and accurate diagnosis of thrombotic episodes is crucial in reducing the morbidity and potential mortality associated with arterial and venous thrombotic disorders by allowing early targeted therapeutic interventions. From a clinical perspective the ability to accurately assess the age and composition of thrombus is highly desirable given that anticoagulation and, in particular, fibrinolytic therapies are more effective in treating acute rather than chronic thrombosis. While there are no imaging tests used in routine clinical practice that can reliably determine the age of thrombus and differentiate between acute and chronic thrombosis there are several emerging non-invasive techniques that can provide an indication of the age of a thrombus depending on its location in the body. Examples of techniques developed for venous thrombosis include Doppler imaging with venous duplex ultrasonography, ultrasound B-mode imaging integrated with IER (intrinsic mode functions-based echogenicity ratio), elastography, scintigraphy imaging with 99mTc-recombinant tissue plasminogen activator (99mTc-rt-PA), and magnetic resonance direct thrombus imaging (MDRTI). Magnetic resonance imaging (MRI) has been used to noninvasively detect and differentiate acute and chronic arterial and venous thrombosis. These methods have limitations that need further investigation to enable cost-effective and clinically relevant treatment practices to be established in the future. This review will discuss the difference between acute and chronic thrombosis and the role of non-invasive imaging techniques in discriminating between the two.
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Affiliation(s)
- Nur Nazifah Mohd Yusof
- School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - Andrew McCann
- Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - Peter J Little
- School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - Hang T Ta
- School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, Woolloongabba, Queensland 4102, Australia; Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.
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14
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Liao Y, Yang L, Huang R, Wu J, Xie J, Bundhoo K, Liu Y, Hu G, Liu C, Bin J. Ultrasound molecular imaging of arterial thrombi with novel microbubbles modified by cyclic RGD in vitro and in vivo. Thromb Haemost 2017; 107:172-83. [DOI: 10.1160/th10-11-0701] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 09/28/2011] [Indexed: 12/17/2022]
Abstract
SummaryDespite immense potential, ultrasound molecular imaging (UMI) of arterial thrombi remains very challenging because the high-shear arterial flow limits binding of site-targeted microbubbles to the thrombi. The linear Arg-Gly-Asp (RGD) peptides have been successfully applied to evaluate venous, atrial, and arteriolar thrombi, but have thus far failed in the detection of arterial thrombi. Cyclic RGD (Arg-Gly-Asp-D-Phe-Cys) is a cyclic conformation of linear RGD peptides, which has much higher binding-affinity and selectivity for binding to the glycoprotein (GP) IIb/IIIa receptor than its linear counterpart and thus is likely to be an optimal targeted molecular probe for ultrasound molecular imaging of arterial thrombi. In this study, we sought to assess the feasibility of a novel microbubble conjugated with cyclic RGD (Mb-cyclic RGD) in UMI of arterial thrombi in vitro and in vivo. As expected, Mb-cyclic RGD had greater GP IIb/IIIa-targeted binding capability in all shear stress conditions. In addition, the shear stress at half-maximal detachment of Mb-cyclic RGD was 5.7-fold higher than that of microbubbles with nonspecific peptide (Mb-CON) (p<0.05). Mb-cyclic RGD enhanced the echogenicity of the platelet-rich thrombus in vitro whereas Mb-CON did not produce enhancement. In the in vivo setting, optimal signal enhancement of the abdominal aortic thrombus was displayed with Mb-cyclic RGD in all cases. Mean video intensity of the abdominal aortic thrombi with Mb-cyclic RGD was 3.2-fold higher than that with Mb-CON (p<0.05). The novel Mb-cyclic RGD facilitated excellent visualisation of arterial thrombi using UMI and showed great promise for clinical applications.
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15
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Gorog DA, Fayad ZA, Fuster V. Arterial Thrombus Stability. J Am Coll Cardiol 2017; 70:2036-2047. [DOI: 10.1016/j.jacc.2017.08.065] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/15/2017] [Accepted: 08/31/2017] [Indexed: 01/27/2023]
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16
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Caspar T, El Ghannudi S, Ohana M, Labani A, Lawson A, Ohlmann P, Morel O, De Mathelin M, Roy C, Gangi A, Germain P. Magnetic resonance evaluation of cardiac thrombi and masses by T1 and T2 mapping: an observational study. Int J Cardiovasc Imaging 2016; 33:551-559. [PMID: 27904982 DOI: 10.1007/s10554-016-1034-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/26/2016] [Indexed: 01/27/2023]
Abstract
The purpose of this work was to evaluate CMR T1 and T2 mapping sequences in patients with intracardiac thrombi and masses in order to assess T1 and T2 relaxometry usefulness and to allow better etiological diagnosis. This observational study of patients scheduled for routine CMR was performed from September 2014 to August 2015. All patients referred to our department for a 1.5 T CMR were screened to participate. T1 mapping were acquired before and after Gadolinium injection; T2 mapping images were obtained before injection. 41 patients were included. 22 presented with cardiac thrombi and 19 with cardiac masses. The native T1 of thrombi was 1037 ± 152 ms (vs 1032 ± 39 ms for myocardium, p = 0.88; vs 1565 ± 88 ms for blood pool, p < 0.0001). T2 were 74 ± 13 ms (vs 51 ± 3 ms for myocardium, p < 0.0001; vs 170 ± 32 ms for blood pool, p < 0.0001). Recent thrombi had a native T1 shorter than old thrombi (911 ± 177 vs 1169 ± 107 ms, p = 0.01). The masses having a shorter T1 than the myocardium were lipomas (278 ± 29 ms), calcifications (621 ± 218 ms), and melanoma (736 ms). All other masses showed T1 values higher than myocardial T1, with T2 consistently >70 ms. T1 and T2 mapping CMR sequences can be useful and represent a new approach for the evaluation of cardiac thrombi and masses.
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Affiliation(s)
- Thibault Caspar
- Department of Cardiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France. .,Pôle d'activité medico-chirurgicale cardiovasculaire, Nouvel Hôpital Civil, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.
| | - Soraya El Ghannudi
- Department of Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.,ICube Laboratory, University of Strasbourg, CNRS, Strasbourg, France
| | - Mickaël Ohana
- Department of Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.,ICube Laboratory, University of Strasbourg, CNRS, Strasbourg, France
| | - Aïssam Labani
- Department of Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Aubrietia Lawson
- Department of Cardiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Patrick Ohlmann
- Department of Cardiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Olivier Morel
- Department of Cardiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | | | - Catherine Roy
- Department of Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.,ICube Laboratory, University of Strasbourg, CNRS, Strasbourg, France
| | - Philippe Germain
- Department of Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
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17
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Kim J, Park JE, Nahrendorf M, Kim DE. Direct Thrombus Imaging in Stroke. J Stroke 2016; 18:286-296. [PMID: 27733029 PMCID: PMC5066439 DOI: 10.5853/jos.2016.00906] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/01/2016] [Accepted: 09/17/2016] [Indexed: 01/02/2023] Open
Abstract
There is an emergent need for imaging methods to better triage patients with acute stroke for tissue-plasminogen activator (tPA)-mediated thrombolysis or endovascular clot retrieval by directly visualizing the size and distribution of cerebral thromboemboli. Currently, magnetic resonance (MR) or computed tomography (CT) angiography visualizes the obstruction of blood flow within the vessel lumen rather than the thrombus itself. The present visualization method, which relies on observation of the dense artery sign (the appearance of cerebral thrombi on a non-enhanced CT), suffers from low sensitivity. When translated into the clinical setting, direct thrombus imaging is likely to enable individualized acute stroke therapy by allowing clinicians to detect the thrombus with high sensitivity, assess the size and nature of the thrombus more precisely, serially monitor the therapeutic effects of thrombolysis, and detect post-treatment recurrence. This review is intended to provide recent updates on stroke-related direct thrombus imaging using MR imaging, positron emission tomography, or CT.
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Affiliation(s)
- Jongseong Kim
- Molecular Imaging and Neurovascular Research (MINER) Laboratory, Dongguk University Ilsan Hospital, Goyang, Korea.,Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA )
| | - Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Matthias Nahrendorf
- Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA ).,Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dong-Eog Kim
- Molecular Imaging and Neurovascular Research (MINER) Laboratory, Dongguk University Ilsan Hospital, Goyang, Korea.,Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA ).,Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
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18
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Palekar RU, Jallouk AP, Lanza GM, Pan H, Wickline SA. Molecular imaging of atherosclerosis with nanoparticle-based fluorinated MRI contrast agents. Nanomedicine (Lond) 2016; 10:1817-32. [PMID: 26080701 DOI: 10.2217/nnm.15.26] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
As atherosclerosis remains one of the most prevalent causes of patient mortality, the ability to diagnose early signs of plaque rupture and thrombosis represents a significant clinical need. With recent advances in nanotechnology, it is now possible to image specific molecular processes noninvasively with MRI, using various types of nanoparticles as contrast agents. In the context of cardiovascular disease, it is possible to specifically deliver contrast agents to an epitope of interest for detecting vascular inflammatory processes, which serve as predecessors to atherosclerotic plaque development. Herein, we review various applications of nanotechnology in detecting atherosclerosis using MRI, with an emphasis on perfluorocarbon nanoparticles and fluorine imaging, along with theranostic prospects of nanotechnology in cardiovascular disease.
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Affiliation(s)
- Rohun U Palekar
- Department of Biomedical Engineering, Washington University, Whitaker Hall, Campus Box 1097, One Brookings Drive, St. Louis, MO 63130, USA
| | - Andrew P Jallouk
- Department of Medicine, Washington University, Campus Box 8215, 4320 Forest Park Avenue, St Louis, MO 63108, USA
| | - Gregory M Lanza
- Department of Biomedical Engineering, Washington University, Whitaker Hall, Campus Box 1097, One Brookings Drive, St. Louis, MO 63130, USA.,Department of Medicine, Washington University, Campus Box 8215, 4320 Forest Park Avenue, St Louis, MO 63108, USA
| | - Hua Pan
- Department of Medicine, Washington University, Campus Box 8215, 4320 Forest Park Avenue, St Louis, MO 63108, USA
| | - Samuel A Wickline
- Department of Biomedical Engineering, Washington University, Whitaker Hall, Campus Box 1097, One Brookings Drive, St. Louis, MO 63130, USA.,Department of Medicine, Washington University, Campus Box 8215, 4320 Forest Park Avenue, St Louis, MO 63108, USA
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19
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Langham MC, Desjardins B, Englund EK, Mohler ER, Floyd TF, Wehrli FW. Rapid High-resolution, Self-registered, Dual Lumen-contrast MRI Method for Vessel-wall Assessment in Peripheral Artery Disease:: A Preliminary Investigation. Acad Radiol 2016; 23:457-67. [PMID: 26916248 DOI: 10.1016/j.acra.2015.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES Contrast-enhanced angiographic evaluation by magnetic resonance imaging (MRI) and computed tomography (CT) is the reference standard for assessing peripheral artery disease (PAD). However, because PAD and diabetes often coexist, the prevalence of renal insufficiency is a major challenge to contrast-based angiography. The objective of this work is to describe and demonstrate a new application of three-dimensional double-echo steady-state (3D DESS) as a noncontrast vascular MRI method for evaluating peripheral atherosclerosis at 3 Tesla (3T). MATERIALS AND METHODS A water-selective 3D DESS pulse sequence was designed to simultaneously collect two steady-state free-precession signals (free induction decay and Echo) yielding "black blood" (BB) and "gray blood" (GB) images. For completeness Bloch equation, simulations were performed to characterize DESS signals of various tissues including blood at different velocities and to assess two healthy subjects for the purpose of pulse sequence optimization. Exploratory studies were performed as an add-on protocol to an existing study involving patients with PAD. To evaluate the method's specificity for detecting calcification, images from select patients were compared against CT angiography. RESULTS Simulations agreed qualitatively with in vivo images supporting DESS' potential for generating distinct lumen contrast (GB vs BB). Lesions representing calcium were easily identifiable on the basis of signal void occurring on both image types and were confirmed by CT angiography. Further, BB allowed visualization of stent restenosis, and data suggest its ability to visualize acute thrombus by virtue of T2 weighting. CONCLUSION Preliminary investigation and results suggest noncontrast 3D DESS to have the potential to improve diagnosis of PAD patients by providing detailed structural assessment of vessel-wall architecture.
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20
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Matsushige T, Chen B, Ringelstein A, Umutlu L, Forsting M, Quick HH, Sure U, Wrede KH. Giant Intracranial Aneurysms at 7T MRI. AJNR Am J Neuroradiol 2016; 37:636-41. [PMID: 26564437 DOI: 10.3174/ajnr.a4569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022]
Abstract
Giant intracranial aneurysms are rare vascular pathologies associated with high morbidity and mortality. The purpose of this in vivo study was to assess giant intracranial aneurysms and their wall microstructure by 7T MR imaging, previously only visualized in histopathologic examinations. Seven giant intracranial aneurysms were evaluated, and 2 aneurysms were available for histopathologic examination. Six of 7 (85.7%) showed intraluminal thrombus of various sizes. Aneurysm walls were depicted as hypointense in TOF-MRA and SWI sequences with excellent contrast ratios to adjacent brain parenchyma (range, 0.01-0.60 and 0.58-0.96, respectively). The triple-layered microstructure of the aneurysm walls was visualized in all aneurysms in TOF-MRA and SWI. This could be related to iron deposition in the wall, similar to the findings in 2 available histopathologic specimens. In vivo 7T TOF-MRA and SWI can delineate the aneurysm wall and the triple-layered wall microstructure in giant intracranial aneurysms.
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Affiliation(s)
- T Matsushige
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany Department of Neurosurgery (T.M.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - B Chen
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - A Ringelstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R., L.U., M.F.)
| | - L Umutlu
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R., L.U., M.F.)
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R., L.U., M.F.)
| | - H H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany High Field and Hybrid MR Imaging (H.H.Q.), University Hospital Essen, Essen, Germany
| | - U Sure
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - K H Wrede
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany
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21
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Morphological and functional carotid vessel wall properties in relation to cerebral white matter lesions in myocardial infarction patients. Neth Heart J 2015; 23:314-20. [PMID: 25963529 PMCID: PMC4446285 DOI: 10.1007/s12471-015-0693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective Atherosclerotic large vessel disease is potentially involved in the pathogenesis of cerebral small vessel disease related to occurrence of white matter lesions (WMLs) in the brain. We aimed to assess morphological and functional carotid vessel wall properties in relation to WML using magnetic resonance imaging (MRI) in myocardial infarction (MI) patients. Materials and methods A total of 20 MI patients (90 % male, 61 ± 11 years) underwent carotid artery and brain MRI. Carotid vessel wall thickness (VWT) was assessed, by detecting lumen and outer wall contours. Carotid pulse wave velocity (PWV), a measure of elasticity, was determined using the transit-time method. Patients were divided according to the median VWT into two groups. Brain MRI allowed for the WML score. Results Mean VWT was 1.41 ± 0.29 mm and mean carotid PWV was 7.0 ± 2.2 m/s. A significant correlation (Pearson r = 0.45, p = 0.046) between VWT and PWV was observed. Furthermore, in the group of high VWT, the median WML score was higher as compared with the group with lower VWT (4.0 vs 3.0, p = 0.035). Conclusions Carotid artery morphological and functional alterations are correlated in MI patients. Patients with high VWT showed a higher amount of periventricular WMLs. These findings support the hypothesis that atherosclerotic large vessel disease is potentially involved in the pathogenesis of cerebral small vessel disease.
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22
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Fang J, Chen CK, Peng JY, Hsu CH, Jeng YM, Lee YH, Lin JJ, Tsui PH. Changes in backscattered ultrasonic envelope statistics as a function of thrombus age: an in vitro study. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:498-508. [PMID: 25542488 DOI: 10.1016/j.ultrasmedbio.2014.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/11/2014] [Accepted: 09/18/2014] [Indexed: 06/04/2023]
Abstract
It is necessary to determine the age of thrombi in planning clinical treatment for thrombolysis. Ultrasound imaging can potentially be used to evaluate thrombus age in real time. The backscattered signals from thrombi may contain useful information regarding their age. On the basis of the randomness of ultrasound backscattering, this study explored changes in backscattered US statistics as a function of thrombus age. Porcine blood samples were used for the in vitro induction of fresh thrombi (day 0) with hematocrits ranging from 0%-40% and aged thrombi (days 0-8) with a hematocrit of 40%. Each thrombus was imaged using a pulse-echo ultrasound scanner equipped with a 7.5-MHz linear array transducer to acquire raw backscattered signals for B-mode and Nakagami imaging, by which the backscattered statistics were visualized. Hematoxylin and eosin staining and scanning electron microscopy were used to observe the histology of fresh and aged thrombi. The results indicated that a decrease in the number of red blood cells in the thrombus caused by the aging effect was observed in the in vitro model, indicating that the proposed model could simulate the structural changes in the thrombus during aging. Compared with fresh thrombi with various hematocrits, the aged thrombi exhibited a trend toward more substantial decreases in the Nakagami parameter with increasing thrombus age (the Nakagami parameter decreased from 1.1 to 0.6 as thrombus age increased from day 0 to day 8), indicating that thrombus aging causes the backscattered statistics to follow a pre-Rayleigh distribution to a high degree. This finding may be applied to the determination of thrombus age using conventional ultrasound imaging in the future.
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Affiliation(s)
- Jui Fang
- Ph.D. Program in Biomedical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ju-Yi Peng
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Hsin Hsu
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Ming Jeng
- Department of Pathology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsin Lee
- Department of Pathology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Jen Lin
- Department of Applied Statistics and Information Science, Ming Chuan University, Taoyuan, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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23
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Discrimination between newly formed and aged thrombi using empirical mode decomposition of ultrasound B-scan image. BIOMED RESEARCH INTERNATIONAL 2015; 2015:403293. [PMID: 25695073 PMCID: PMC4324496 DOI: 10.1155/2015/403293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/16/2014] [Indexed: 11/29/2022]
Abstract
Ultrasound imaging is a first-line diagnostic method for screening the thrombus. During thrombus aging, the proportion of red blood cells (RBCs) in the thrombus decreases and therefore the signal intensity of B-scan can be used to detect the thrombus age. To avoid the effect of system gain on the measurements, this study proposed using the empirical mode decomposition (EMD) of ultrasound image as a strategy to classify newly formed and aged thrombi. Porcine blood samples were used for the in vitro induction of fresh and aged thrombi (at hematocrits of 40%). Each thrombus was imaged using an ultrasound scanner at different gains (15, 20, and 30 dB). Then, EMD of ultrasound signals was performed to obtain the first and second intrinsic mode functions (IMFs), which were further used to calculate the IMF-based echogenicity ratio (IER). The results showed that the performance of using signal amplitude of B-scan to reflect the thrombus age depends on gain. However, the IER is less affected by the gain in discriminating between fresh and aged thrombi. In the future, ultrasound B-scan combined with the EMD may be used to identify the thrombus age for the establishment of thrombolytic treatment planning.
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Vidmar J, Kralj E, Bajd F, Serša I. Multiparametric MRI in characterizing venous thrombi and pulmonary thromboemboli acquired from patients with pulmonary embolism. J Magn Reson Imaging 2014; 42:354-61. [DOI: 10.1002/jmri.24816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/12/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jernej Vidmar
- Institute of Physiology; Medical Faculty, University of Ljubljana; Slovenia
- Jožef Stefan Institute; Ljubljana Slovenia
| | - Eduard Kralj
- Institute of Forensic Medicine; Medical Faculty, University of Ljubljana; Slovenia
| | - Franci Bajd
- Jožef Stefan Institute; Ljubljana Slovenia
- Faculty of Mathematics and Physics; University of Ljubljana; Slovenia
| | - Igor Serša
- Jožef Stefan Institute; Ljubljana Slovenia
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Xu WH, Li ML, Niu JW, Feng F, Jin ZY, Gao S. Luminal thrombosis in middle cerebral artery occlusions: a high-resolution MRI study. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:75. [PMID: 25333050 DOI: 10.3978/j.issn.2305-5839.2014.07.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/28/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND PURPOSE High signals within occluded vessels on T1-weighted fat-suppressed images (HST1) are highly suggestive of luminal thrombosis. We sought to investigate the feasibility of in vivo identification of luminal thrombosis in middle cerebral artery (MCA) occlusions using high-resolution magnetic resonance imaging (HR-MRI). METHODS We retrospectively reviewed the HR-MRI data of 25 patients with unilateral symptomatic MCA occlusion. HST1 were defined as an area of high signal within the cross-section of occluded MCA, the intensity of which was >150% of the signal of adjacent muscles. The prevalence of HST1 and their relationship to infarct sizes and infarct patterns were analyzed. RESULTS The average time from stroke onset to HR-MRI examination was 9±6 days. There were 18 (72%) occluded vessels with HST1 on HR-MRI. HST1 were observed in 5/7 patients with a large territory infarct (≥1/3 MCA distribution) and 13/18 patients without (P=0.37). In the patients with non-large territory infarcts, the presence of HST1 was similar in those with and without border zone infarcts (9/13 vs. 4/5, P=0.42). CONCLUSIONS It's feasible to in vivo identify luminal thrombosis in occluded MCA. HR-MRI is a potentially powerful tool for investigating the mechanisms of stroke due to MCA occlusions.
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Affiliation(s)
- Wei-Hai Xu
- 1 Departments of Neurology, 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Li Li
- 1 Departments of Neurology, 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing-Wen Niu
- 1 Departments of Neurology, 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Feng
- 1 Departments of Neurology, 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng-Yu Jin
- 1 Departments of Neurology, 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shan Gao
- 1 Departments of Neurology, 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Pazos-López P, Pozo E, Siqueira ME, García-Lunar I, Cham M, Jacobi A, Macaluso F, Fuster V, Narula J, Sanz J. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging 2014; 7:896-905. [PMID: 25129516 DOI: 10.1016/j.jcmg.2014.05.009] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the diagnostic value of CMR features for the differential diagnosis of cardiac masses. BACKGROUND Differentiation of cardiac tumors and thrombi and differentiation of benign from malignant cardiac neoplasms is often challenging but important in clinical practice. Studies assessing the value of cardiac magnetic resonance (CMR) in this regard are scarce. METHODS We reviewed the CMR scans of patients with a definite cardiac thrombus or tumor. Mass characteristics on cine, T1-weighted turbo spin echo (T1w-TSE) and T2-weighted turbo spin echo (T2w-TSE), contrast first-pass perfusion (FPP), post-contrast inversion time (TI) scout, and late gadolinium enhancement (LGE) sequences were analyzed. RESULTS There were 84 thrombi, 17 benign tumors, and 25 malignant tumors in 116 patients. Morphologically, thrombi were smaller (median area 1.6 vs. 8.5 cm(2); p < 0.0001), more homogeneous (99% vs. 46%; p < 0.0001), and less mobile (13% vs. 33%; p = 0.007) than tumors. Hyperintensity compared with normal myocardium on T2w-TSE, FPP, and LGE were more common in tumors than in thrombi (85% vs. 42%, 70% vs. 4%, and 71% vs. 5%, respectively; all p < 0.0001). A pattern of hyperintensity/isointensity (compared with normal myocardium) with short TI and hypointensity with long TI was very frequent in thrombi (94%), rare in tumors (2%), and had the highest accuracy (95%) for the differentiation of both entities. Regarding the characterization of neoplastic masses, malignant tumors were larger (median area 11.9 vs. 6.3 cm(2); p = 0.006) and more frequently exhibited FPP (84% vs. 47%; p = 0.03) and LGE (92% vs. 41%; p = 0.001). The ability of CMR features to distinguish benign from malignant neoplasms was moderate, with LGE showing the highest accuracy (79%). CONCLUSIONS CMR features demonstrated excellent accuracy for the differentiation of cardiac thrombi from tumors and can be helpful for the distinction of benign versus malignant neoplasms.
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Affiliation(s)
- Pablo Pazos-López
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Eduardo Pozo
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York
| | - Maria E Siqueira
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York
| | - Inés García-Lunar
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Matthew Cham
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York
| | - Adam Jacobi
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York
| | - Frank Macaluso
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York
| | - Valentín Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York
| | - Javier Sanz
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York.
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Dharmarajah B, Sounderajah V, Rowland SP, Leen ELS, Davies AH. Aging techniques for deep vein thrombosis: a systematic review. Phlebology 2014; 30:77-84. [DOI: 10.1177/0268355514528691] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Deep vein thrombosis is common with an incidence of 1 in 1000. Acute thrombus removal for extensive proximal deep vein thrombosis using catheter-directed techniques highlights the need for accurate assessment of thrombus age. This systematic review summarises experimental and clinical evidence of imaging techniques for aging deep vein thrombosis. Ultrasound elastography and magnetic resonance imaging were highlighted as the most studied imaging modalities. Elastography was shown to distinguish between acute and chronic clots, despite demonstrating difficulty in accurate aging of clots older than 10 days in rat models. Elastography is noted as a feasible adjunct to current first-line imaging for deep vein thrombosis using duplex ultrasonography. Combinations of magnetic resonance imaging techniques can identify acute, sub-acute and chronic thrombi using endogenous contrast agents and provide objective standardisation of the diagnostic process, with reduced onus upon operator dependency. Further validation is required of these novel imaging techniques prior to clinical implementation for deep vein thrombosis aging.
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Affiliation(s)
- B Dharmarajah
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Experimental Medicine, Imperial College London, London, UK
| | - V Sounderajah
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - SP Rowland
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - ELS Leen
- Division of Experimental Medicine, Imperial College London, London, UK
| | - AH Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Zhou Y, Murugappan SK, Sharma VK. Effect of clot aging and cholesterol content on ultrasound-assisted thrombolysis. Transl Stroke Res 2014; 5:627-34. [PMID: 24488442 DOI: 10.1007/s12975-014-0332-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/12/2014] [Accepted: 01/15/2014] [Indexed: 11/26/2022]
Abstract
Exposure to 2-MHz transcranial diagnostic ultrasound enhances the thrombolytic activity of intravenously administered tissue plasminogen activator (IV-tPA) in acute ischemic stroke (sonothrombolysis). However, rates of arterial recanalization vary widely, depending upon the clot burden, its location, and stroke subtype. We evaluated the influence of age and cholesterol level of the blood clots on sonothrombolysis in an in vitro model. To "age" the clots, serum was replaced by fresh blood periodically. We increased the cholesterol content of the clots by adding cholesterin to the blood. The clots were lysed by tPA and/or transcranial Doppler ultrasound sonication for 1 h. The extent of thrombolysis induced by various treatment protocols (controls, sonication, tPA, and sonothrombolysis) was evaluated with relative changes in the clot weights and in the clot structure by scanning electron microscopy (SEM) at end of the experiment. Sonothrombolysis induced significantly higher weight reduction in fresh clots (37.3 % in 2-h old clots versus 24.8 % in 10-h ones, p < 0.005) as well as the clots with higher cholesterol levels (41.7 versus 30.6 % in normal cholesterol clots, p < 0.005). SEM demonstrated patterns of clot dissolution among various treatment modalities. Sonothrombolysis induced better clot lysis in fresh thrombi with high cholesterol levels.
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Affiliation(s)
- Yufeng Zhou
- Division of Engineering Mechanics, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, Singapore, 639798,
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Phinikaridou A, Andia ME, Saha P, Modarai B, Smith A, Botnar RM. In vivo magnetization transfer and diffusion-weighted magnetic resonance imaging detects thrombus composition in a mouse model of deep vein thrombosis. Circ Cardiovasc Imaging 2013; 6:433-440. [PMID: 23564561 DOI: 10.1161/circimaging.112.000077] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Deep vein thrombosis remains a major health problem necessitating accurate diagnosis. Thrombolysis is associated with significant morbidity and is effective only for the treatment of unorganized thrombus. We tested the feasibility of in vivo magnetization transfer (MT) and diffusion-weighted magnetic resonance imaging to detect thrombus organization in a murine model of deep vein thrombosis. METHODS AND RESULTS Deep vein thrombosis was induced in the inferior vena cava of male BALB/C mice. Magnetic resonance imaging was performed at days 1, 7, 14, 21, and 28 after thrombus induction using MT, diffusion-weighted, inversion-recovery, and T1-mapping protocols. Delayed enhancement and T1 mapping were repeated 2 hours after injection of a fibrin contrast agent. Finally, excised thrombi were used for histology. We found that MT and diffusion-weighted imaging can detect histological changes associated with thrombus aging. MT rate (MTR) maps and percentage of MT rate (%MTR) allowed visualization and quantification of the thrombus protein content, respectively. The %MTR increased with thrombus organization and was significantly higher at days 14, 21, and 28 after thrombus induction (days 1, 7, 14, 21, 28: %MTR=2483±451, 2079±1210, 7029±2490, 10 295±4356, 32 994±25 449; PANOVA<0.05). There was a significant positive correlation between the %MTR and the histological protein content of the thrombus (r=0.70; P<0.05). The apparent diffusion coefficient was lower in erythrocyte-rich and collagen-rich thrombus (0.72±0.10 and 0.69±0.05 [×10(-3) mm(2)/s]). Thrombus at days 7 and 14 had the highest apparent diffusion coefficient values (0.95±0.09 and 1.10±0.18 [×10(-3) mm(2)/s]). CONCLUSIONS MT and diffusion-weighted magnetic resonance imaging sequences are promising for the staging of thrombus composition and could be useful in guiding medical intervention.
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Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Marcelo E Andia
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Prakash Saha
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Bijan Modarai
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - Alberto Smith
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
| | - René M Botnar
- Division of Imaging Science and Biomedical Engineering (A.P., M.E.A., R.M.B.), Cardiovascular Division, Academic Department of Surgery (P.S., B.M., A.S.), Cardiovascular Division, BHF Centre of Excellence (A.P., P.S., A.S., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B.), King's College London, London, UK; and Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.)
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Phinikaridou A, Andia ME, Shah AM, Botnar RM. Advances in molecular imaging of atherosclerosis and myocardial infarction: shedding new light on in vivo cardiovascular biology. Am J Physiol Heart Circ Physiol 2012; 303:H1397-410. [PMID: 23064836 DOI: 10.1152/ajpheart.00583.2012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular imaging of the cardiovascular system heavily relies on the development of new imaging probes and technologies to facilitate visualization of biological processes underlying or preceding disease. Molecular imaging is a highly active research discipline that has seen tremendous growth over the past decade. It has broadened our understanding of oncologic, neurologic, and cardiovascular diseases by providing new insights into the in vivo biology of disease progression and therapeutic interventions. As it allows for the longitudinal evaluation of biological processes, it is ideally suited for monitoring treatment response. In this review, we will concentrate on the major accomplishments and advances in the field of molecular imaging of atherosclerosis and myocardial infarction with a special focus on magnetic resonance imaging.
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Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Science and Biomedical Engineering, King's College London, United Kingdom.
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Phinikaridou A, Qiao Y, Giordano N, Hamilton JA. Detection of thrombus size and protein content by ex vivo magnetization transfer and diffusion weighted MRI. J Cardiovasc Magn Reson 2012; 14:45. [PMID: 22731842 PMCID: PMC3419091 DOI: 10.1186/1532-429x-14-45] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/06/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To utilize a rabbit model of plaque disruption to assess the accuracy of different magnetic resonance sequences [T1-weighted (T1W), T2-weighted (T2W), magnetization transfer (MT) and diffusion weighting (DW)] at 11.7 T for the ex vivo detection of size and composition of thrombus associated with disrupted plaques. METHODS Atherosclerosis was induced in the aorta of male New Zealand White rabbits (n = 17) by endothelial denudation and high-cholesterol diet. Subsequently, plaque disruption was induced by pharmacological triggering. Segments of infra-renal aorta were excised fixed in formalin and examined by ex vivo magnetic resonance imaging (MRI) at 11.7 T and histology. RESULTS MRI at 11.7 T showed that: (i) magnetization transfer contrast (MTC) and diffusion weighted images (DWI) detected thrombus with higher sensitivity compared to T1W and T2W images [sensitivity: MTC = 88.2%, DWI = 76.5%, T1W = 66.6% and T2W = 43.7%, P < 0.001]. Similarly, the contrast-to-noise (CNR) between the thrombus and the underlying plaque was superior on the MTC and DWI images [CNR: MTC = 8.5 ± 1.1, DWI = 6.0 ± 0.8, T1W = 1.8 ± 0.5, T2W = 3.0 ± 1.0, P < 0.001]; (ii) MTC and DWI provided a more accurate detection of thrombus area with histology as the gold-standard [underestimation of 6% (MTC) and 17.6% (DWI) compared to an overestimation of thrombus area of 53.7% and 46.4% on T1W and T2W images, respectively]; (iii) the percent magnetization transfer rate (MTR) correlated with the fibrin (r = 0.73, P = 0.003) and collagen (r = 0.9, P = 0.004) content of the thrombus. CONCLUSIONS The conspicuity of the thrombus was increased on MTC and DW compared to T1W and T2W images. Changes in the %MTR and apparent diffusion coefficient can be used to identify the organization stage of the thrombus.
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Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA, USA
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nick Giordano
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - James A Hamilton
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
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Vidmar J, Blinc A, Kralj E, Balažic J, Bajd F, Serša I. An MRI study of the differences in the rate of thrombolysis between red blood cell-rich and platelet-rich components of venous thrombi ex vivo. J Magn Reson Imaging 2012; 34:1184-91. [PMID: 22006553 DOI: 10.1002/jmri.22731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To test whether T(1)-weighted MRI can detect the differences in the rate of thrombolysis induced by recombinant tissue plasminogen activator (rt-PA) between platelet-rich regions and red blood cell (RBC)-rich regions of venous thrombi ex vivo. MATERIALS AND METHODS Each of 21 venous thrombi ex vivo (8 pulmonary emboli and 13 in situ thrombi) was dissected along the longitudinal axis. Half of it was analyzed for the presence of platelet, fibrin, and RBC components by immunohistochemistry and the other half was imaged serially by high-resolution T(1)-weighted three-dimensional MRI to assess the progression of thrombolysis. The MR images were analyzed for proportions of the remaining platelet-rich and RBC-rich regions. RESULTS Laminated platelet-rich regions, corresponding to Zahn lines, were confirmed immunohistochemically and by MRI in 18/21 venous thrombi. In T(1)-weighted MR images (TE/TR = 10/105 ms) the mean signal intensity of platelet-rich regions was on average 2.3 higher than that of RBC-rich regions. The rate of thrombolysis in platelet-rich regions was on average 30% lower than in RBC-rich regions. After 120 min of thrombolysis the proportion of lysed platelet-rich regions was 0.27 ± 0.04 versus 0.40 ± 0.08 in RBC regions, which resulted in 1.4% decrease of lysed thrombus volume per 1% increase of platelet-rich content. CONCLUSION Venous thrombi are most often composed of interspersed platelet-rich and RBC-rich regions. T(1) -weighted MRI is capable of noninvasive discrimination between those two components of venous thrombi ex vivo which have a different susceptibility to thrombolysis by rt-PA.
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Affiliation(s)
- Jernej Vidmar
- Institute of Physiology, Medical faculty of Ljubljana, Slovenia
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Yang E, Vargas JD, Bluemke DA. Understanding the genetics of coronary artery disease through the lens of noninvasive imaging. Expert Rev Cardiovasc Ther 2012; 10:27-36. [PMID: 22149524 PMCID: PMC3482161 DOI: 10.1586/erc.11.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary artery disease is a common condition with a known heritable component that has spurred interest in genetic research for decades, resulting in a handful of candidate genes and an appreciation for the complexity of its genetic contributions. Recent advances in sequencing technologies have resulted in large-scale association studies, possibly adding to our current understanding of the genetics of coronary artery disease. Sifting through the statistical noise, however, requires the selection of effective phenotypic markers. New imaging technologies have improved our ability to detect subclinical atherosclerosis in a safe and reproducible manner in large numbers of patients. In this article, we propose that advances in imaging technology have generated improved phenotypic markers for genetic association studies of coronary artery disease.
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Affiliation(s)
| | - Jose D Vargas
- Radiology and Imaging Sciences, National Institutes of Health
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Dr, Rm 10/1C355, Bethesda, MD, 20892
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Kuroiwa Y, Yamashita A, Miyati T, Furukoji E, Takahashi M, Azuma T, Sugimura H, Asanuma T, Tamura S, Kawai K, Asada Y. MR signal change in venous thrombus relates organizing process and thrombolytic response in rabbit. Magn Reson Imaging 2011; 29:975-84. [DOI: 10.1016/j.mri.2011.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 04/18/2011] [Accepted: 04/22/2011] [Indexed: 10/18/2022]
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Paunipagar BK, Rasalkar DD, Ng A, Griffith JF, Bagaria V. Intravascular papillary endothelial hyperplasia: report of two cases. Acta Radiol 2011; 52:499-502. [PMID: 21498284 DOI: 10.1258/ar.2011.100482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intravascular papillary endothelial hyperplasia is a rare benign vascular proliferative process as a result of papillary proliferation of the endothelial cells within the vascular lumen. We report two cases of intravascular papillary endothelial hyperplasia affecting the extremities. The characteristic sonological and MR imaging features are discussed, with updated review of literature. Imaging features are helpful in achieving a definitive diagnosis of the intravascular papillary endothelial hyperplasia.
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Affiliation(s)
- Bhawan K Paunipagar
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, ChinaSAR
| | - Darshana D Rasalkar
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, ChinaSAR
| | - Alex Ng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, ChinaSAR
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, ChinaSAR
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MRI discriminates thrombus composition and ST resolution after percutaneous coronary intervention in patients with ST-elevation myocardial infarction. PLoS One 2011; 6:e18459. [PMID: 21494632 PMCID: PMC3072998 DOI: 10.1371/journal.pone.0018459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 03/08/2011] [Indexed: 11/19/2022] Open
Abstract
Histological composition of material obtained by thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (STEMI) is highly variable. We aimed to characterize this material using magnetic resonance imaging (MRI) and to correlate MRI findings with the success of PCI in terms of ST-segment resolution. Thrombus aspiration during primary or rescue PCI was attempted in 100 consecutive STEMI patients, of whom enough material for MRI was obtained in 59. MR images were obtained at 9.4T and T1 and T2 values were measured. Patients with (n = 31) and without (n = 28) adequate ST resolution 120 min after PCI (≥70% of pre-PCI value) had similar baseline characteristics except for a higher prevalence of diabetes mellitus in the latter (10 vs. 43%, p = 0.003). T1 values were similar in both groups (1248±112 vs. 1307±85 ms, respectively, p = 0.7). T2 values averaged 31.2±10.3 and 36.6±12.2 ms; in thrombus from patients with and without adequate ST resolution (p = 0.09). After adjusting for diabetes and other baseline characteristics, lower T2 values were significantly associated with inadequate ST resolution (odds ratio for 1 ms increase 1.08, CI 95% 1.01-1.16, p = 0.027). Histology classified thrombus in 3 groups: coagulated blood (n = 38), fibrin rich (n = 9) and lipid-rich (n = 3). Thrombi composed mostly of coagulated blood were characterized as being of short (n = 10), intermediate (n = 15) or long evolution (n = 13), T2 values being 34.0±13.2, 31.9±8.3 and 31.5±7.9 ms respectively (p = NS). In this subgroup, T2 was significantly higher in specimens from patients with inadequate perfusion (35.9±10.3 versus 28.6±6.7 ms, p = 0.02). This can be of clinical interest as it provides information on the probability of adequate ST resolution, a surrogate for effective myocardial reperfusion.
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In vivo MR imaging of plaque disruption and thrombus formation in an atherosclerotic rabbit model. Int J Cardiovasc Imaging 2011; 28:577-86. [PMID: 21461662 DOI: 10.1007/s10554-011-9854-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
Abstract
Our aim is to introduce an atherosclerotic rabbit model for inducing atherosclerosis lesions in rabbits, and to validate the model in vivo with 3T high resolution magnetic resonance imaging of the thrombosis followed a pharmacologically triggered plaque disruption. Twenty male New Zealand White rabbits were randomly allocated into an experimental group (n = 16) and a control group (n = 4). The aortic wall injuries were induced by an intravascular balloon in the experimental group rabbits after feeding them with a high cholesterol diet for 2 weeks. The pharmacological triggering with Russell's viper venom and histamine was performed after totally 16 weeks of intermittent cholesterol feeding. All of the animals underwent both the pre-trigger and post-trigger MR examinations including TOF, T1WI, T2WI and post contrast T1WI. Euthanasia was performed in all rabbits; gross anatomy and histological specimen of aorta were obtained. MR images were analyzed and compared with histological results. Compared with the control group rabbits, the aorta of the experimental group rabbits in the pre-triggered MR images showed an increased vessel wall thickening, luminal narrowing, and vessel wall enhancement. Fourteen rabbits survived the triggering, and 8 of them developed thrombosis (58.1%). No thrombus was found in the control group. The accuracy of the multi-sequences MR including TOF, T1WI, T2WI and post contrast T1WI was 87.1% (27/31) for detecting thrombus. MR data significantly correlated with the histopathology data for both thrombus length (r = 0.94, P < 0.01) and thrombus location (r = 0.85, P < 0.01), respectively. The study demonstrated that MR reliably determined the plaque disruption and thrombus formation in the atherosclerotic rabbit model.
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Abstract
Vessel wall imaging of large vessels has the potential to identify culprit atherosclerotic plaques that lead to cardiovascular events. Comprehensive assessment of atherosclerotic plaque size, composition, and biological activity is possible with magnetic resonance imaging (MRI). Magnetic resonance imaging of the atherosclerotic plaque has demonstrated high accuracy and measurement reproducibility for plaque size. The accuracy of in vivo multicontrast MRI for identification of plaque composition has been validated against histological findings. Magnetic resonance imaging markers of plaque biological activity such as neovasculature and inflammation have been demonstrated. In contrast to other plaque imaging modalities, MRI can be used to study multiple vascular beds noninvasively over time. In this review, we compare the status of in vivo plaque imaging by MRI to competing imaging modalities. Recent MR technological improvements allow fast, accurate, and reproducible plaque imaging. An overview of current MRI techniques required for carotid plaque imaging including hardware, specialized pulse sequences, and processing algorithms are presented. In addition, the application of these techniques to coronary, aortic, and peripheral vascular beds is reviewed.
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Martin AJ, Hetts SW, Dillon WP, Higashida RT, Halbach V, Dowd CF, Lawton MT, Saloner D. MR imaging of partially thrombosed cerebral aneurysms: characteristics and evolution. AJNR Am J Neuroradiol 2010; 32:346-51. [PMID: 21087941 DOI: 10.3174/ajnr.a2298] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A comprehensive evaluation of aneurysmal morphometry requires appreciation of both the vascular lumen and the intraluminal thrombus. MR imaging methods can both evaluate the lumen and directly image the vessel wall. We investigated the ability of T1-weighted, T2-weighted, and steady-state MR imaging techniques to delineate thrombus morphology and reveal changes with time. MATERIALS AND METHODS Nine patients with fusiform basilar or intracranial vertebral artery aneurysms that contained intraluminal thrombus were studied with MR imaging. All patients underwent at least 2 imaging sessions, which were separated by 4-22 months. Analysis of signal intensity to determine the mean signal intensity from thrombus, blood, CSF, and brain in matched regions was performed. Aneurysm maximal diameter and cross-sectional area were determined with and without thrombus. RESULTS Thrombus was identified on all image sequences, and its general appearance was consistent between imaging sessions. Thrombus produced the highest and most consistent signal intensities with T1-weighted and steady-state techniques, though the latter showed superior contrast between luminal blood and thrombus. Heterogeneity within clot was evident in 4/9 of patients, with peripheral hyperintensity being a common feature. CONCLUSIONS Steady-state imaging was found to be superior to T1- and T2-weighted imaging for delineating and characterizing intraluminal thrombus within aneurysms. The imaging characteristics of intraluminal thrombus proved to be very consistent for long periods. Assessment of overall aneurysm size, including thrombosed portions, permits more accurate evaluation of aneurysm growth and concomitantly may permit more informed clinical decision-making with regard to the timing and need for aneurysm treatment.
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Affiliation(s)
- A J Martin
- Department of Radiology, University of California, San Francisco, 94143, USA.
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Wang Q, Wang Y, Cai J, Cai Y, Ma L, Xu X. Differences of signal evolution of intraplaque hemorrhage and associated stenosis between symptomatic and asymptomatic atherosclerotic carotid arteries: an in vivo high-resolution magnetic resonance imaging follow-up study. Int J Cardiovasc Imaging 2010; 26:323-32. [PMID: 20730495 DOI: 10.1007/s10554-010-9686-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 01/09/2023]
Abstract
To evaluate the differences of signal evolution of intraplaque hemorrhage (IPH) and associated stenosis between symptomatic and asymptomatic atherosclerotic carotid arteries. Thirty-three carotid arteries (15 symptomatic and 18 asymptomatic plaques) with recent carotid IPH underwent serial high-resolution MRI examinations on a 3.0-Tesla (3.0T) MRI scanner over a period of 18 months. MR sequences included three-dimensional time-of-flight (3D-TOF), quadruple-inversion-recovery T1-weighted imaging (QIR T1 WI), proton density-weighted imaging (PDWI), and T2-weighted imaging (T2WI). The contrast-to-noise ratios (CNRs) of subsequent IPH during the follow-up period between symptomatic and asymptomatic carotid IPH showed a significant difference on 3D-TOF (P = 0.029), T1 WI (P = 0.005), and PDWI (P = 0.028), except for that on T2WI (P = 0.362). Compared with no significant signal intensity change of symptomatic IPH, CNRs of asymptomatic IPH exhibited a gradually descending trend on all contrast weighted images (P < 0.05). Compared with asymptomatic arteries, the degree of diameter stenosis associated with IPH increased significantly in the symptomatic atherosclerotic carotid arteries between baseline and the 18th month (10.53 ± 12.29% vs. 1.65 ± 7.74%, P = 0.017). Symptomatic and asymptomatic carotid IPH demonstrated different MRI signal evolution and associated carotid stenosis. Repeated carotid IPH may be more common in symptomatic plaques than in asymptomatic plaques and might produce a stronger stimulus for progression of atherosclerosis than one-time carotid IPH.
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Affiliation(s)
- Qingjun Wang
- Department of Radiology, Chinese PLA General Hospital, #28 Fuxing Road, 100853, Beijing, China
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Oei ML, Ozgun M, Seifarth H, Bunck A, Fischbach R, Orwat S, Heindel W, Botnar R, Maintz D. T1-weighted MRI for the detection of coronary artery plaque haemorrhage. Eur Radiol 2010; 20:2817-23. [PMID: 20677007 DOI: 10.1007/s00330-010-1878-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 06/01/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Hyperintense areas in atherosclerotic plaques on pre-contrast T1-weighted MRI have been shown to correlate with intraplaque haemorrhage. We evaluated the presence of T1 hyperintensity in coronary artery plaques in coronary artery disease (CAD) patients and correlated results with multi-detector computed tomography (MDCT) findings. METHODS Fifteen patients with CAD were included. Plaques detected by MDCT were categorised based on their Hounsfield number. T1-weighted inversion recovery (IR) MRI prepared coronary MRI for the detection of plaque and steady-state free-precession coronary MR-angiography for anatomical correlation was performed. After registration of MDCT and MRI, regions of interest were defined on MDCT-visible plaques and in corresponding vessel segments acquired with MRI. MDCT density and MR signal measurement were performed in each plaque. RESULTS Forty-three plaques were identified with MDCT. With IR-MRI 5/43 (12%) plaques were hyperintense, 2 of which were non-calcified and 3 mixed. Average signal-to-noise and contrast-to-noise ratios of hyperintense plaques were 15.7 and 9.1, compared with 5.6 and 1.2 for hypointense plaques. Hyperintense plaques exhibited a significantly lower CT density than hypointense plaques (63.6 vs. 140.8). There was no correlation of plaque signal intensity with degree of stenosis. CONCLUSION T1-weighted IR-MRI may be useful for non-invasive detection and characterisation of intraplaque haemorrhage in coronary artery plaques.
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Affiliation(s)
- May Lin Oei
- Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany
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Fifi JT, Komotar R, Meyers P, Khandji A, Tanji K, Connolly ES. Restricted diffusion in a thrombosed anterior cerebral artery aneurysm mimicking a dermoid cyst. J Neuroimaging 2010; 22:85-8. [PMID: 20572913 DOI: 10.1111/j.1552-6569.2010.00495.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A neurologically intact 37-year-old woman presented with an acute severe frontal headache after a month of intermittent headaches. Multimodal radiological examination including computed tomography scan, magnetic resonance imaging, and conventional angiography demonstrated a 1 cm mass in the anterior interhemispheric region with heterogenous calcifications. Of note, MR revealed restricted diffusion within the mass. The presumptive diagnosis of dermoid tumor was made and the patient was scheduled for surgical resection. On operative exploration, a 1 cm thrombosed aneurysm was revealed. Thrombosed aneurysms must be considered in the differential diagnosis for midline cerebral masses with negative angiogram and restricted diffusion. This distinction has implications for the clinical management of the patient.
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Affiliation(s)
- Johanna T Fifi
- Department of Neurology and Radiology, St. Lukes Roosevelt Hospital, New York, NY 10025, USA.
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43
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Recent developments and new perspectives on imaging of atherosclerotic plaque: role of anatomical, cellular and molecular MRI Part I and II. Int J Cardiovasc Imaging 2010; 26:433-45. [DOI: 10.1007/s10554-009-9565-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
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Oppenheim C, Naggara O, Touzé E, Lacour JC, Schmitt E, Bonneville F, Crozier S, Guégan-Massardier E, Gerardin E, Leclerc X, Neau JP, Sirol M, Toussaint JF, Mas JL, Méder JF. High-resolution MR imaging of the cervical arterial wall: what the radiologist needs to know. Radiographics 2009; 29:1413-31. [PMID: 19755603 DOI: 10.1148/rg.295085183] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The emergence of high-resolution rapid imaging methods has enabled magnetic resonance (MR) imagers to noninvasively image the fine internal structure of cervical arterial walls. In this article, a comprehensive guide to performing high-resolution MR imaging of cervical arteries is provided, including the choice of coils, sequences, and imaging parameters, as well as tips for optimal image quality. Explanations and illustrations are given of using high-resolution MR imaging to quantify plaque volume, determine atherosclerotic plaque burden, depict plaque composition, and ultimately identify unstable plaque before it leads to a clinical event. Finally, the role of high-resolution MR imaging in the diagnosis of cervical dissection and inflammatory disease of the arterial wall is emphasized.
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Affiliation(s)
- Catherine Oppenheim
- Department of Imaging, Université Paris Descartes, EA 4055, Centre Hospitalier Sainte-Anne, 1, Rue Cabanis, 75674 Paris Cedex 14, France.
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45
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MRI of subclinical coronary atherosclerosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Juan YH, Huang GS, Chiu YC, Chang WC, Hsu YC. Intravascular papillary endothelial hyperplasia of the calf in an infant: MR features with histological correlation. Pediatr Radiol 2009; 39:282-5. [PMID: 19093106 DOI: 10.1007/s00247-008-1074-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 09/05/2008] [Accepted: 09/21/2008] [Indexed: 11/25/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson tumour, is a rare nonneoplastic vascular lesion caused by the abnormal proliferation of endothelial cells. IPEH presenting as a soft-tissue mass may simulate a sarcomatous tumour clinically and radiographically. We report an infant with IPEH affecting the right calf. The MRI appearance is described, and the literature is briefly reviewed. Knowledge of the MR characteristics of IPEH may facilitate its diagnosis and obviate an invasive procedure.
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Affiliation(s)
- Yu-Hsiu Juan
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325, Sec.2, Cheng-Kung Rd, Neihu 114, Taipei, Taiwan, Republic of China
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MR imaging of thrombi using EP-2104R, a fibrin-specific contrast agent: initial results in patients. Eur Radiol 2008; 18:1995-2005. [PMID: 18425519 DOI: 10.1007/s00330-008-0965-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Revised: 02/23/2008] [Accepted: 03/05/2008] [Indexed: 12/19/2022]
Abstract
This study was an initial phase II trial in humans of molecular magnetic resonance (MR) imaging for improved visualization of thrombi in vessel territories potentially responsible for stroke using a new fibrin-specific contrast agent (EP-2104R). Eleven patients with thrombus in the left ventricle (n = 2), left or right atrium (n = 4), thoracic aorta (n = 4) or carotid artery (n = 1) as verified by an index examination (ultrasound, computed tomograpy, or conventional MR) were enrolled. All MR imaging was performed on 1.5 T whole-body MR-system using an inversion-recovery black-blood gradient-echo sequence. The same sequence was performed before and 2-6 h after low-dose intravenous administration of 4 mumol/kg EP-2104R. Two investigators assessed image quality and signal amplification. Furthermore, contrast-to-noise ratios (CNR) between the clot and the blood pool/surrounding soft tissue before and after administration of the contrast agent were compared using Student's t-test. MR imaging and data analysis were successfully completed in 10 patients. No major adverse effects occurred. On enhanced images, thrombi demonstrated high signal amplification, typically at the clot surface, with a significantly increased contrast in comparison to the surrounding blood pool and soft tissue (CNR for clot vs. blood pool, unenhanced and enhanced: 6 +/- 8 and 29 +/- 14; CNR for clot vs. soft tissue, unenhanced and enhanced: 0 +/- 4 and 21 +/- 13; P < 0.01 for both comparisons). EP-2104R allows for molecular MR imaging of thrombi potentially responsible for stroke. High contrast between thrombus and surrounding blood and soft tissues can be achieved with enhanced imaging.
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IRM haute résolution de l’athérosclérose carotidienne :au-delà de la lumière artérielle. ACTA ACUST UNITED AC 2008; 89:293-301. [DOI: 10.1016/s0221-0363(08)93003-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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49
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Spuentrup E, Katoh M, Buecker A, Fausten B, Wiethoff AJ, Wildberger JE, Haage P, Parsons EC, Botnar RM, Graham PB, Vettelschoss M, Günther RW. Molecular MR imaging of human thrombi in a swine model of pulmonary embolism using a fibrin-specific contrast agent. Invest Radiol 2007; 42:586-95. [PMID: 17620942 DOI: 10.1097/rli.0b013e31804fa154] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Molecular targeted MR imaging of human clots material in a model of pulmonary embolism using a fibrin-specific magnetic resonance imaging contrast agent (EP-2104R, EPIX Pharmaceuticals, Cambridge, MA). MATERIAL AND METHODS Fresh ex vivo engineered thrombi (human blood) and human clots removed from patients were delivered in 11 swine. Molecular MR imaging with a 3D gradient-echo [3D fast field echo (3DFFE)] sequence and a navigator-gated and cardiac-triggered 3D inversion-recovery black-blood gradient-echo sequence (IR) was performed before thrombus delivery, after thrombus delivery but before contrast media application, and 2 hours after i.v. administration of 4 micromol/kg EP-2104R. MR images were analyzed by 2 investigators and contrast-to-noise ratio (CNR) was assessed. Thrombi were removed for assessment of gadolinium (Gd) concentration. RESULTS Only after contrast media application were pulmonary emboli [freshly engineered thrombi (n = 23) and human clot material removed from patients (n = 25)] visualized as white foci on MR images. CNR was 13 +/- 3 (ex vivo engineered clot) and 22 +/- 9 (patient clot material) for the fast field echo (FFE)-sequence and 29 +/- 9 (ex vivo engineered clot) and 43 +/- 18 (patient clot material) for the IR-sequence, respectively. A high Gd concentration in the clots was found (82 +/- 43 microM for the freshly engineered and 247 +/- 44 microM for the clots removed from patients, respectively). CONCLUSIONS EP-2104R allows for molecular MR imaging of human clot material in the pulmonary vessels of a swine model.
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Affiliation(s)
- Elmar Spuentrup
- Departments of Diagnostic Radiology, Aachen Technical University, Aachen, Germany.
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Saam T, Hatsukami TS, Takaya N, Chu B, Underhill H, Kerwin WS, Cai J, Ferguson MS, Yuan C. The vulnerable, or high-risk, atherosclerotic plaque: noninvasive MR imaging for characterization and assessment. Radiology 2007; 244:64-77. [PMID: 17581895 DOI: 10.1148/radiol.2441051769] [Citation(s) in RCA: 276] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
"Vulnerable" plaques are atherosclerotic plaques that have a high likelihood to cause thrombotic complications, such as myocardial infarction or stroke. Plaques that tend to progress rapidly are also considered to be vulnerable. Besides luminal stenosis, plaque composition and morphology are key determinants of the likelihood that a plaque will cause cardiovascular events. Noninvasive magnetic resonance (MR) imaging has great potential to enable characterization of atherosclerotic plaque composition and morphology and thus to help assess plaque vulnerability. A classification for clinical, as well as pathologic, evaluation of vulnerable plaques was recently put forward in which five major and five minor criteria to define vulnerable plaques were proposed. The purpose of this review is to summarize the status of MR imaging with regard to depiction of the criteria that define vulnerable plaques by using existing MR techniques. The use of MR imaging in animal models and in human disease in various vascular beds, particularly the carotid arteries, is presented.
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Affiliation(s)
- Tobias Saam
- Department of Radiology, University of Washington, Seattle, Washington, USA.
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