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Yan H, Geng D, Zhao W, Li S, Du X, Zhang S, Wang H. Differences in intracranial atherosclerosis plaque between posterior circulation and anterior circulation on high-resolution magnetic resonance imaging: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107616. [PMID: 38316284 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The clinical characteristics and mechanisms of stroke caused by anterior circulation atherosclerotic plaques (ACAPs) and posterior circulation atherosclerotic plaques (PCAPs) are distinct. We aimed to compare the differences in vulnerability, morphology, and distribution between ACAPs and PCAPs based on hign-resolution magnetic resonance imaging (HR-MRI). MATERIALS AND METHODS The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database were retrieved from inception through May 2023. Meta-analysis was performed by R 4.2.1 software. The quality of the literature was assessed by the Agency for Healthcare Research and Quality (AHRQ). Subgroup analysis was conducted to explore the heterogeneity of the pooled results. RESULTS There were a total of 13 articles, including 1194 ACAPs and 1037 PCAPs. The pooled estimates demonstrated that the incidence of intraplaque hemorrhage in the PCAPs was higher (OR 1.72, 95%CI 1.35-2.18). The plaque length (SMD 0.23, 95%CI 0.06-0.39) and remodeling index (SMD 0.29, 95%CI 0.14-0.44) of PCAPs were larger than those in ACAPs. However, there were no evident differences in significant enhancement or stenosis degree between the two groups. CONCLUSION There were more unstable features in PCAPs, highlighting an elevated risk of recurrent ischemic stroke in the posterior circulation. Furthermore, PCAPs were prone to developing penetrating artery disease due to their wider distribution. Nevertheless, posterior circulation arteries exhibited a greater propensity for outward remodeling, which may lead treatment team to miss the optimal intervention stage by being overlooked on angiographic detection.
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Affiliation(s)
- Han Yan
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Dandan Geng
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Wannian Zhao
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Shasha Li
- Hebei North University, Zhangjiakou, Hebei, China.
| | - Xiaomeng Du
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Shijing Zhang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China; Hebei North University, Zhangjiakou, Hebei, China.
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China; Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China.
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Li S, Tang M, Zhang D, Han F, Zhou L, Yao M, Li M, Cui L, Zhang S, Peng B, Jin Z, Zhu Y, Ni J. The prevalence and prognosis of asymptomatic intracranial atherosclerosis in a community-based population: Results based on high-resolution magnetic resonance imaging. Eur J Neurol 2023; 30:3761-3771. [PMID: 37738517 DOI: 10.1111/ene.16057] [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: 05/16/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke in China, but the prevalence and prognosis of asymptomatic ICAD detected using high-resolution magnetic resonance imaging (HR-MRI) is largely unknown. The aim of this study was to investigate the prevalence and prognosis in order to guide neurologists in interpreting ICAD detected on HR-MRI. METHODS We included stroke-free participants from a community-based prospective cohort (Shunyi study participants) who underwent HR-MRI between July 2014 and April 2016. The participants were divided into two groups: those with or without ICAD (ICAD+ and ICAD- , respectively). ICAD included intracranial artery stenosis and non-stenotic plaque. The primary outcome was ischemic stroke. Cox proportional hazard models were used to evaluate the association between ICAD and event outcomes. RESULTS A total of 1060 stroke-free participants evaluated by HR-MRI were included from the Shunyi study. The median age at HR-MRI was 56 years and 64.7% were female. The ICAD prevalence was 36.3% (n = 385). The ICAD+ group was older and had more cerebrovascular risk factors. The rates of ischemic stroke in the ICAD- and ICAD+ groups were 1.3% (n = 9) and 5.2% (n = 20), respectively, with a median follow-up time of 54 months. ICAD was associated with an increased risk of ischemic stroke in the unadjusted and adjusted Cox models, with hazard ratios of 4.12 (95% confidence interval [CI] 1.87-9.05) and 2.50 (95% CI 1.05-5.94), respectively. The greatest risk of an event outcome was observed in participants with ≥70% stenosis or occlusion. The features of high-risk plaques were also identified. CONCLUSIONS We found that ICAD detected using HR-MRI increases the long-term risk of a first-ever ischemic stroke in a stroke-free population, suggesting that the current primary prevention protocol of stroke awaits further optimization.
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Affiliation(s)
- Shengde Li
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mingyu Tang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dingding Zhang
- Medical Research Center, State Key laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lixin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mingli Li
- Department of Radiology, State Key laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Peng
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, State Key laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Sun J, Mossa-Basha M, Canton G, Balu N, Guo Y, Chen L, Xu D, Hippe DS, Pimentel KD, Hatsukami TS, Yuan C. Characterization of non-stenotic plaques in intracranial arteries with multi-contrast, multi-planar vessel wall image analysis. J Stroke Cerebrovasc Dis 2022; 31:106719. [PMID: 35994880 PMCID: PMC9509474 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Non-stenotic plaques have been observed in intracranial arteries but are less understood compared to those in coronary and carotid arteries. We sought to compare plaque distribution and morphology between stenotic and non-stenotic intracranial plaques with MR vessel wall imaging (VWI) and quantitative image analysis. MATERIALS AND METHODS Twenty-four patients with intracranial arterial stenosis or luminal irregularity on clinical imaging were scanned with a multi-contrast VWI protocol. Plaques were detected as focal wall thickening on co-registered multiplanar reformats of multi-contrast VWI, with assessment of the location and morphology. TOF-MRA was independently reviewed for any appreciable stenosis using the WAISD criteria. RESULTS Across 504 arterial segments, a total of 80 plaques were detected, including 23 (29%) with stenosis on TOF-MRA, 56 (70%) without, and 1 (1%) not covered by TOF-MRA. Plaques involving the ICA were more likely to be non-stenotic than those involving other segments (80% versus 55%, p = 0.030) whereas the basilar artery (40%) and PCA (33%) had the lowest proportions of non-stenotic plaques. Maximum wall thickness, indicative of plaque burden, correlated poorly with degree of stenosis (p = 0.10) and overlapped substantially between stenotic and non-stenotic plaques (1.9 [1.5, 2.4] versus 2.0 [1.5, 2.2] mm, p = 0.074). CONCLUSIONS Intracranial plaques without appreciable stenosis on TOF-MRA represent a large proportion of lesions throughout arterial segments but disproportionately affect the ICA. Morphological characterization of plaques with and without stenosis shows that luminal stenosis is a poor indicator of the underlying burden of intracranial atherosclerosis.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Gador Canton
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Niranjan Balu
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Yin Guo
- Department of Bioengineering, University of Washington, United States
| | - Li Chen
- Department of Bioengineering, University of Washington, United States
| | - Dongxiang Xu
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Daniel S Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, United States
| | - Kristi D Pimentel
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | | | - Chun Yuan
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States; Department of Bioengineering, University of Washington, United States
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Wu CH, Chung CP, Chen TY, Yu KW, Lin TM, Tai WA, Luo CB, Chang FC. Influence of angioplasty and stenting on intracranial artery stenosis: preliminary results of high-resolution vessel wall imaging evaluation. Eur Radiol 2022; 32:6788-6799. [DOI: 10.1007/s00330-022-09010-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022]
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Song JW, Moon BF, Burke MP, Kamesh Iyer S, Elliott MA, Shou H, Messé SR, Kasner SE, Loevner LA, Schnall MD, Kirsch JE, Witschey WR, Fan Z. MR Intracranial Vessel Wall Imaging: A Systematic Review. J Neuroimaging 2020; 30:428-442. [PMID: 32391979 DOI: 10.1111/jon.12719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
The purpose of this systematic review is to identify trends and extent of variability in intracranial vessel wall MR imaging (VWI) techniques and protocols. Although variability in selection of protocol design and pulse sequence type is known, data on what and how protocols vary are unknown. Three databases were searched to identify publications using intracranial VWI. Publications were screened by predetermined inclusion/exclusion criteria. Technical development publications were scored for completeness of reporting using a modified Nature Reporting Summary Guideline to assess reproducibility. From 2,431 articles, 122 met the inclusion criteria. Trends over the last 23 years (1995-2018) show increased use of 3-Tesla MR (P < .001) and 3D volumetric T1-weighted acquisitions (P < .001). Most (65%) clinical VWI publications report achieving a noninterpolated in-plane spatial resolution of ≤.55 mm. In the last decade, an increasing number of technical development (n = 20) and 7 Tesla (n = 12) publications have been published, focused on pulse sequence development, improving cerebrospinal fluid suppression, scan efficiency, and imaging ex vivo specimen for histologic validation. Mean Reporting Summary Score for the technical development publications was high (.87, range: .63-1.0) indicating strong scientific technical reproducibility. Innovative work continues to emerge to address implementation challenges. Gradual adoption into the research and scientific community was suggested by a shift in the name in the literature from "high-resolution MR" to "vessel wall imaging," specifying diagnostic intent. Insight into current practices and identifying the extent of technical variability in the literature will help to direct future clinical and technical efforts to address needs for implementation.
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Affiliation(s)
- Jae W Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Brianna F Moon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Morgan P Burke
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Mark A Elliott
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Steven R Messé
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Scott E Kasner
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA.,Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Laurie A Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA.,Department of Otolaryngology, Hospital of University of Pennsylvania, Philadelphia, PA
| | | | - John E Kirsch
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Walter R Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Zhaoyang Fan
- Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Qin G, Wang L, Hua Y, Hou H, Zou Q, Wang D, Hu Z, Lu D. Comparative morphology of the internal elastic lamina of cerebral and peripheral arteries. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:764-770. [PMID: 32355525 PMCID: PMC7191140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Atherosclerosis progresses later and with fewer complicated plaques in cerebral arteries than in peripheral arteries. The internal elastic lamina has been proposed to be important for the migration of smooth muscle cells into the intima during intimal thickening and atherosclerosis. METHODS A total of 280 segments were retrieved from 14 autopsy specimens. Five sites were selected for analysis in each case: the middle cerebral artery, basilar artery, coronary artery, iliac artery and renal artery. We investigated the differences in the internal elastic lamina of cerebral and peripheral arteries. RESULTS The average thickness of the internal elastic lamina of the cerebral arteries was larger than that of the peripheral arteries in both the early and advanced atherosclerotic plaque groups. Among the cerebral arteries, the basilar arteries had a thicker internal elastic lamina than the middle cerebral arteries. Among the peripheral arteries, the renal arteries had the thickest internal elastic lamina, followed by the iliac arteries and coronary arteries. Atherosclerosis led to a reduction in the thickness of the internal elastic lamina of the basilar, middle cerebral, and renal arteries. The stratification of the internal elastic lamina of iliac arteries significantly affected its measurement. The internal elastic lamina of coronary arteries was not affected by atherosclerosis, but it appeared fragmented. CONCLUSION The results suggest that the characteristics of atherosclerotic plaques in cerebral and peripheral arteries may be related to the characteristics of the internal elastic lamina.
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Affiliation(s)
- Guiping Qin
- Department of Pathology, Xuanwu Hospital, Capital Medical UniversityBeijing, China
- Department of Pathology, Liangxiang Teaching Hospital, Capital Medical UniversityBeijing, China
| | - Leiming Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical UniversityBeijing, China
| | - Yulan Hua
- Department of Pathology, Liangxiang Teaching Hospital, Capital Medical UniversityBeijing, China
| | - Haina Hou
- Department of Pathology, Liangxiang Teaching Hospital, Capital Medical UniversityBeijing, China
| | - Qiuju Zou
- Department of Pathology, Liangxiang Teaching Hospital, Capital Medical UniversityBeijing, China
| | - Daye Wang
- Department of Clinical Pathology, Capital Medical UniversityBeijing, China
| | - Zijing Hu
- Department of Clinical Pathology, Capital Medical UniversityBeijing, China
| | - Dehong Lu
- Department of Pathology, Xuanwu Hospital, Capital Medical UniversityBeijing, China
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Chen Q, Wang W, Chen YC, Chen G, Ni L, Zhang D, Zhou J, Yin XD. Peri-thrombus vascular hyperintensity sign: detection of intracranial thrombus location and length in acute ischemic stroke. Jpn J Radiol 2020; 38:516-523. [DOI: 10.1007/s11604-020-00937-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/18/2020] [Indexed: 01/03/2023]
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Song JW, Guiry SC, Shou H, Wang S, Witschey WR, Messé SR, Kasner SE, Loevner LA. Qualitative Assessment and Reporting Quality of Intracranial Vessel Wall MR Imaging Studies: A Systematic Review. AJNR Am J Neuroradiol 2019; 40:2025-2032. [PMID: 31727743 DOI: 10.3174/ajnr.a6317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the last quarter-century, the number of publications using vessel wall MR imaging has increased. Although many narrative reviews offer insight into technique and diagnostic applications, a systematic review of publication trends and reporting quality has not been conducted to identify unmet needs and future directions. PURPOSE We aimed to identify which intracranial vasculopathies need more data and to highlight areas of strengths and weaknesses in reporting. DATA SOURCES PubMed, EMBASE, and MEDLINE databases were searched up to September 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA ANALYSIS Two independent reviewers screened and extracted data from 128 articles. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used to assess the reporting quality of analytic observational studies. DATA SYNTHESIS There has been an exponentially increasing trend in the number of vessel wall MR imaging publications during the past 24 years (P < .0001). Intracranial atherosclerosis is the most commonly studied intracranial vasculopathy (49%), followed by dissections (13%), aneurysms (8%), and vasculitis (5%). Analytic observational study designs composed 48% of the studies. Transcontinental collaborations showed nonsignificantly higher reporting quality compared with work originating from single continents (P = .20). LIMITATIONS A limitation is the heterogeneity in study designs. CONCLUSIONS Investigations on the diagnostic utility of vessel wall MR imaging in less commonly studied intracranial vasculopathies such as dissections, aneurysms, and vasculitis are warranted. More consistent adherence to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines should improve transparency and maximize effective synthesis for clinical translation. Diverse collaborative teams are encouraged to advance the understanding of intracranial vasculopathies using vessel wall MR imaging.
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Affiliation(s)
- J W Song
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - S C Guiry
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - H Shou
- Department of Biostatistics, Epidemiology and Informatics (H.S.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Wang
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - W R Witschey
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | | | | | - L A Loevner
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
- Otolaryngology (L.A.L.)
- Neurosurgery (L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Shi F, Yang Q, Guo X, Qureshi TA, Tian Z, Miao H, Dey D, Li D, Fan Z. Intracranial Vessel Wall Segmentation Using Convolutional Neural Networks. IEEE Trans Biomed Eng 2019; 66:2840-2847. [PMID: 30716027 DOI: 10.1109/tbme.2019.2896972] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop an automated vessel wall segmentation method using convolutional neural networks to facilitate the quantification on magnetic resonance (MR) vessel wall images of patients with intracranial atherosclerotic disease (ICAD). METHODS Vessel wall images of 56 subjects were acquired with our recently developed whole-brain three-dimensional (3-D) MR vessel wall imaging (VWI) technique. An intracranial vessel analysis (IVA) framework was presented to extract, straighten, and resample the interested vessel segment into 2-D slices. A U-net-like fully convolutional networks (FCN) method was proposed for automated vessel wall segmentation by hierarchical extraction of low- and high-order convolutional features. RESULTS The network was trained and validated on 1160 slices and tested on 545 slices. The proposed segmentation method demonstrated satisfactory agreement with manual segmentations with Dice coefficient of 0.89 for the lumen and 0.77 for the vessel wall. The method was further applied to a clinical study of additional 12 symptomatic and 12 asymptomatic patients with >50% ICAD stenosis at the middle cerebral artery (MCA). Normalized wall index at the focal MCA ICAD lesions was found significantly larger in symptomatic patients compared to asymptomatic patients. CONCLUSION We have presented an automated vessel wall segmentation method based on FCN as well as the IVA framework for 3-D intracranial MR VWI. SIGNIFICANCE This approach would make large-scale quantitative plaque analysis more realistic and promote the adoption of MR VWI in ICAD management.
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Moccia S, Foti S, Routray A, Prudente F, Perin A, Sekula RF, Mattos LS, Balzer JR, Fellows-Mayle W, De Momi E, Riviere CN. Toward Improving Safety in Neurosurgery with an Active Handheld Instrument. Ann Biomed Eng 2018; 46:1450-1464. [PMID: 30014286 PMCID: PMC6150797 DOI: 10.1007/s10439-018-2091-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
Microsurgical procedures, such as petroclival meningioma resection, require careful surgical actions in order to remove tumor tissue, while avoiding brain and vessel damaging. Such procedures are currently performed under microscope magnification. Robotic tools are emerging in order to filter surgeons' unintended movements and prevent tools from entering forbidden regions such as vascular structures. The present work investigates the use of a handheld robotic tool (Micron) to automate vessel avoidance in microsurgery. In particular, we focused on vessel segmentation, implementing a deep-learning-based segmentation strategy in microscopy images, and its integration with a feature-based passive 3D reconstruction algorithm to obtain accurate and robust vessel position. We then implemented a virtual-fixture-based strategy to control the handheld robotic tool and perform vessel avoidance. Clay vascular phantoms, lying on a background obtained from microscopy images recorded during petroclival meningioma surgery, were used for testing the segmentation and control algorithms. When testing the segmentation algorithm on 100 different phantom images, a median Dice similarity coefficient equal to 0.96 was achieved. A set of 25 Micron trials of 80 s in duration, each involving the interaction of Micron with a different vascular phantom, were recorded, with a safety distance equal to 2 mm, which was comparable to the median vessel diameter. Micron's tip entered the forbidden region 24% of the time when the control algorithm was active. However, the median penetration depth was 16.9 μm, which was two orders of magnitude lower than median vessel diameter. Results suggest the system can assist surgeons in performing safe vessel avoidance during neurosurgical procedures.
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Affiliation(s)
- Sara Moccia
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Simone Foti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Arpita Routray
- Robotics Institute, Carnegie Mellon University, Pittsburgh, USA
| | - Francesca Prudente
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandro Perin
- Besta NeuroSim Center, IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Jeffrey R Balzer
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Wendy Fellows-Mayle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Usman A, Yuan J, Patterson AJ, Graves MJ, Varty K, Sadat U, Gillard JH. Neovascularization in Vertebral Artery Atheroma—A Dynamic Contrast-Enhanced Magnetic Resonance Imaging-Based Comparative Study in Patients with Symptomatic and Asymptomatic Carotid Artery Disease. J Stroke Cerebrovasc Dis 2018; 27:2505-2512. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/06/2018] [Indexed: 11/16/2022] Open
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Lee DH, Park JH. Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging. J Lipid Atheroscler 2017. [DOI: 10.12997/jla.2017.6.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dong Hyun Lee
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
| | - Jong-Ho Park
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
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