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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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Zhang C, Dou W, Yu K, Ji Y, Wang W, Sami MU, Shen Y, Xu K. The feasibility of non-contrast-enhanced zero echo time magnetic resonance angiography for characterization of intracranial atherosclerotic disease. Quant Imaging Med Surg 2021; 11:2442-2452. [PMID: 34079714 DOI: 10.21037/qims-20-696] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Accurate and non-invasive assessment of intracranial atherosclerotic disease (ICAD) is important because of its effect on treatment planning. The aim of this study is to investigate if zero echo time (zTE) magnetic resonance angiography (zTE-MRA) is feasible in the characterization of ICAD. Methods A total of 175 patients with ICAD were recruited. ZTE-MRA and time-of-flight (TOF)-MRA sequences were conducted for all participants using a 3T clinical MR system. Forty-one patients also underwent digital subtraction angiography (DSA), and were confirmed to have intracranial arterial stenosis (ICAS). Weighted kappa (κ) statistics were used to assess the inter-observer agreement and diagnostic consistency of both zTE- and TOF-MRA, using DSA as a reference. The Wilcoxon signed-rank test was used to evaluate differences in image quality between zTE- and TOF-MRA images. The nonparametric test of multiple paired samples was used to compare the results of vascular stenosis diagnosis between zTE-, TOF-MRA and DSA. Results Supported by high inter-observer agreement (weighted κ=0.78), zTE-MRA generated significantly higher scores than TOF-MRA for susceptibility artifact signal (mean: 3.03±0.98 vs. 2.72±1.09; P=0.017) and flow signal in parent artery (mean: 3.63±0.49 vs. 3.07±0.82; P<0.001). Additionally, zTE-MRA showed more robust diagnostic performance than TOF-MRA for patients with ICAD and degree of vascular stenosis (P<0.05), and was highly consistent with reference DSA images (weighted κ=0.80). Conclusions ZTE-MRA has potential for use as a routine clinical method for patients with ICAD.
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Affiliation(s)
- Chao Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Ke Yu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Ji
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Radiology, Traditional Chinese Medical Hospital of Yixing, Yixing, China
| | - Wenliang Wang
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Muhammad Umair Sami
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Shen
- GE Healthcare, MR Enhanced Application China, Beijing, China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Zhang J, Ding S, Zhao H, Sun B, Li X, Zhou Y, Wan J, Degnan AJ, Xu J, Zhu C. Evaluation of chronic carotid artery occlusion by non-contrast 3D-MERGE MR vessel wall imaging: comparison with 3D-TOF-MRA, contrast-enhanced MRA, and DSA. Eur Radiol 2020; 30:5805-5814. [PMID: 32529567 DOI: 10.1007/s00330-020-06989-1] [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: 03/19/2020] [Revised: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To analyze the accuracy of a non-contrast MR vessel wall imaging technique, three-dimensional motion-sensitized driven equilibrium prepared rapid gradient echo (3D-MERGE) for diagnosing chronic carotid artery occlusion (CCAO) characteristics compared with 3D time-of-flight (TOF) MRA, and contrast-enhanced MRA (CE-MRA), using digital subtraction angiography (DSA) as a reference standard. METHODS Subjects diagnosed with possible CCAO by ultrasound were retrospectively analyzed. Patients underwent 3.0-T MR imaging with 3D-MERGE, 3D-TOF-MRA, and CE-MRA followed by DSA within 1 week. Diagnostic accuracy of occlusion, occlusion site, and proximal stump condition were assessed independently on 3 MRI sequences and DSA. Agreement of the above indicators was evaluated in reference to DSA. RESULTS One hundred twenty-four patients with 129 suspected CCAO (5 with bilateral occlusions) met the inclusion criteria for our study. 3D-MERGE demonstrated a sensitivity, specificity, and accuracy of 97.0%, 86.7%, and 94.6%, respectively, with excellent agreement (Cohen's κ = 0.85; 95% CI, 0.71, 0.94) for diagnosing CCAO in reference to DSA. 3D-MERGE was superior in diagnosing CCAO compared with 3D-TOF-MRA (Cohen's κ = 0.61; 95% CI, 0.42, 0.77) and similar to CE-MRA (Cohen's κ = 0.93; 95% CI, 0.86, 1.00). 3D-MERGE also had excellent agreement compared with DSA for assessing occlusion sites (Cohen's κ = 0.85; 95% CI, 0.71, 0.97) and stump condition (Cohen's κ = 0.83; 95% CI, 0.71, 0.94). Moreover, 3D-MERGE provided additional information regarding the occluded segment, such as distal lumen collapse and vessel wall lesion components. CONCLUSION 3D-MERGE can reliably assess chronic carotid occlusive characteristics and has the ability to identify other vessel wall features of the occluded segment. This non-contrast MR vessel wall imaging technique is promising for assessment of CCAO. KEY POINTS • Excellent agreement was found between 3D-MERGE and DSA for assessing chronic carotid artery occlusion, occlusion site, and proximal stump condition. • 3D-MERGE was shown to be a more accurate and efficient tool than 3D-TOF-MRA to detect the characteristics of the occluded segment. • 3D-MERGE provides not only luminal images for characterizing the proximal characteristics of occlusion but also vessel wall images for assessing the distal lumen and morphology of occlusion segment, which might help clinicians to optimize the treatment strategy for patients with chronic carotid artery occlusion.
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Affiliation(s)
- Jin Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Andrew J Degnan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,American Institute for Radiologic Pathology, Silver Spring, MD, USA.,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, USA
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Poree J, Chayer B, Soulez G, Ohayon J, Cloutier G. Noninvasive Vascular Modulography Method for Imaging the Local Elasticity of Atherosclerotic Plaques: Simulation and In Vitro Vessel Phantom Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:1805-1817. [PMID: 28961110 DOI: 10.1109/tuffc.2017.2757763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mechanical and morphological characterization of atherosclerotic lesions in carotid arteries remains an essential step for the evaluation of rupture prone plaques and the prevention of strokes. In this paper, we propose a noninvasive vascular imaging modulography (NIV-iMod) method, which is capable of reconstructing a heterogeneous Young's modulus distribution of a carotid plaque from the Von Mises strain elastogram. Elastograms were computed with noninvasive ultrasound images using the Lagrangian speckle model estimator and a dynamic segmentation-optimization procedure to highlight mechanical heterogeneities. This methodology, based on continuum mechanics, was validated in silico with finite-element model strain fields and ultrasound simulations, and in vitro with polyvinyl alcohol cryogel phantoms based on magnetic resonance imaging geometries of carotid plaques. In silico, our results show that the NiV-iMod method: 1) successfully detected and quantified necrotic core inclusions with high positive predictive value (PPV) and sensitivity value (SV) of 81±10% and 91±6%; 2) quantified Young's moduli of necrotic cores, fibrous tissues, and calcium inclusions with mean values of 32±23, 515±30, and 3160±218 kPa (ground true values are 10, 600, and 5000 kPa); and 3) overestimated the cap thickness by . In vitro, the PPV and SV for detecting soft inclusions were 60±21% and 88±9%, and Young's modulus mean values of mimicking lipid, fibrosis, and calcium were 34±19, 193±14, and 649±118 kPa (ground true values are 25±3, 182±21, and 757±87 kPa).
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Porée J, Garcia D, Chayer B, Ohayon J, Cloutier G. Noninvasive Vascular Elastography With Plane Strain Incompressibility Assumption Using Ultrafast Coherent Compound Plane Wave Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:2618-2631. [PMID: 26625341 DOI: 10.1109/tmi.2015.2450992] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Plane strain tensor estimation using non-invasive vascular ultrasound elastography (NIVE) can be difficult to achieve using conventional focus beamforming due to limited lateral resolution and frame rate. Recent developments in compound plane wave (CPW) imaging have led to high speed and high resolution imaging. In this study, we present the performance of NIVE using coherent CPW. We show the impact of CPW beamforming on strain estimates compared to conventional focus sequences. To overcome the inherent variability of lateral strains, associated with the low lateral resolution of linear array transducers, we use the plane strain incompressibility to constrain the estimator. Taking advantage of the approximate tenfold increase in frame rate of CPW compared with conventional focus imaging, we introduce a time-ensemble estimation approach to further improve the elastogram quality. By combining CPW imaging with the constrained Lagrangian speckle model estimator, we observe an increase in elastography quality (∼ 10 dB both in signal-to-noise and contrast-to-noise ratios) over a wide range of applied strains (0.02 to 3.2%).
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Tognolini A, Arellano C, Marfori W, Heidari G, Sayre J, Krishnam M, Ruehm S. Comprehensive low-dose imaging of carotid and coronary arteries with a single-injection dual-source CT angiography protocol. Clin Radiol 2014; 69:246-53. [DOI: 10.1016/j.crad.2013.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 09/27/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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Kramer H, Runge VM, Morelli JN, Williams KD, Naul LG, Nikolaou K, Reiser MF, Wintersperger BJ. Magnetic resonance angiography of the carotid arteries: comparison of unenhanced and contrast enhanced techniques. Eur Radiol 2011; 21:1667-76. [DOI: 10.1007/s00330-011-2110-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 02/02/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
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Ultra-fast carotid CT-angiography: low versus standard volume contrast material protocol for a 128-slice CT-system. Invest Radiol 2009; 44:257-64. [PMID: 19550377 DOI: 10.1097/rli.0b013e31819b08a0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Noninvasive imaging is increasingly accepted for the evaluation of atherosclerotic disease of the carotid arteries. We sought to evaluate the feasibility of a low-contrast media volume protocol for carotid computed tomography angiography (CTA) using a 128-slice-spiral-computed tomography scanner with a gantry rotation time of 300 milliseconds. METHODS AND MATERIALS Thirty consecutive patients underwent CTA for the evaluation of the carotid vessels, with a 128-section scanner. Fifteen patients were examined with a standard volume contrast injection protocol (group A): 80 mL of contrast material (CM) were injected at 5 mL/s using the test bolus method to assess individual transit time. Another 15 patients were examined with a low-volume contrast media protocol (group B): 30 mL CM were injected at 4 mL/s using bolus tracking to trigger the CTA acquisition. In both groups, contrast administration was followed by a saline flush. Image quality and segmental vascular enhancement as well as the presence and degree of arterial stenosis were independently evaluated by 2 radiologists. Venous enhancement and streak artifacts at the thoracic inlet because of highly concentrated CM in the subclavian veins were evaluated in both groups. Kappa statistic and Pearson correlation coefficient were used to quantify interobserver variability. Qualitative data were compared using the Wilcoxon signed rank test and student t test was used to investigate differences in segmental vessel attenuation. RESULTS All studies were of diagnostic quality in both groups. Interobserver agreement was high (kappa = 0.82, group A; kappa = 0.78, group B). Attenuation measurement showed excellent interobserver correlation in both groups (r > 0.9). Mean enhancement values were slightly higher in group A, but without statistical significance when averaged for all segments (P = 0.06). Streak artifacts impaired evaluation of 13 adjacent arterial segments in 8 patients at the level of the thoracic inlet in group A. In group B, only 1 segment was rated insufficient by both radiologists. Venous enhancement was significantly lower in group B (P = 0.04). The low-contrast protocol proved to be the more robust method with constant high arterial enhancement, less streak artifacts at the thoracic inlet, and less venous overlay. CONCLUSION Using the latest CT technology, optimal depiction of the craniocervical arteries can be archived with a low-volume (30 mL) CM protocol.
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Wu RH, Kallmes D. High Resolution Contrast-Enhanced MR Angiography in the Evaluation of Rabbit Carotid Artery. RIVISTA DI NEURORADIOLOGIA 2005; 18:529-536. [DOI: 10.1177/197140090501800502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study compared a high resolution contrast-enhanced MR angiography (MRA) sequence to conventional contrast-enhanced MRA sequence for imaging of rabbit carotid artery. Fifteen rabbits underwent an evaluation using both high resolution contrast-enhanced MRA sequence and conventional contrast-enhanced MRA sequence. Siemens 1.5 Tesla Magnetom Vision system was utilized. The parameters of high resolution sequence were: TR/TE= 6.2/2.0 msec, flip angle 25°, matrix 130×512, pixel size 0.96×0.49 mm, partition thickness 1.58 mm, acquisition time 24 sec. The parameters of conventional sequence were: TR/TE=3.8/1.4 msec, flip angle 35°, matrix 110×256, pixel size 1.48×1.02 mm, partition thickness 2mm, acquisition time 10 sec. Maximum intensity projection (MIP) images were created. Both original single slices and MIP images were used for image quality evaluation. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), distinctness of artery edge, and venous contamination were analyzed for both techniques. Higher average CNR and SNR were obtained with high resolution contrast-enhanced MRA, compared to average CNR and SNR with conventional contrast-enhanced MRA. The differences were statistically significant (P<0.01). The artery edge with high resolution method was more distinct than conventional method. Jugular venous contamination was found in five of 15 cases with high resolution contrast-enhanced MRA and in four of 15 cases with conventional contrast-enhanced MRA. High resolution contrast-enhanced MRA has significant potential for high quality noninvasive vascular imaging. The image quality with high resolution contrast-enhanced MRA sequence is better than conventional contrast-enhanced MRA sequence.
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Affiliation(s)
- R.-H. Wu
- Department of Radiology, Shantou University Medical College; Shantou, China
- Department of Radiology, University of Virginia Health Services; Charlottesville, VA, USA
| | - D.F. Kallmes
- Department of Radiology, Mayo Clinic; Rochester, MN, USA
- Department of Radiology, University of Virginia Health Services; Charlottesville, VA, USA
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