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Evans NR, Bhakta S, Chowdhury MM, Markus H, Warburton E. Management of carotid atherosclerosis in stroke. Pract Neurol 2024:pn-2023-003918. [PMID: 38589215 DOI: 10.1136/pn-2023-003918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
Internal carotid artery atherosclerosis is a major risk factor for stroke, accounting for 15-20% of ischaemic strokes. Revascularisation procedures-either carotid endarterectomy or carotid artery stenting-can reduce the risk of stroke for those with significant (>50%) luminal stenosis but particularly for those with more severe (70-99%) stenosis. However, advances in medical pharmacotherapy have implications for the relative benefit from surgery for symptomatic carotid atherosclerosis, as well as our approach to asymptomatic disease. This review considers the evidence underpinning the current medical and surgical management of symptomatic carotid atherosclerosis, the importance of factors beyond the degree of luminal stenosis, and developments in therapeutic strategies. We also discuss the importance of non-stenotic but high-risk carotid atherosclerotic plaques on the cause of stroke, and their implications for clinical practice.
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Affiliation(s)
| | - Shiv Bhakta
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Hugh Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Elizabeth Warburton
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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2
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de Buck MHS, Jezzard P, Frost R, Randell C, Hurst K, Choudhury RP, Robson MD, Biasiolli L. 10-channel phased-array coil for carotid wall MRI at 3T. PLoS One 2023; 18:e0288529. [PMID: 37556496 PMCID: PMC10411804 DOI: 10.1371/journal.pone.0288529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Accurate assessment of plaque accumulation near the carotid bifurcation is important for the effective prevention and treatment of stroke. However, vessel and plaque delineation using MRI can be limited by low contrast-to-noise ratio (CNR) and long acquisition times. In this work, a 10-channel phased-array receive coil design for bilateral imaging of the carotid bifurcation using 3T MRI is proposed. METHODS The proposed 10-channel receive coil was compared to a commercial 4-channel receive coil configuration using data acquired from phantoms and healthy volunteers (N = 9). The relative performance of the coils was assessed, by comparing signal-to-noise ratio (SNR), noise correlation, g-factor noise amplification, and the CNR between vessel wall and lumen using black-blood sequences. Patient data were acquired from 12 atherosclerotic carotid artery disease patients. RESULTS The 10-channel coil consistently provided substantially increased SNR in phantoms (+77 ± 27%) and improved CNR in healthy carotid arteries (+62 ± 11%), or reduced g-factor noise amplification. Patient data showed excellent delineation of atherosclerotic plaque along the length of the carotid bifurcation using the 10-channel coil. CONCLUSIONS The proposed 10-channel coil design allows for improved visualization of the carotid arteries and the carotid bifurcation and increased parallel imaging acceleration factors relative to a commercial 4-channel coil design.
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Affiliation(s)
- Matthijs H. S. de Buck
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Peter Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Robert Frost
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Radiology, Harvard Medical School, Boston, MA, United States of America
| | | | - Katherine Hurst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Robin P. Choudhury
- Acute Vascular Imaging Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew D. Robson
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Perspectum, Gemini One, John Smith Drive, Oxford, United Kingdom
| | - Luca Biasiolli
- Acute Vascular Imaging Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Zhang R, Zhang Q, Ji A, Lv P, Acosta-Cabronero J, Fu C, Ding J, Guo D, Teng Z, Lin J. Prediction of new cerebral ischemic lesion after carotid artery stenting: a high-resolution vessel wall MRI-based radiomics analysis. Eur Radiol 2022; 33:4115-4126. [PMID: 36472695 DOI: 10.1007/s00330-022-09302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Carotid artery stenting (CAS) is an established treatment for local stenosis. The most common complication is new ipsilateral ischemic lesions (NIILs). This study aimed to develop models considering lesion morphological and compositional features, and radiomics to predict NIILs. MATERIALS AND METHODS One hundred and forty-six patients who underwent brain MRI and high-resolution vessel wall MR imaging (hrVWI) before and after CAS were retrospectively recruited. Lumen and outer wall boundaries were segmented on hrVWI as well as atherosclerotic components. A traditional model was constructed with patient clinical information, and lesion morphological and compositional features. Least absolute shrinkage and selection operator algorithm was performed to determine key radiomics features for reconstructing a radiomics model. The model in predicting NIILs was trained and its performance was tested. RESULTS Sixty-one patients were NIIL-positive and eighty-five negative. Volume percentage of intraplaque hemorrhage (IPH) and patients' clinical presentation (symptomatic/asymptomatic) were risk factors of NIILs. The traditional model considering these two features achieved an area under the curve (AUC) of 0.778 and 0.777 in the training and test cohorts, respectively. Twenty-two key radiomics features were identified and the model based on these features achieved an AUC of 0.885 and 0.801 in the two cohorts. The AUCs of the combined model considering IPH volume percentage, clinical presentation, and radiomics features were 0.893 and 0.842 in the training and test cohort respectively. CONCLUSIONS Compared with traditional features (clinical and compositional features), the combination of traditional and radiomics features improved the power in predicting NIILs after CAS. KEY POINTS • Volume percentage of IPH and symptomatic events were independent risk factors of new ipsilateral ischemic lesions (NIILs). • Radiomics features derived from carotid artery high-resolution vessel wall imaging had great potential in predicting NIILs after CAS. • The combination model with radiomics and traditional features further improved the diagnostic performance than traditional features alone.
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Affiliation(s)
- Ranying Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, China
| | - Aihua Ji
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | | | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK.
- Nanjing Jingsan Medical Science and Technology, Nanjing, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China.
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Wang J, Wang L, Shen Y, Gong X, Ju Y. Relationship Between Carotid Artery Angle and Plaque Morphology in Acute Cerebral Infarction Patients. Neurologist 2022; 27:240-244. [PMID: 35051966 PMCID: PMC9439691 DOI: 10.1097/nrl.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-resolution magnetic resonance imaging (HRMRI) can be used to clearly distinguish the luminal structure of the carotid artery (CA); measure the lumen, vessel wall, and total blood vessel area; and accurately describe the morphologic features of plaques. METHODS This study used HRMRI to investigate the relationship between geometric features and volume and composition of carotid atherosclerotic plaques. Patients (n=81) who had experienced acute cerebral infarction (CI) within 7±3 days before admission to the Neurology Department of Beijing Tiantan Hospital between November 2011 and June 2012 were enrolled in the study. CA HRMRI was performed to analyze the geometry and morphology of plaques in 160 blood vessels. RESULTS The median left and right internal carotid artery angles (ICAAs) were 32.79 and 31.00 degrees, respectively. Aside from the nonplanar external CA angle, plaque volume and angles did not differ significantly between the left and right sides. Age ( B =3.77; P =0.03) and nonplanar ICAA ( B =4.70; P =0.01) were predictors of left but not right carotid plaque volume. ICAA and bifurcation angle did not predict plaque volume. CONCLUSIONS In this study, CA morphology in acute stroke patients is not associated with plaque volume or composition, but age and nonplanar ICAA can predict left carotid plaque volume.
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Affiliation(s)
- Jing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
| | - Lin Wang
- Department of Neurology, People’s Hospital of Daxing District, Beijing, China
| | - Yuan Shen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
| | - Xiping Gong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
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Geiger MA, Flumignan RLG, Sobreira ML, Avelar WM, Fingerhut C, Stein S, Guillaumon AT. Carotid Plaque Composition and the Importance of Non-Invasive in Imaging Stroke Prevention. Front Cardiovasc Med 2022; 9:885483. [PMID: 35651908 PMCID: PMC9149096 DOI: 10.3389/fcvm.2022.885483] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022] Open
Abstract
Luminal stenosis has been the standard feature for the current management strategies in patients with atherosclerotic carotid disease. Histological and imaging studies show considerable differences between plaques with identical degrees of stenosis. They indicate that specific plaque characteristics like Intraplaque hemorrhage, Lipid Rich Necrotic Core, Plaque Inflammation, Thickness and Ulceration are responsible for the increased risk of ischemic events. Intraplaque hemorrhage is defined by the accumulation of blood components within the plaque, Lipid Rich Necrotic Core is composed of macrophages loaded with lipid, Plaque Inflammation is defined as the process of atherosclerosis itself and Plaque thickness and Ulceration are defined as morphological features. Advances in imaging methods like Magnetic Resonance Imaging, Ultrasound, Computed Tomography and Positron Emission Tomography have enabled a more detailed characterization of the plaque, and its vulnerability is linked to these characteristics, changing the management of these patients based only on the degree of plaque stenosis. Studies like Rotterdam, ARIC, PARISK, CAPIAS and BIOVASC were essential to evaluate and prove the relevance of these characteristics with cerebrovascular symptoms. A better approach for the prevention of stroke is needed. This review summarizes the more frequent carotid plaque features and the available validation from recent studies with the latest evidence.
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Affiliation(s)
- Martin Andreas Geiger
- Division of Vascular Surgery, Department of Surgery, Universidade Estadual de Campinas—UNICAMP, São Paulo, Brazil
- *Correspondence: Martin Andreas Geiger
| | - Ronald Luiz Gomes Flumignan
- Division of Vascular and Endovascular Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcone Lima Sobreira
- Division of Vascular and Endovascular Surgery, Department of Surgery and Orthopedics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), São Paulo, Brazil
| | - Wagner Mauad Avelar
- Department of Neurology, Universidade Estadual de Campinas—UNICAMP, São Paulo, Brazil
| | - Carla Fingerhut
- Division of Radiology, Department of Anesthesiology and Radiology, Universidade Estadual de Campinas—UNICAMP, São Paulo, Brazil
| | - Sokrates Stein
- Division of Vascular Surgery, Department of Surgery, Universidade Estadual de Campinas—UNICAMP, São Paulo, Brazil
| | - Ana Terezinha Guillaumon
- Division of Vascular Surgery, Department of Surgery, Universidade Estadual de Campinas—UNICAMP, São Paulo, Brazil
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He Y, Northrup H, Le H, Cheung AK, Berceli SA, Shiu YT. Medical Image-Based Computational Fluid Dynamics and Fluid-Structure Interaction Analysis in Vascular Diseases. Front Bioeng Biotechnol 2022; 10:855791. [PMID: 35573253 PMCID: PMC9091352 DOI: 10.3389/fbioe.2022.855791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 01/17/2023] Open
Abstract
Hemodynamic factors, induced by pulsatile blood flow, play a crucial role in vascular health and diseases, such as the initiation and progression of atherosclerosis. Computational fluid dynamics, finite element analysis, and fluid-structure interaction simulations have been widely used to quantify detailed hemodynamic forces based on vascular images commonly obtained from computed tomography angiography, magnetic resonance imaging, ultrasound, and optical coherence tomography. In this review, we focus on methods for obtaining accurate hemodynamic factors that regulate the structure and function of vascular endothelial and smooth muscle cells. We describe the multiple steps and recent advances in a typical patient-specific simulation pipeline, including medical imaging, image processing, spatial discretization to generate computational mesh, setting up boundary conditions and solver parameters, visualization and extraction of hemodynamic factors, and statistical analysis. These steps have not been standardized and thus have unavoidable uncertainties that should be thoroughly evaluated. We also discuss the recent development of combining patient-specific models with machine-learning methods to obtain hemodynamic factors faster and cheaper than conventional methods. These critical advances widen the use of biomechanical simulation tools in the research and potential personalized care of vascular diseases.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - Hannah Northrup
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ha Le
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
- Vascular Surgery Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Yan Tin Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
- *Correspondence: Yan Tin Shiu,
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7
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Zhang L, Zhu L, Lu M, Zhao X, Li F, Cai J, Yuan C. Comparison of Carotid Plaque Characteristics Between Men and Women Using Magnetic Resonance Vessel Wall Imaging: A Chinese Atherosclerosis Risk Evaluation Study. J Magn Reson Imaging 2021; 54:646-654. [PMID: 33638575 DOI: 10.1002/jmri.27576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Carotid vulnerable plaque is a major cause of stroke and differs between men and women. Few studies have investigated the differences in carotid plaque features between sexes in a Chinese population. PURPOSE To compare carotid atherosclerotic plaque features between men and women in a Chinese population using magnetic resonance imaging. STUDY TYPE Cross-sectional. SUBJECTS A total of 567 patients (mean age: 61.5 ± 10.1 years; 404 men) who had recent stroke or transient ischemia attack and atherosclerotic plaque in at least one carotid artery. FIELD STRENGTH A 3.0 T. SEQUENCE T1- and T2-weighted turbo spin echo, three-dimensional time-of-flight (TOF) fast field echo and magnetization-prepared rapid acquisition gradient echo sequences. ASSESSMENT Plaque characteristics including lumen area (LA), wall area (WA), total vessel area (TVA), mean wall thickness (MWT), and mean normalized wall index (NWI); presence of calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR); and percent composition area (%area) were evaluated and compared between men and women. STATISTICAL TESTS Independent-sample t test, Mann-Whitney U test, chi-square test, and multiple linear and logistic regressions. RESULTS In symptomatic arteries, men had significantly greater LA (46.2 ± 15.6 mm2 vs. 40.7 ± 12.9 mm2 , P < 0.05), WA (33.9 ± 11.5 mm2 vs. 26.3 ± 7.5 mm2 , P < 0.05), and TVA (80.1 ± 20.4 mm2 vs. 67.0 ± 18.0 mm2 , P < 0.05); higher MWT (1.2 ± 0.4 mm vs. 1.0 ± 0.2 mm, P < 0.05); and higher prevalence of LRNC (72.3% vs. 46.0%, P < 0.05) and IPH (18.6% vs. 4.9%, P < 0.05) compared with women. In asymptomatic arteries, men had significantly greater LA (48.3 ± 16.9 mm2 vs. 42.1 ± 12.6 mm2 , P < 0.05), WA (32.9 ± 11.0 mm2 vs. 25.8 ± 6.1 mm2 , P < 0.05), and TVA (81.2 ± 22.1 mm2 vs. 67.9 ± 16.5 mm2 , P < 0.05); higher MWT (1.2 ± 0.3 mm vs. 1.0 ± 0.2 mm, P < 0.05); higher prevalence of LRNC (67.8% vs. 42.9%, P < 0.05), IPH (14.9% vs. 1.2%, P < 0.05), and FCR (6.4% vs. 1.2%, P < 0.05); and higher %LRNC area (24.8 ± 17.2% vs. 17.8 ± 14.1%, P < 0.05) compared with women. DATA CONCLUSION Men have similar plaque burden but more vulnerable atherosclerotic plaques compared with women in both symptomatic and asymptomatic carotid arteries in a Chinese population. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lichen Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lina Zhu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Zhengzhou, Henan Province, China
| | - Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Xihai Zhao
- Center For Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Feiyu Li
- Operation Department, RIMAG Medical Imaging Corporation, Beijing, China
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, USA
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8
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Cardiovascular magnetic resonance imaging and its role in the investigation of stroke: an update. J Neurol 2021; 268:2597-2604. [PMID: 33439327 DOI: 10.1007/s00415-020-10393-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 01/17/2023]
Abstract
Recent advances in complementary diagnostic exams have helped to clarify stroke etiology, not only by helping to confirm established stroke causes but also by unveiling new possible stroke mechanisms. Etiological investigation for cardioembolic stroke has benefited in the last years from information provided by studies analysing serum biomarkers, heart rhythm monitoring and imaging methods like cardiovascular magnetic resonance (CMR) imaging. CMR has been particularly important for the characterization of possible new cardioembolic stroke mechanisms including atrial cardiomyopathy, silent myocardial infarction and cardiomyopathies.
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9
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Saba L, Mossa-Basha M, Abbott A, Lanzino G, Wardlaw JM, Hatsukami TS, Micheletti G, Balestrieri A, Hedin U, Moody AR, Wintermark M, DeMarco JK. Multinational Survey of Current Practice from Imaging to Treatment of Atherosclerotic Carotid Stenosis. Cerebrovasc Dis 2021; 50:108-120. [PMID: 33440369 DOI: 10.1159/000512181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the last 20-30 years, there have been many advances in imaging and therapeutic strategies for symptomatic and asymptomatic individuals with carotid artery stenosis. Our aim was to examine contemporary multinational practice standards. METHODS Departmental Review Board approval for this study was obtained, and 3 authors prepared the 44 multiple choice survey questions. Endorsement was obtained by the European Society of Neuroradiology, American Society of Functional Neuroradiology, and African Academy of Neurology. A link to the online questionnaire was sent to their respective members and members of the Faculty Advocating Collaborative and Thoughtful Carotid Artery Treatments (FACTCATS). The questionnaire was open from May 16 to July 16, 2019. RESULTS The responses from 223 respondents from 46 countries were included in the analyses including 65.9% from academic university hospitals. Neuroradiologists/radiologists comprised 68.2% of respondents, followed by neurologists (15%) and vascular surgeons (12.9%). In symptomatic patients, half (50.4%) the respondents answered that the first exam they used to evaluate carotid bifurcation was ultrasound, followed by computed tomography angiography (CTA, 41.6%) and then magnetic resonance imaging (MRI 8%). In asymptomatic patients, the first exam used to evaluate carotid bifurcation was ultrasound in 88.8% of respondents, CTA in 7%, and MRA in 4.2%. The percent stenosis upon which carotid endarterectomy or stenting was recommended was reduced in the presence of imaging evidence of "vulnerable plaque features" by 66.7% respondents for symptomatic patients and 34.2% for asymptomatic patients with a smaller subset of respondents even offering procedural intervention to patients with <50% symptomatic or asymptomatic stenosis. CONCLUSIONS We found heterogeneity in current practices of carotid stenosis imaging and management in this worldwide survey with many respondents including vulnerable plaque imaging into their decision analysis despite the lack of proven benefit from clinical trials. This study highlights the need for new clinical trials using vulnerable plaque imaging to select high-risk patients despite maximal medical therapy who may benefit from procedural intervention.
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Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy,
| | - Mahmoud Mossa-Basha
- Department of Neuroradiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Anne Abbott
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Michigan, USA
| | - Joanna M Wardlaw
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | | | | | - Ulf Hedin
- Department of Vascular Surgery and Molecular Medicine and Surgery, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Max Wintermark
- Neuroradiology Division, Department of Radiology, Stanford University, Stanford, California, USA
| | - J Kevin DeMarco
- Department of Radiology, Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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10
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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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11
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Anufriev PL, Tanashyan MM, Gulevskaya TS. Contemporary approach to diagnosis of ischemic stroke pathogenetic variants in patients with atherosclerosis and arterial hypertension. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The angio- and neurovisualization methods vigorously developing in recent decades determine the relevance of improvement of etiopathogenetic ischemic stroke classification used for the treatment tactics selection and for secondary prevention of the disorder. The study was aimed to clarify the capabilities of clinical diagnosis for pathogenetic variants of ischemic stroke. For that, in 125 postmortem cases, the macro and microscopic examination of brain and cardiovascular system was carried out in order to verify the stroke pathogenesis established as a result of the previous patients’ examination. The study demonstrates the great potential of the major pathogenetic stroke subtypes (large-artery atherosclerosis, cardioembolism, small-artery occlusion) diagnosis using the complex of contemporary clinical and instrumental methods and the main morphological criteria of these subtypes in accordance with the TOAST classification. Moreover, the clinical and pathomorphological assessment allowed us to differentiate stroke resulting from various alterations of single cerebral artery, the atherothrombotic occlusion (44% of cases for the subtype), arterio-arterial embolism (13%) and critical stenosis (10%), as well as stroke resulting from cerebrovascular insufficiency (33%), within the “large-artery atherosclerosis” subtype. Thus, the high informativity of the existing examination methods allows for a more differentiated understanding of the cause of ischemic stroke, which is fully in line with modern personalized medicine.
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Affiliation(s)
- PL Anufriev
- Research Center of Neurology, Moscow, Russia
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12
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Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
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Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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13
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Imaging Features of Vulnerable Carotid Atherosclerotic Plaque and the Associated Clinical Implications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00821-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Calcagno C, Pérez-Medina C, Mulder WJM, Fayad ZA. Whole-Body Atherosclerosis Imaging by Positron Emission Tomography/Magnetic Resonance Imaging: From Mice to Nonhuman Primates. Arterioscler Thromb Vasc Biol 2020; 40:1123-1134. [PMID: 32237905 DOI: 10.1161/atvbaha.119.313629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiovascular disease due to atherosclerosis is still the main cause of morbidity and mortality worldwide. This disease is a complex systemic disorder arising from a network of pathological processes within the arterial vessel wall, and, outside of the vasculature, in the hematopoietic system and organs involved in metabolism. Recent years have seen tremendous efforts in the development and validation of quantitative imaging technologies for the noninvasive evaluation of patients with atherosclerotic cardiovascular disease. Specifically, the advent of combined positron emission tomography and magnetic resonance imaging scanners has opened new exciting opportunities in cardiovascular imaging. In this review, we will describe how combined positron emission tomography/magnetic resonance imaging scanners can be leveraged to evaluate atherosclerotic cardiovascular disease at the whole-body level, with specific focus on preclinical animal models of disease, from mouse to nonhuman primates. We will broadly describe 3 major areas of application: (1) vascular imaging, for advanced atherosclerotic plaque phenotyping and evaluation of novel imaging tracers or therapeutic interventions; (2) assessment of the ischemic heart and brain; and (3) whole-body imaging of the hematopoietic system. Finally, we will provide insights on potential novel technical developments which may further increase the relevance of integrated positron emission tomography/magnetic resonance imaging in preclinical atherosclerosis studies.
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Affiliation(s)
- Claudia Calcagno
- From the BioMedical Engineering and Imaging Institute (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY.,Department of Radiology (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY
| | - Carlos Pérez-Medina
- From the BioMedical Engineering and Imaging Institute (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY.,Department of Radiology (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (C.P.-M.)
| | - Willem J M Mulder
- From the BioMedical Engineering and Imaging Institute (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY.,Department of Radiology (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY.,Department of Oncological Sciences (W.J.M.M.), Icahn School of Medicine at Mount Sinai, NY.,Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, the Netherlands (W.J.M.M.)
| | - Zahi A Fayad
- From the BioMedical Engineering and Imaging Institute (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY.,Department of Radiology (C.C., C.P.-M., W.J.M.M., Z.A.F.), Icahn School of Medicine at Mount Sinai, NY
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15
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Ruytenberg T, Webb A, Zivkovic I. A flexible five-channel shielded-coaxial-cable (SCC) transceive neck coil for high-resolution carotid imaging at 7T. Magn Reson Med 2020; 84:1672-1677. [PMID: 32052472 PMCID: PMC7317455 DOI: 10.1002/mrm.28215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/10/2020] [Accepted: 01/25/2020] [Indexed: 11/13/2022]
Abstract
Purpose Imaging the carotid arteries at 7T ideally requires a flexible multichannel array that allows B1‐shimming and conforms to different neck sizes. The major challenge is to minimize coupling between closely spaced coils and to make the coupling relatively insensitive to loading conditions. Methods We have designed a five‐channel flexible transceive array composed of shielded‐coaxial‐cable coils placed on the anterior part of the neck and conforming to the anatomy. In vivo imaging of the carotid arteries in three subjects has been performed. Results The measured noise correlation matrices show the decoupling level between the individual elements to be −12.5 dB and better. Anatomical localizer imaging of the carotids shows both carotids in every subject well visualized after B1‐shimming. In vivo black‐blood, carotid images were acquired with very high in‐plane spatial resolution (0.25 × 0.25 mm2) with clear depiction of the vessel walls. Conclusions The flexibility of the proposed coil has been demonstrated by imaging subjects with different neck circumferences. To the best of our knowledge, the in‐plane resolution of 0.25 × 0.25 mm2 is the highest reported at 7T.
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Affiliation(s)
- Thomas Ruytenberg
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrew Webb
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Carle Foundation Hospital, Urbana, IL, USA
| | - Irena Zivkovic
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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16
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Wüst RCI, Calcagno C, Daal MRR, Nederveen AJ, Coolen BF, Strijkers GJ. Emerging Magnetic Resonance Imaging Techniques for Atherosclerosis Imaging. Arterioscler Thromb Vasc Biol 2020; 39:841-849. [PMID: 30917678 DOI: 10.1161/atvbaha.118.311756] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis is a prevalent disease affecting a large portion of the population at one point in their lives. There is an unmet need for noninvasive diagnostics to identify and characterize at-risk plaque phenotypes noninvasively and in vivo, to improve the stratification of patients with cardiovascular disease, and for treatment evaluation. Magnetic resonance imaging is uniquely positioned to address these diagnostic needs. However, currently available magnetic resonance imaging methods for vessel wall imaging lack sufficient discriminative and predictive power to guide the individual patient needs. To address this challenge, physicists are pushing the boundaries of magnetic resonance atherosclerosis imaging to increase image resolution, provide improved quantitative evaluation of plaque constituents, and obtain readouts of disease activity such as inflammation. Here, we review some of these important developments, with specific focus on emerging applications using high-field magnetic resonance imaging, the use of quantitative relaxation parameter mapping for improved plaque characterization, and novel 19F magnetic resonance imaging technology to image plaque inflammation.
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Affiliation(s)
- Rob C I Wüst
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Claudia Calcagno
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., G.J.S.)
| | - Mariah R R Daal
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Aart J Nederveen
- Radiology and Nuclear Medicine (A.J.N.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Bram F Coolen
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Gustav J Strijkers
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands.,Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., G.J.S.)
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17
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Hajhosseiny R, Bahaei TS, Prieto C, Botnar RM. Molecular and Nonmolecular Magnetic Resonance Coronary and Carotid Imaging. Arterioscler Thromb Vasc Biol 2020; 39:569-582. [PMID: 30760017 DOI: 10.1161/atvbaha.118.311754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerosis is the leading cause of cardiovascular morbidity and mortality. Over the past 2 decades, increasing research attention is converging on the early detection and monitoring of atherosclerotic plaque. Among several invasive and noninvasive imaging modalities, magnetic resonance imaging (MRI) is emerging as a promising option. Advantages include its versatility, excellent soft tissue contrast for plaque characterization and lack of ionizing radiation. In this review, we will explore the recent advances in multicontrast and multiparametric imaging sequences that are bringing the aspiration of simultaneous arterial lumen, vessel wall, and plaque characterization closer to clinical feasibility. We also discuss the latest advances in molecular magnetic resonance and multimodal atherosclerosis imaging.
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Affiliation(s)
- Reza Hajhosseiny
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,National Heart and Lung Institute, Imperial College London, United Kingdom (R.H.)
| | - Tamanna S Bahaei
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.)
| | - Claudia Prieto
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
| | - René M Botnar
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
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18
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Chen SY, Wu WF, Di C, Zhao XX. Association between magnetic resonance imaging of carotid artery and coronary stenosis detected by computed tomography angiography. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:299-309. [PMID: 32065808 DOI: 10.3233/xst-190619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the correlation between carotid artery stenosis (CAS) measured by magnetic resonance imaging (MRI) and the coronary stenosis (CS) determined by computed tomography angiography (CTA). METHODS In this prospective study, 42 subjects diagnosed with coronary artery disease (CAD) underwent MRI and CTA examinations. The severity degree and number of CAS, the score, detection rate and type of carotid plaque, and also the severity degree and number of CS were assessed. Spearman's rank correlation test was used to evaluate the correlation between CAS and CS. RESULTS CS was detected in 42 (100%) subjects, while CAS was detected in 36 (85.7%) subjects. Distribution of CAS severity grades in multiple-vessel group was significantly different from other groups, which with more moderate and severe stenosis (p < 0.05). A positive and significant correlation between the CAS severity and CS severity (r = 0.612, p < 0.05), and the number of involved coronary vessels (r = 0.572, p < 0.05) were observed, respectively. Both detection rate (r = 0.587, p < 0.05) and score (r = 0.735, p < 0.05) of carotid plaque showed a good correlation with the number of involved coronary vessels. After carotid MRI, 71 carotid plaques were detected in 42 subjects, with an incidence rate of 9.9% in subjects with mild CS, 18.3% in moderate CS and 71.8% in severe CS. CONCLUSION Correlation between CAS measured by MRI and CS determined by CTA was identified in present study. These results indicated that the non-invasive CAS evaluation employing the MRI may be clinically useful for the assessment of CS.
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Affiliation(s)
- Si-Ying Chen
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Wen-Fang Wu
- Department of Radiology, Jining No.1 People's Hospital, Shandong Province, China
| | - Cong Di
- Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Shandong Province, China
| | - Xin-Xiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
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19
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Magnetic Resonance Imaging Identified Brain Ischaemia in Symptomatic Patients Undergoing Carotid Endarterectomy Is Related to Histologically Apparent Intraplaque Haemorrhage. Eur J Vasc Endovasc Surg 2019; 58:796-804. [PMID: 31631008 DOI: 10.1016/j.ejvs.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Intraplaque haemorrhage (IPH) has been independently associated with a higher risk of future ipsilateral stroke in patients with carotid artery stenosis. Evaluation of plaque characteristics may contribute to risk assessment of recurrent (silent) cerebrovascular events in order to prioritise patients for timing of treatment. It is unknown if patients showing histologically apparent IPH also have increased risk of silent ischaemic brain lesions in the waiting period between index event and revascularisation. METHODS A retrospective analysis was performed based on prospectively collected data of patients included simultaneously in the magnetic resonance imaging (MRI) substudy of the International Carotid Stenting Study and Athero-Express biobank. Patients randomised for carotid endarterectomy (CEA) underwent surgery between 2003 and 2008. Brain MRI was performed one to seven days prior to CEA. Plaques were histologically examined for presence of IPH. The primary outcome parameter was presence of silent ipsilateral brain ischaemia on magnetic resonance diffusion weighted imaging (MR-DWI) appearing hypo or isointense on apparent diffusion coefficient. RESULTS Fifty-three patients with symptomatic carotid stenosis meeting the study criteria were identified, of which 13 showed one or more recent ipsilateral DWI lesion on pre-operative scan. The median time between latest ipsilateral neurological event and revascularisation was 45 days (range 6-200) in DWI negative patients vs. 34 days (range 6-74, p = .16) in DWI positive patients. IPH was present in 24/40 (60.0%) DWI negative patients vs. 12/13 (92.3%) DWI positive patients (OR 8.00; 95% CI 0.95-67.7, p = .06). Multivariable logistic regression analysis correcting for age and type of index event revealed that IPH was independently associated with DWI lesions in the waiting period till surgery (OR 10.8; 95% CI 1.17-99.9, p = .04). CONCLUSION Symptomatic patients with ipsilateral carotid stenosis and silent brain ischaemia on pre-operative MR-DWI, more often showed pathological evidence of IPH compared with those without ischaemic lesions. This identifies carotid IPH as a marker for patients at risk of silent brain ischaemia and possibly for future stroke and other arterial disease complications. Such patients may be more likely to benefit from CEA than those without evidence of ipsilateral carotid IPH.
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20
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Liu L, Huo C, Sun H, Yang H, Zhang R, Wang L, Xia Z. Vascular Morphology has No Direct Relationship with Atherosclerotic Plaque Burden in Patients with Symptomatic Middle Cerebral Artery Stenosis. Curr Neurovasc Res 2019; 16:224-231. [PMID: 31258086 DOI: 10.2174/1567202616666190618122746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The vascular morphology and the characteristics of atherosclerotic plaques in the middle cerebral artery (MCA) have not been fully studied with high-resolution magnetic resonance imaging (HR-MRI). OBJECTIVE HR-MRI was applied to investigate vascular morphology and atherosclerotic plaque in patients with symptomatic MCA stenosis. MATERIALS AND METHODS A total of 343 patients with symptomatic MCA stenosis were enrolled in this study. All the patients were examined by HR-MRI to analyze the morphology of MCA and the M1 segment (MCA-M1), the characteristics and the location of the plaques. RESULTS The proportion of L-shaped MCA-M1 decreased, while the proportion of S-shaped MCAM1 increased with age. The anterior plaques were the most common in all the patients. The superior plaques were relatively common in patients with L-shaped and U-shaped MCA-M1, while the inferior plaques were relatively common in patients with inverted U-shaped and S-shaped MCAM1. Among all the plaques, the majority were isointense or heterogeneous. The MCA-M1 morphology had no direct relationship with the common risk factors of atherosclerosis and the clinical outcomes of the patients after 12 months of follow up. CONCLUSION The morphology of MCA-M1 is not directly related to the plaque burden or the degree of stenosis in patients with symptomatic MCA stenosis. The morphology of MCA-M1 is not associated with the risk factors of atherosclerosis, or the clinical outcomes of the patients.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Chengju Huo
- Department of Neurology, The Third People's Hospital of Liaocheng, Liaocheng, Shandong, 252000, China
| | - Hao Sun
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Hua Yang
- Department of Neurology, The Third People's Hospital of Liaocheng, Liaocheng, Shandong, 252000, China
| | - Rui Zhang
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Lexin Wang
- Department of Cardiology, Liaocheng People's Hospital, Liaocheng, Shandong, 252000, China.,School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Zhangyong Xia
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
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21
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Xiong Y, Zhang Z, He L, Ma Y, Han H, Zhao X, Guo H. Intracranial simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MRA: Analyzation, optimization, and extension for dynamic MRA. Magn Reson Med 2019; 82:1646-1659. [DOI: 10.1002/mrm.27855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Yuhui Xiong
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Zhe Zhang
- China National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital, Capital Medical University Beijing People's Republic of China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Yu Ma
- Tsinghua University Yuquan Hospital Beijing People's Republic of China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
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22
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Roy-Cardinal MH, Destrempes F, Soulez G, Cloutier G. Assessment of Carotid Artery Plaque Components With Machine Learning Classification Using Homodyned-K Parametric Maps and Elastograms. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:493-504. [PMID: 29994706 DOI: 10.1109/tuffc.2018.2851846] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Quantitative ultrasound (QUS) imaging methods, including elastography, echogenicity analysis, and speckle statistical modeling, are available from a single ultrasound (US) radio-frequency data acquisition. Since these US imaging methods provide complementary quantitative tissue information, characterization of carotid artery plaques may gain from their combination. Sixty-six patients with symptomatic ( n = 26 ) and asymptomatic ( n = 40 ) carotid atherosclerotic plaques were included in the study. Of these, 31 underwent magnetic resonance imaging (MRI) to characterize plaque vulnerability and quantify plaque components. US radio-frequency data sequence acquisitions were performed on all patients and were used to compute noninvasive vascular US elastography and other QUS features. Additional QUS features were computed from three types of images: homodyned-K (HK) parametric maps, Nakagami parametric maps, and log-compressed B-mode images. The following six classification tasks were performed: detection of 1) a small area of lipid; 2) a large area of lipid; 3) a large area of calcification; 4) the presence of a ruptured fibrous cap; 5) differentiation of MRI-based classification of nonvulnerable carotid plaques from neovascularized or vulnerable ones; and 6) confirmation of symptomatic versus asymptomatic patients. Feature selection was first applied to reduce the number of QUS parameters to a maximum of three per classification task. A random forest machine learning algorithm was then used to perform classifications. Areas under receiver-operating curves (AUCs) were computed with a bootstrap method. For all tasks, statistically significant higher AUCs were achieved with features based on elastography, HK parametric maps, and B-mode gray levels, when compared to elastography alone or other QUS alone ( ). For detection of a large area of lipid, the combination yielding the highest AUC (0.90, 95% CI 0.80-0.92, ) was based on elastography, HK, and B-mode gray-level features. To detect a large area of calcification, the highest AUC (0.95, 95% CI 0.94-0.96, ) was based on HK and B-mode gray level features. For other tasks, AUCs varied between 0.79 and 0.97. None of the best combinations contained Nakagami features. This study shows the added value of combining different features computed from a single US acquisition with machine learning to characterize carotid artery plaques.
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