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Savvopoulos F, Keeling MC, Carassiti D, Fogell NA, Patel MB, Naser J, Gavara N, de Silva R, Krams R. Assessment of the nano-mechanical properties of healthy and atherosclerotic coronary arteries by atomic force microscopy. J R Soc Interface 2024; 21:20230674. [PMID: 38320600 PMCID: PMC10846958 DOI: 10.1098/rsif.2023.0674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
Nano-indentation techniques might be better equipped to assess the heterogeneous material properties of plaques than macroscopic methods but there are no bespoke protocols for this kind of material testing for coronary arteries. Therefore, we developed a measurement protocol to extract mechanical properties from healthy and atherosclerotic coronary artery tissue sections. Young's modulus was derived from force-indentation data. Metrics of collagen fibre density were extracted from the same tissue, and the local material properties were co-registered to the local collagen microstructure with a robust framework. The locations of the indentation were retrospectively classified by histological category (healthy, plaque, lipid-rich, fibrous cap) according to Picrosirius Red stain and adjacent Hematoxylin & Eosin and Oil-Red-O stains. Plaque tissue was softer (p < 0.001) than the healthy coronary wall. Areas rich in collagen within the plaque (fibrous cap) were significantly (p < 0.001) stiffer than areas poor in collagen/lipid-rich, but less than half as stiff as the healthy coronary media. Young's moduli correlated (Pearson's ρ = 0.53, p < 0.05) with collagen content. Atomic force microscopy (AFM) is capable of detecting tissue stiffness changes related to collagen density in healthy and diseased cardiovascular tissue. Mechanical characterization of atherosclerotic plaques with nano-indentation techniques could refine constitutive models for computational modelling.
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Affiliation(s)
- Fotios Savvopoulos
- Department of Bioengineering, Imperial College London, London SW3 6LR, UK
- National Heart and Lung Institute, Department of Medicine, Imperial College London, London SW3 6LR, UK
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Michael C. Keeling
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Daniele Carassiti
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Nicholas A. Fogell
- National Heart and Lung Institute, Department of Medicine, Imperial College London, London SW3 6LR, UK
| | - Miten B. Patel
- National Heart and Lung Institute, Department of Medicine, Imperial College London, London SW3 6LR, UK
| | - Jarka Naser
- National Heart and Lung Institute, Department of Medicine, Imperial College London, London SW3 6LR, UK
| | - Núria Gavara
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
- Unit of Biophysics and Bioengineering, Medical School, University of Barcelona, Barcelona 08007, Spain
| | - Ranil de Silva
- National Heart and Lung Institute, Department of Medicine, Imperial College London, London SW3 6LR, UK
| | - Rob Krams
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
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Csore J, Drake M, Roy TL. Peripheral arterial disease treatment planning using noninvasive and invasive imaging methods. J Vasc Surg Cases Innov Tech 2023; 9:101263. [PMID: 37767348 PMCID: PMC10520537 DOI: 10.1016/j.jvscit.2023.101263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 09/29/2023] Open
Abstract
With the growing prevalence and mortality of peripheral arterial disease, preoperative assessment, risk stratification, and determining the correct indication for endovascular and open surgical procedures are essential for therapeutic decision-making. The effectiveness of interventional procedures is significantly influenced by the plaque composition and calcification pattern. Therefore, the identification of patients for whom endovascular treatment is the most appropriate therapeutic solution often remains a challenge. The most commonly used imaging techniques have their own limitations and do not provide findings detailed enough for specific, personalized treatment planning. Using state-of-the-art noninvasive and invasive imaging modalities, it is now possible to obtain a view, not only of the complex vascular anatomy and plaque burden of the lower extremity arterial system, but also of complex plaque structures and various pathologic calcium distribution patterns. In the future, as these latest advancements in diagnostic methods become more widespread, we will be able to obtain more accurate views of the plaque structure and anatomic complexity to guide optimal treatment planning and device selection. We reviewed the implications of the most recent invasive and noninvasive lower extremity imaging techniques and future directions.
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Affiliation(s)
- Judit Csore
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Madeline Drake
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Trisha L. Roy
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
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Bianchini E, Guala A, Golemati S, Alastruey J, Climie RE, Dalakleidi K, Francesconi M, Fuchs D, Hartman Y, Malik AEF, Makūnaitė M, Nikita KS, Park C, Pugh CJA, Šatrauskienė A, Terentes-Printizios D, Teynor A, Thijssen D, Schmidt-Trucksäss A, Zupkauskienė J, Boutouyrie P, Bruno RM, Reesink KD. The Ultrasound Window Into Vascular Ageing: A Technology Review by the VascAgeNet COST Action. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2183-2213. [PMID: 37148467 DOI: 10.1002/jum.16243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
Non-invasive ultrasound (US) imaging enables the assessment of the properties of superficial blood vessels. Various modes can be used for vascular characteristics analysis, ranging from radiofrequency (RF) data, Doppler- and standard B/M-mode imaging, to more recent ultra-high frequency and ultrafast techniques. The aim of the present work was to provide an overview of the current state-of-the-art non-invasive US technologies and corresponding vascular ageing characteristics from a technological perspective. Following an introduction about the basic concepts of the US technique, the characteristics considered in this review are clustered into: 1) vessel wall structure; 2) dynamic elastic properties, and 3) reactive vessel properties. The overview shows that ultrasound is a versatile, non-invasive, and safe imaging technique that can be adopted for obtaining information about function, structure, and reactivity in superficial arteries. The most suitable setting for a specific application must be selected according to spatial and temporal resolution requirements. The usefulness of standardization in the validation process and performance metric adoption emerges. Computer-based techniques should always be preferred to manual measures, as long as the algorithms and learning procedures are transparent and well described, and the performance leads to better results. Identification of a minimal clinically important difference is a crucial point for drawing conclusions regarding robustness of the techniques and for the translation into practice of any biomarker.
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Affiliation(s)
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Spyretta Golemati
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jordi Alastruey
- Department of Biomedical Engineering, King's College London, London, UK
| | - Rachel E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou - APHP, Paris, France
| | - Kalliopi Dalakleidi
- Biomedical Simulations and Imaging (BIOSIM) Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Martina Francesconi
- Institute of Clinical Physiology, CNR, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Dieter Fuchs
- Fujifilm VisualSonics, Amsterdam, The Netherlands
| | - Yvonne Hartman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Afrah E F Malik
- CARIM School for Cardiovascular Diseases and Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Monika Makūnaitė
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Konstantina S Nikita
- Biomedical Simulations and Imaging (BIOSIM) Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Christopher J A Pugh
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Agnė Šatrauskienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Dimitrios Terentes-Printizios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Teynor
- Faculty of Computer Science, Augsburg University of Applied Sciences, Augsburg, Germany
| | - Dick Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division Sport and Exercise Medicine, University of Basel, Basel, Switzerland
| | - Jūratė Zupkauskienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Pierre Boutouyrie
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou - APHP, Paris, France
| | - Rosa Maria Bruno
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou - APHP, Paris, France
| | - Koen D Reesink
- CARIM School for Cardiovascular Diseases and Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
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Role of Preoperative Ultrasound Shear-Wave Elastography and Radiofrequency-Based Arterial Wall Tracking in Assessing the Vulnerability of Carotid Plaques: Preliminary Results. Diagnostics (Basel) 2023; 13:diagnostics13040805. [PMID: 36832293 PMCID: PMC9955800 DOI: 10.3390/diagnostics13040805] [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: 12/26/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
We aimed at evaluating the ability of point shear-wave elastography (pSWE) and of a radiofrequency (RF) echo-tracking-based method in preoperatively assessing the vulnerability of the carotid plaque in patients undergoing carotid endarterectomy (CEA) for significant asymptomatic stenosis. All patients who underwent CEA from 03/2021 to 03/2022 performed a preoperative pSWE and an RF echo-based wall evaluation of arterial stiffness using an Esaote MyLab ultrasound system (EsaoteTM, Genova, Italy) with dedicated software. The data derived from these evaluations (Young's modulus (YM), augmentation index (AIx), pulse-wave velocity (PWV)) were correlated with the outcome of the analysis of the plaque removed during the surgery. Data were analyzed on 63 patients (33 vulnerable and 30 stable plaques). In stable plaques, YM was significantly higher than in vulnerable plaques (49.6 + 8.1 kPa vs. 24.6 + 4.3 kPa, p = 0.009). AIx also tended to be slightly higher in stable plaques, even if it was not statistically significant (10.4 + 0.9% vs. 7.7 + 0.9%, p = 0.16). The PWV was similar (12.2 + 0.9 m/s for stable plaques vs. 10.6 + 0.5 m/s for vulnerable plaques, p = 0.16). For YM, values >34 kPa had a sensitivity of 50% and a specificity of 73.3% in predicting plaque nonvulnerability (area under the curve = 0.66). Preoperative measurement of YM by means of pSWE could be a noninvasive and easily applicable tool for assessing the preoperative risk of plaque vulnerability in asymptomatic patients who are candidates for CEA.
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Introduction of a Novel Image-Based and Non-Invasive Method for the Estimation of Local Elastic Properties of Great Vessels. ELECTRONICS 2022. [DOI: 10.3390/electronics11132055] [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
Background: In the context of a growing demand for the use of in silico models to meet clinical requests, image-based methods play a crucial role. In this study, we present a parametric equation able to estimate the elasticity of vessel walls, non-invasively and indirectly, from information uniquely retrievable from imaging. Methods: A custom equation was iteratively refined and tuned from the simulations of a wide range of different vessel models, leading to the definition of an indirect method able to estimate the elastic modulus E of a vessel wall. To test the effectiveness of the predictive capability to infer the E value, two models with increasing complexity were used: a U-shaped vessel and a patient-specific aorta. Results: The original formulation was demonstrated to deviate from the ground truth, with a difference of 89.6%. However, the adoption of our proposed equation was found to significantly increase the reliability of the estimated E value for a vessel wall, with a mean percentage error of 9.3% with respect to the reference values. Conclusion: This study provides a strong basis for the definition of a method able to estimate local mechanical information of vessels from data easily retrievable from imaging, thus potentially increasing the reliability of in silico cardiovascular models.
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Alyami J, Almutairi F. Arterial Stiffness Assessment in Healthy Participants Using Shear Wave Elastography. Curr Med Imaging 2022; 18:1086-1092. [PMID: 35430974 DOI: 10.2174/1573405618666220415124535] [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: 09/17/2021] [Revised: 12/29/2021] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Arterial stiffness is an important biomarker for cardiovascular disease. Shear wave elastography (SWE) provides quantitative estimates of tissue stiffness. OBJECTIVE This study aimed to provide reference values for arterial wall, assessing the suitability of SWE to quantify elasticity of the common carotid artery (CCA) and evaluating inter- and intra-observer reproducibility. METHODS A Supersonic Aixplorer ultrasound system with L15-4 probe was used to scan longitudinal sections of the CCA. Young's modulus (YM) was measured within 2-mm regions of interest. Reproducibility was assessed within a subgroup of 16 participants by two operators (one novice and one experienced) during two sessions >one week apart. RESULTS This study involves seventy-three participants with a mean age of 40±10 years and body mass index of 26 ±6 kg/m2. YM estimates were 59 kPa ±19 in men and 56 kPa ±12 in women. The average YM of the CCA walls was 58 kPa ±15 (57 ±15 kPa for the anterior wall and 58 ±20 kPa for the posterior wall, p=0.75). There was no significant difference in the mean of YM estimates of the CCA between the observers (observer: one 51 ±14 kPa and observer two: 55 ±17 kPa [p=0.46]). inter- and intra-observer reproducibility was fair to good (Intra-class correlations, ranging from 0.46 to 0.71). Inter-frame variability was 28%. CONCLUSION In healthy individuals, SWE provided an estimate of YM of the CCA (58 kPa) with fair to good reproducibility. This study demonstrated the potential of using SWE for assessing biomechanical properties of blood vessels.
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Affiliation(s)
- Jaber Alyami
- Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad Almutairi
- Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Tjan A, Widiana IGR, Martadiani ED, Ayusta IMD, Asih MW, Sitanggang FP. Carotid artery stiffness measured by strain elastography ultrasound is a stroke risk factor. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100850] [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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Cismaru G, Serban T, Tirpe A. Ultrasound Methods in the Evaluation of Atherosclerosis: From Pathophysiology to Clinic. Biomedicines 2021; 9:418. [PMID: 33924492 PMCID: PMC8070406 DOI: 10.3390/biomedicines9040418] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/11/2022] Open
Abstract
Atherosclerosis is a key pathological process that causes a plethora of pathologies, including coronary artery disease, peripheral artery disease, and ischemic stroke. The silent progression of the atherosclerotic disease prompts for new surveillance tools that can visualize, characterize, and provide a risk evaluation of the atherosclerotic plaque. Conventional ultrasound methods-bright (B)-mode US plus Doppler mode-provide a rapid, cost-efficient way to visualize an established plaque and give a rapid risk stratification of the patient through the Gray-Weale standardization-echolucent plaques with ≥50% stenosis have a significantly greater risk of ipsilateral stroke. Although rather disputed, the measurement of carotid intima-media thickness (C-IMT) may prove useful in identifying subclinical atherosclerosis. In addition, contrast-enhanced ultrasonography (CEUS) allows for a better image resolution and the visualization and quantification of plaque neovascularization, which has been correlated with future cardiovascular events. Newly emerging elastography techniques such as strain elastography and shear-wave elastography add a new dimension to this evaluation-the biomechanics of the arterial wall, which is altered in atherosclerosis. The invasive counterpart, intravascular ultrasound (IVUS), enables an individualized assessment of the anti-atherosclerotic therapies, as well as a direct risk assessment of these lesions through virtual histology IVUS.
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Affiliation(s)
- Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Teodora Serban
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania;
| | - Alexandru Tirpe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
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Pruijssen JT, de Korte CL, Voss I, Hansen HHG. Vascular Shear Wave Elastography in Atherosclerotic Arteries: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2145-2163. [PMID: 32620385 DOI: 10.1016/j.ultrasmedbio.2020.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Ischemic stroke is a leading cause of death and disability worldwide, so adequate prevention strategies are crucial. However, current stroke risk stratification is based on epidemiologic studies and is still suboptimal for individual patients. The aim of this systematic review was to provide a literature overview on the feasibility and diagnostic value of vascular shear wave elastography (SWE) using ultrasound (US) in (mimicked) human and non-human arteries affected by different stages of atherosclerotic diseases or diseases related to atherosclerosis. An online search was conducted on Pubmed, Embase, Web of Science and IEEE databases to identify studies using US SWE for the assessment of vascular elasticity. A quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) checklist, and relevant data were extracted. A total of 19 studies were included: 10 with human patients and 9 with non-human subjects (i.e., [excised] animal arteries and polyvinyl alcohol phantoms). All studies revealed the feasibility of using US SWE to assess individually stiffness of the arterial wall and plaques. Quantitative elasticity values were highly variable between studies. However, within studies, SWE could detect statistically significant elasticity differences in patient/subject characteristics and could distinguish different plaque types with good reproducibility. US SWE, with its unique ability to assess the elasticity of the vessel wall and plaque throughout the cardiac cycle, might be a good candidate to improve stroke risk stratification. However, more clinical studies have to be performed to assess this technique's exact clinical value.
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Affiliation(s)
- Judith T Pruijssen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Chris L de Korte
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Physics of Fluid Group, MESA+ Institute for Nanotechnology, and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Iona Voss
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hendrik H G Hansen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Miura K, Yamashita K. Mechanical Weakness of Thoracic Aorta Related to Aging or Dissection Predicted by Speed of Sound with Collagenase. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3102-3115. [PMID: 31537389 DOI: 10.1016/j.ultrasmedbio.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
Scanning acoustic microscopy reveals information on histology and speed of sound (SOS) through tissues. Slower SOS corresponds to lower stiffness. The aim of the present study was to investigate whether SOS values reflect the degree of degeneration with aging or dissection and whether enzymatic digestion susceptibility is distinct. The SOSs of media other than the atheromatous areas of normal and surgical dissections were measured and compared using medial degeneration grade (MDG) scores. To evaluate the damage rate, SOS was assessed after collagenase digestion. SOS scores negatively correlated with aging and MDG scores. Dissected aortas had higher SOS and MDG scores without age correlation. Collagenase digestion was present in all aortas, but older aortas were more injured than younger aortas. Dissected aortas were more vulnerable to collagenase. Older and dissected aortas expressed specific extracellular matrix components to compensate for mechanical weakness. The present method can evaluate mechanical weakness corresponding to histology to investigate the cause of rupture.
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Affiliation(s)
- Katsutoshi Miura
- Department of Health Science, Pathology and Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Kanna Yamashita
- Department of Health Science, Pathology and Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Marlevi D, Maksuti E, Urban MW, Winter R, Larsson M. Plaque characterization using shear wave elastography—evaluation of differentiability and accuracy using a combined ex vivo and in vitro setup. ACTA ACUST UNITED AC 2018; 63:235008. [DOI: 10.1088/1361-6560/aaec2b] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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