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Hosadurg N, Kramer CM. Magnetic Resonance Imaging Techniques in Peripheral Arterial Disease. Adv Wound Care (New Rochelle) 2023; 12:611-625. [PMID: 37058352 PMCID: PMC10468560 DOI: 10.1089/wound.2022.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 04/15/2023] Open
Abstract
Significance: Peripheral arterial disease (PAD) leads to a significant burden of morbidity and impaired quality of life globally. Diabetes is a significant risk factor accelerating the development of PAD with an associated increase in the risk of chronic wounds, tissue, and limb loss. Various magnetic resonance imaging (MRI) techniques are being increasingly acknowledged as useful methods of accurately assessing PAD. Recent Advances: Conventionally utilized MRI techniques for assessing macrovascular disease have included contrast enhanced magnetic resonance angiography (MRA), noncontrast time of flight MRA, and phase contrast MRI, but have significant limitations. In recent years, novel noncontrast MRI methods assessing skeletal muscle perfusion and metabolism such as arterial spin labeling (ASL), blood-oxygen-level dependent (BOLD) imaging, and chemical exchange saturation transfer (CEST) have emerged. Critical Issues: Conventional non-MRI (such as ankle-brachial index, arterial duplex ultrasonography, and computed tomographic angiography) and MRI based modalities image the macrovasculature. The underlying mechanisms of PAD that result in clinical manifestations are, however, complex, and imaging modalities that can assess the interaction between impaired blood flow, microvascular tissue perfusion, and muscular metabolism are necessary. Future Directions: Further development and clinical validation of noncontrast MRI methods assessing skeletal muscle perfusion and metabolism, such as ASL, BOLD, CEST, intravoxel incoherent motion microperfusion, and techniques that assess plaque composition, are advancing this field. These modalities can provide useful prognostic data and help in reliable surveillance of outcomes after interventions.
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Affiliation(s)
- Nisha Hosadurg
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M. Kramer
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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Rrapo-Kaso E, Loffler AI, Petroni GR, Meyer CH, Walker M, Kay JR, DiMaria JM, Domanchuk K, Carr JC, McDermott MM, Kramer CM. Alirocumab and plaque volume, calf muscle blood flow, and walking performance in peripheral artery disease: A randomized clinical trial. Vasc Med 2023; 28:282-289. [PMID: 37093712 PMCID: PMC10552651 DOI: 10.1177/1358863x231169324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The distal superficial femoral artery (SFA) is most commonly affected in peripheral artery disease (PAD). The effects of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab added to statin therapy on SFA atherosclerosis, downstream flow, and walking performance are unknown. METHODS Thirty-five patients with PAD on maximally tolerated statin therapy were recruited. Patients were randomized to alirocumab 150 mg subcutaneously (n = 18) or matching placebo (n = 17) therapy every 2 weeks for 1 year. The primary outcome was change in SFA plaque volume by black blood magnetic resonance imaging (MRI). Secondary outcomes were changes in calf muscle perfusion by cuff/occlusion hyperemia arterial spin labeling MRI, 6-minute walk distance (6MWD), low-density lipoprotein (LDL) cholesterol, and other biomarkers. RESULTS Age (mean ± SD) was 64 ± 8 years, 20 (57%) patients were women, 17 (49%) were Black individuals, LDL was 107 ± 36 mg/dL, and the ankle-brachial index 0.71 ± 0.20. The LDL fell more with alirocumab than placebo (mean [95% CI]) (-49.8 [-66.1 to -33.6] vs -7.7 [-19.7 to 4.3] mg/dL; p < 0.0001). Changes in SFA plaque volume and calf perfusion showed no difference between groups when adjusted for baseline (+0.25 [-0.29 to 0.79] vs -0.04 [-0.47 to 0.38] cm3; p = 0.37 and 0.22 [-8.67 to 9.11] vs 3.81 [-1.45 to 9.08] mL/min/100 g; p = 0.46, respectively), nor did 6MWD. CONCLUSION In this exploratory study, the addition of alirocumab therapy to statins did not alter SFA plaque volume, calf perfusion or 6MWD despite significant LDL lowering. Larger studies with longer follow up that include plaque characterization may improve understanding of the effects of intensive LDL-lowering therapy in PAD (ClinicalTrials.gov Identifier: NCT02959047).
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Affiliation(s)
- Elona Rrapo-Kaso
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Adrian I Loffler
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Gina R Petroni
- Departments of Public Health Sciences, University of Virginia Health, Charlottesville, VA, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia Health, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | - McCall Walker
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Jennifer R. Kay
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | - Joseph M DiMaria
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | | | - James C Carr
- Department of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Mary M McDermott
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
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Wang X, Nai YH, Gan J, Lian CPL, Ryan FK, Tan FSL, Chan DYS, Ng JJ, Lo ZJ, Chong TT, Hausenloy DJ. Multi-Modality Imaging of Atheromatous Plaques in Peripheral Arterial Disease: Integrating Molecular and Imaging Markers. Int J Mol Sci 2023; 24:11123. [PMID: 37446302 DOI: 10.3390/ijms241311123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral artery disease (PAD) is a common and debilitating condition characterized by the narrowing of the limb arteries, primarily due to atherosclerosis. Non-invasive multi-modality imaging approaches using computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging have emerged as valuable tools for assessing PAD atheromatous plaques and vessel walls. This review provides an overview of these different imaging techniques, their advantages, limitations, and recent advancements. In addition, this review highlights the importance of molecular markers, including those related to inflammation, endothelial dysfunction, and oxidative stress, in PAD pathophysiology. The potential of integrating molecular and imaging markers for an improved understanding of PAD is also discussed. Despite the promise of this integrative approach, there remain several challenges, including technical limitations in imaging modalities and the need for novel molecular marker discovery and validation. Addressing these challenges and embracing future directions in the field will be essential for maximizing the potential of molecular and imaging markers for improving PAD patient outcomes.
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Affiliation(s)
- Xiaomeng Wang
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Ying-Hwey Nai
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Julian Gan
- Siemens Healthineers, Singapore 348615, Singapore
| | - Cheryl Pei Ling Lian
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Fraser Kirwan Ryan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Forest Su Lim Tan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Dexter Yak Seng Chan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Jun Jie Ng
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore 258499, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore 168752, Singapore
- Surgical Academic Clinical Programme, Singapore General Hospital, Singapore 169608, Singapore
- Vascular SingHealth Duke-NUS Disease Centre, Singapore 168752, Singapore
| | - Derek John Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, Singapore
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
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Detection and Prediction of Peripheral Arterial Plaque Using Vessel Wall MR in Patients with Diabetes. BIOMED RESEARCH INTERNATIONAL 2021. [PMID: 31638151 PMCID: PMC8088372 DOI: 10.1155/2021/5585846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate the predictive performance of a newly developed delay alternating with nutation for tailored excitation (DANTE) pulse sequence for detecting lower extremity artery wall morphology and distribution in patients with peripheral artery disease (PAD) with diabetes. Methods Seventy-four PAD patients diagnosed according to 2011 WHO criteria were enrolled, who has diabetic diagnosis by 1999 WHO diabetes criteria. All patients received sequential DANTE, T2WI, DANTE-enhance, and CE-MRA scans. The images consisted of three parts: the iliac artery (segment 1), femoral artery (segment 2), and popliteal artery (segment 3). Regions of interest (ROIs) were drawn on vessels, muscle, and background, and multiple imaging metrics compared between modalities, including image quality score, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). In the images with a score greater than 2, the lumen area (LA), total vessel area (TVA), and vessel thickness (VT) can be identified using semiautomatic image analysis vessel morphology parameters. Results All 222 arterial segments were successfully analyzed from 71 patients, after exclusion of three subjects with poor image quality (IQ < 2) in segment 3. There were 54 diabetic and 17 nondiabetic patients. Quantitative analysis shows that the CNR difference between diabetic patients and nondiabetic patients was statistically significant for the same segment, while there was no significant difference among the three segments of SNR and CNR. There were a total of 54 diabetics with plaque distribution data, which showed that LA of segments 1 and 2 was higher than that of segment 3. The VWI of segments 1 and 2 was lower than segment 3. Diabetic was associated with vascular WT 3 and WA3, which increased by 0.23 and 0.83 units on average compared without diabetic foot, respectively. Diabetic foot was associated with vascular WT 3, which increased by 0.37 units on average compared without diabetic foot. The incidence of segment 3 plaques was higher than that of segment 1. The incidence of the left and right plaques was different. Conclusions MR imaging using the DANTE and multicontrast sequence could evaluate plaque morphology, and distribution of lower extremities and the occurrence of diabetic foot development are closely related; it may predict occurrence of PAD with diabetic foot.
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Wang L, Deng W, Liang J, Zhuang W, Feng H, Zhuang G, Liu D, Chen H. Loan sharking: changing patterns in, and challenging perceptions of, an abuse of deprivation. JOURNAL OF PUBLIC HEALTH (OXFORD, ENGLAND) 2021; 43:e62-e68. [PMID: 31638151 PMCID: PMC8088372 DOI: 10.1093/pubmed/fdz090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Illegal high interest lending or 'loan sharking' exploits the vulnerable and has profound negative impacts on individuals and communities. The 2008 UK financial crash and subsequent austerity programme coupled with changes in the consumer credit market have fuelled an increase in predatory lending. METHODS The study is a descriptive analysis of demographic, financial, health and behavioural data on 753 victims (2011-2017). A review of the causative factors and potential political, economic and public health responses is analysed. RESULTS Most victims were female but males were considerably more indebted. Illegal loans are largely taken out for routine living expenses and over 70% of victims reported other serious debts. Victims are disproportionately poor, unemployed and on benefits but fewer than half have had financial or benefits advice. Despite 90% reporting they would not borrow illegally again, 30% had previously done so from the same shark and over half considered them a friend. CONCLUSIONS The increase in loan sharking has coincided with the withdrawal of traditional sub-prime lenders and local welfare assistance schemes, and the low penetration of Credit Unions in many areas. Conventional perceptions of loan sharks and their relationships with victims are largely incorrect. A range of coordinated financial, political and social interventions is required.
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Affiliation(s)
- Li Wang
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Wei Deng
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Jianke Liang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Weizhao Zhuang
- Invasive Technology Department, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Huigang Feng
- Invasive Technology Department, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Gaoming Zhuang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- Medical Imaging Institute of Panyu, Guangzhou, China
| | - Dexiang Liu
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Hanwei Chen
- Invasive Technology Department, Guangzhou Panyu Central Hospital, Guangzhou, China
- Invasive Technology Department, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Wang Y, Liu X, Haraldsson H, Zhu C, Ballweber M, Gasper W, Hatsukami T, Saloner D. Quantitative measurement of atheroma burden: reproducibility in serial studies of atherosclerotic femoral arteries. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:855-863. [PMID: 32297164 DOI: 10.1007/s10334-020-00843-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to evaluate the reproducibility of measures of plaque morphology in serially acquired black-blood MRI of untreated atherosclerotic femoral arteries. MATERIALS AND METHODS MR studies was obtained from 42 timepoints, on 12 patients with known femoral artery atherosclerosis. Images with a 3D isotropic FLASH with DANTE-prepared black blood contrast (DASH) at a 3-T scanner were acquired at baseline, within 1 week, and at 1 month. Six of the patients were scanned additionally at 6 months. Inter-scan and inter-observer variations of arterial area/volume measurements were evaluated. RESULTS Measurement of vessel area, lumen area, wall area and wall volume showed inter-scan intraclass correlation coefficients (ICC) ranging from 0.92 to 0.97 for 3 scans, 0.91-0.97 for 4 scans, and inter-observer ICCs of 0.89-0.96. Among 3 scans, the coefficients of variance (CV) for the vessel area, lumen area, wall area and wall volume were 4.1%, 6.5%, 7.5%, and 4.4%. CVs among 4 scans ranged from 4.4% to 7.9%, and interobserver CVs ranged from 6.1% to 11.8% for the different area/volume measurements. CONCLUSION DASH MRI is useful for quantifying atherosclerotic vessel area and volume of femoral arteries with low variability among serial repeated scans and between observers.
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Affiliation(s)
- Yuting Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 2006 Xiyuan Avenue, Chengdu, 611731, China. .,Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Xinke Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.,Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Henrik Haraldsson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Megan Ballweber
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Warren Gasper
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA
| | - Thomas Hatsukami
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Donohue CM, Adler JV, Bolton LL. Peripheral arterial disease screening and diagnostic practice: A scoping review. Int Wound J 2019; 17:32-44. [PMID: 31680419 DOI: 10.1111/iwj.13223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022] Open
Abstract
Early reliable, valid screening, diagnosis, and treatment improve peripheral arterial disease outcomes, yet screening and diagnostic practices vary across settings and specialties. A scoping literature review described reliability and validity of peripheral ischaemia diagnosis or screening tools. Clinical studies in the PUBMED database January 1, 1970, to August 13, 2018, were reviewed summarising ranges of reliability and validity of peripheral ischaemia diagnostic and screening tools for patients with non-neuropathic lower leg ischaemia. Peripheral ischaemia screening and diagnostic practices varied in parameters measured such as timing, frequency, setting, ordering clinicians, degree of invasiveness, costs, definitions, and cut-off points informing clinical and referral decisions. Traditional ankle/brachial systolic blood pressure index <0.9 was a reliable, valid lower leg ischaemia screening test to trigger specialist referral for detailed diagnosis. For patients with advanced peripheral ischaemia or calcified arteries, toe-brachial index, claudication, or invasive angiographic imaging techniques that can have complications were reliable, valid screening, and diagnostic tools to inform management decisions. Ankle/brachial index testing is sufficiently reliable and valid for use during routine examinations to improve timing and consistency of peripheral ischaemia screening, triggering prompt specialist referral for more reliable, accurate Doppler, or other diagnosis to inform treatment decisions.
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Affiliation(s)
- Cornelius M Donohue
- Wound Healing and Limb Preservation Center of Philadelphia LLC, Ardmore, Pennsylvania
| | - Joseph V Adler
- Department of Occupational and Physical Therapy, Good Shepherd Penn Partners at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura L Bolton
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Russell KS, Yates DP, Kramer CM, Feller A, Mahling P, Colin L, Clough T, Wang T, LaPerna L, Patel A, Lawall H, Shennak MM, Fulmer J, Nikol S, Smith WB, Müller OJ, Ratchford EV, Basson CT. A randomized, placebo-controlled trial of canakinumab in patients with peripheral artery disease. Vasc Med 2019; 24:414-421. [PMID: 31277561 DOI: 10.1177/1358863x19859072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extensive atherosclerotic plaque burden in the lower extremities often leads to symptomatic peripheral artery disease (PAD) including impaired walking performance and claudication. Interleukin-1β (IL-1β) may play an important pro-inflammatory role in the pathogenesis of this disease. Interruption of IL-1β signaling was hypothesized to decrease plaque progression in the leg macrovasculature and improve the mobility of patients with PAD with intermittent claudication. Thirty-eight patients (mean age 65 years; 71% male) with symptomatic PAD (confirmed by ankle-brachial index) were randomized 1:1 to receive canakinumab (150 mg subcutaneously) or placebo monthly for up to 12 months. The mean vessel wall area (by 3.0 T black-blood magnetic resonance imaging (MRI)) of the superficial femoral artery (SFA) was used to measure plaque volume. Mobility was assessed using the 6-minute walk test. Canakinumab was safe and well tolerated. Markers of systemic inflammation (interleukin-6 and high-sensitivity C-reactive protein) fell as early as 1 month after treatment. MRI (32 patients at 3 months; 21 patients at 12 months) showed no evidence of plaque progression in the SFA in either placebo-treated or canakinumab-treated patients. Although an exploratory endpoint, placebo-adjusted maximum and pain-free walking distance (58 m) improved as early as 3 months after treatment with canakinumab when compared with placebo. Although canakinumab did not alter plaque progression in the SFA, there is an early signal that it may improve maximum and pain-free walking distance in patients with symptomatic PAD. Larger studies aimed at this endpoint will be required to definitively demonstrate this. ClinicalTrials.gov Identifier: NCT01731990.
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Affiliation(s)
- Kerry S Russell
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Denise P Yates
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | - Andrea Feller
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Ping Mahling
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Laurence Colin
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Timothy Clough
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Tianke Wang
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Lucy LaPerna
- Remington-Davis Clinical Research, Columbus, OH, USA
| | - Alpa Patel
- Jacksonville Center for Clinical Research, Jacksonville, FL, USA
| | - Holger Lawall
- Praxis für Herzkreislauferkrankungen, Max Grundig Klinik Bühlerhöhe, Bühl, Germany
| | | | | | | | | | - Oliver J Müller
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Craig T Basson
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
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Chen L, Zhan Q, Peng W, Song T, Liu Q, Lu J. Comparison of two different measurement methods in evaluating basilar atherosclerotic plaque using high-resolution MRI at 3 tesla. BMC Med Imaging 2018; 18:49. [PMID: 30509197 PMCID: PMC6276224 DOI: 10.1186/s12880-018-0293-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background To compare the Self-referenced and Referenced measurement methods in assessing basilar artery (BA) atherosclerotic plaque employing dark blood high-resolution MRI at 3 Tesla. Methods Forty patients with > 20% stenosis as identified by conventional MRA were recruited and evaluated on a 3 Tesla MRI system. The outer wall, inner wall and lumen areas of maximal lumen narrowing site and the outer wall and lumen areas of sites that were proximal and distal to the maximal lumen narrowing site were manually traced. Plaque area (PA), stenosis rate (SR) and percent plaque burden (PPB) were calculated using the Self-referenced and Referenced measurement methods, respectively. To assess intra-observer reproducibility, BA plaque was measured twice with a 2-week interval in between measurements. Results Thirty-seven patients were included in the final analysis. There were no significant differences in PA, SR and PPB measurements between the two methods. The intra-class coefficients and coefficient of variations (CV) ranged from 0.976 to 0.990 and from 3.73 to 5.61% for the Self-referenced method and ranged from 0.928 to 0.971 and from 4.64 to 9.95% for the Referenced method, respectively. Both methods are effective in the evaluation of BA plaque. However, the CVs of the Self-referenced method is lower than the Referenced measurement method. Moreover, Bland-Altman plots showed that the Self-referenced method has a narrower interval than the Referenced measurement method. Conclusions The Self-referenced method is better and more convenient for evaluating BA plaque, and it may serve as a promising method for evaluation of basilar atherosclerotic plaque.
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Affiliation(s)
- Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Qian Zhan
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Tao Song
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China.
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10
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Mathew RC, Kramer CM. Recent advances in magnetic resonance imaging for peripheral artery disease. Vasc Med 2018; 23:143-152. [PMID: 29633922 DOI: 10.1177/1358863x18754694] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The global burden of peripheral artery disease (PAD) is significant. This has led to numerous recent advances in magnetic resonance imaging (MRI) techniques in PAD. Older techniques such as time of flight MRI or phase contrast MRI are burdened by long acquisition times and significant issues with artifacts. In addition, the most used MRI modality, contrast-enhanced MR angiography (CE-MRA) is limited by the use of gadolinium contrast and its potential toxicity. Novel MRI techniques such as arterial spin labeling (ASL), blood-oxygen-level dependent imaging (BOLD), and first-pass perfusion gadolinium enhancement are advancing the field by providing skeletal muscle perfusion/oxygenation data while maintaining excellent spatial and temporal resolution. Perfusion data can be critical to providing objective clinical data of a visualized stenosis. In addition, there are a number of new MRI sequences assessing plaque composition and lesion severity in the absence of contrast. These approaches used in combination can provide useful clinical and prognostic data and provide critical endpoints in PAD research.
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Affiliation(s)
- Roshin C Mathew
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M Kramer
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
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11
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Roy TL, Forbes TL, Dueck AD, Wright GA. MRI for peripheral artery disease: Introductory physics for vascular physicians. Vasc Med 2018. [DOI: 10.1177/1358863x18759826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has advanced significantly in the past decade and provides a safe and non-invasive method of evaluating peripheral artery disease (PAD), with and without using exogenous contrast agents. MRI offers a promising alternative for imaging patients but the complexity of MRI can make it less accessible for physicians to understand or use. This article provides a brief introduction to the technical principles of MRI for physicians who manage PAD patients. We discuss the basic principles of how MRI works and tailor the discussion to how MRI can evaluate anatomic characteristics of peripheral arterial lesions.
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Affiliation(s)
- Trisha L Roy
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andrew D Dueck
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Graham A Wright
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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12
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Zettervall SL, Marshall AP, Fleser P, Guzman RJ. Association of arterial calcification with chronic limb ischemia in patients with peripheral artery disease. J Vasc Surg 2017; 67:507-513. [PMID: 28870682 DOI: 10.1016/j.jvs.2017.06.086] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/04/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Arterial calcification is associated with an increased risk of limb events, including amputation. The association between calcification in lower extremity arteries and the severity of ischemia, however, has not been assessed. We thus sought to determine whether the extent of peripheral artery calcification (PAC) was correlated with Rutherford chronic ischemia categories and hypothesized that it could independently contribute to worsening limb status. METHODS We retrospectively reviewed all patients presenting with symptomatic peripheral artery disease who underwent evaluation by contrast and noncontrast computed tomography scan of the lower extremities as part of their assessment. Demographic and cardiovascular risk factors were recorded. Rutherford ischemia categories were determined based on history, physical examination, and noninvasive testing. PAC scores and the extent of occlusive disease were measured on noncontrast and contrast computed tomography scans, respectively. Spearman's correlation testing was used to assess the relationship between occlusive disease and calcification scores. Multivariable logistic regression was used to identify factors associated with increasing Rutherford ischemia categories. RESULTS There were 116 patients identified, including 75 with claudication and 41 with critical limb ischemia. In univariate regression, there was a significant association between increasing Rutherford ischemia category and age, diabetes duration, hypertension, the occlusion score, and PAC. There was a moderate correlation between the extent of occlusive disease and PAC scores (Spearman's R = 0.6). In multivariable analysis, only tobacco use (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-8.3), diabetes duration (OR, 1.04; 95% CI, 1.01-1.08), and the calcification score (OR, 2.1; 95% CI, 1.4-3.2) maintained an association with increasing ischemia categories after adjusting for relevant cardiovascular risk factors and the extent of occlusive disease. CONCLUSIONS PAC is independently associated with increased ischemia categories in patients with peripheral artery disease. Further research aimed at understanding the relationship between arterial calcification and worsening limb ischemia is warranted.
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Affiliation(s)
- Sara L Zettervall
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Division of Vascular Surgery, George Washington University Medical Center, Washington, D.C
| | - Andre P Marshall
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC; Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Paul Fleser
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Middle Tennessee Vascular, Williamson Medical Center, Franklin, Tenn
| | - Raul J Guzman
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
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Magnetic Resonance Venous Volume Measurements in Peripheral Artery Disease (from ELIMIT). Am J Cardiol 2016; 118:1399-1404. [PMID: 27670795 DOI: 10.1016/j.amjcard.2016.07.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/22/2022]
Abstract
The relation between the arterial and venous systems in patients with impaired lower extremity blood flow remains poorly described. The objective of this secondary analysis of the Effectiveness of Intensive Lipid Modification Medication in Preventing the Progression on Peripheral Artery Disease Trial was to determine the association between femoral vein (FV) volumes and measurements of peripheral artery disease. FV wall, lumen, and total volumes were quantified with fast spin-echo proton density-weighted magnetic resonance imaging scans in 79 patients with peripheral artery disease over 2 years. Reproducibility was excellent for FV total vessel (intraclass correlation coefficient 0.924, confidence interval 0.910 to 0.935) and lumen volumes (intraclass correlation coefficient 0.893, confidence interval 0.873 to 0.910). Baseline superficial femoral artery volumes were directly associated with FV wall (r = 0.46, p <0.0001), lumen (r = 0.42, p = 0.0001), and total volumes (r = 0.46, p <0.0001). The 2-year change in maximum walking time was inversely associated with the 24-month change in FV total volume (r = -0.45, p = 0.03). In conclusion, FV volumes can be measured reliably with fast spin-echo proton density-weighted magnetic resonance imaging, and baseline superficial femoral artery plaque burden is positively associated with FV volumes, whereas the 2-year change in FV volumes and leg function show an inverse relation.
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Langham MC, Desjardins B, Englund EK, Mohler ER, Floyd TF, Wehrli FW. Rapid High-resolution, Self-registered, Dual Lumen-contrast MRI Method for Vessel-wall Assessment in Peripheral Artery Disease:: A Preliminary Investigation. Acad Radiol 2016; 23:457-67. [PMID: 26916248 DOI: 10.1016/j.acra.2015.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES Contrast-enhanced angiographic evaluation by magnetic resonance imaging (MRI) and computed tomography (CT) is the reference standard for assessing peripheral artery disease (PAD). However, because PAD and diabetes often coexist, the prevalence of renal insufficiency is a major challenge to contrast-based angiography. The objective of this work is to describe and demonstrate a new application of three-dimensional double-echo steady-state (3D DESS) as a noncontrast vascular MRI method for evaluating peripheral atherosclerosis at 3 Tesla (3T). MATERIALS AND METHODS A water-selective 3D DESS pulse sequence was designed to simultaneously collect two steady-state free-precession signals (free induction decay and Echo) yielding "black blood" (BB) and "gray blood" (GB) images. For completeness Bloch equation, simulations were performed to characterize DESS signals of various tissues including blood at different velocities and to assess two healthy subjects for the purpose of pulse sequence optimization. Exploratory studies were performed as an add-on protocol to an existing study involving patients with PAD. To evaluate the method's specificity for detecting calcification, images from select patients were compared against CT angiography. RESULTS Simulations agreed qualitatively with in vivo images supporting DESS' potential for generating distinct lumen contrast (GB vs BB). Lesions representing calcium were easily identifiable on the basis of signal void occurring on both image types and were confirmed by CT angiography. Further, BB allowed visualization of stent restenosis, and data suggest its ability to visualize acute thrombus by virtue of T2 weighting. CONCLUSION Preliminary investigation and results suggest noncontrast 3D DESS to have the potential to improve diagnosis of PAD patients by providing detailed structural assessment of vessel-wall architecture.
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15
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Ukwatta E, Yuan J, Qiu W, Rajchl M, Chiu B, Fenster A. Joint segmentation of lumen and outer wall from femoral artery MR images: Towards 3D imaging measurements of peripheral arterial disease. Med Image Anal 2015; 26:120-32. [PMID: 26387053 DOI: 10.1016/j.media.2015.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
Three-dimensional (3D) measurements of peripheral arterial disease (PAD) plaque burden extracted from fast black-blood magnetic resonance (MR) images have shown to be more predictive of clinical outcomes than PAD stenosis measurements. To this end, accurate segmentation of the femoral artery lumen and outer wall is required for generating volumetric measurements of PAD plaque burden. Here, we propose a semi-automated algorithm to jointly segment the femoral artery lumen and outer wall surfaces from 3D black-blood MR images, which are reoriented and reconstructed along the medial axis of the femoral artery to obtain improved spatial coherence between slices of the long, thin femoral artery and to reduce computation time. The developed segmentation algorithm enforces two priors in a global optimization manner: the spatial consistency between the adjacent 2D slices and the anatomical region order between the femoral artery lumen and outer wall surfaces. The formulated combinatorial optimization problem for segmentation is solved globally and exactly by means of convex relaxation using a coupled continuous max-flow (CCMF) model, which is a dual formulation to the convex relaxed optimization problem. In addition, the CCMF model directly derives an efficient duality-based algorithm based on the modern multiplier augmented optimization scheme, which has been implemented on a GPU for fast computation. The computed segmentations from the developed algorithm were compared to manual delineations from experts using 20 black-blood MR images. The developed algorithm yielded both high accuracy (Dice similarity coefficients ≥ 87% for both the lumen and outer wall surfaces) and high reproducibility (intra-class correlation coefficient of 0.95 for generating vessel wall area), while outperforming the state-of-the-art method in terms of computational time by a factor of ≈ 20.
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Affiliation(s)
- Eranga Ukwatta
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Jing Yuan
- Robarts Research Institute, Western University, London, ON, Canada; Biomedical Engineering Graduate Program, Western University, London, ON, Canada
| | - Wu Qiu
- Robarts Research Institute, Western University, London, ON, Canada; Biomedical Engineering Graduate Program, Western University, London, ON, Canada
| | - Martin Rajchl
- Department of Computing, Imperial College London, London, UK
| | - Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Hong Kong
| | - Aaron Fenster
- Robarts Research Institute, Western University, London, ON, Canada; Biomedical Engineering Graduate Program, Western University, London, ON, Canada
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Intra-individual comparison of carotid and femoral atherosclerotic plaque features with in vivo MR plaque imaging. Int J Cardiovasc Imaging 2015; 31:1611-8. [PMID: 26296806 DOI: 10.1007/s10554-015-0737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to evaluate differences of plaque composition and morphology within the same patient in different vascular beds using non-invasive MR-plaque imaging. 28 patients (67.8 ± 7.4 years, 8 females) with high Framingham general cardiovascular disease 10-year risk score and mild-to-moderate atherosclerosis were consecutively included in the study. All subjects underwent a dedicated MRI-plaque imaging protocol using TOF and T1w and T2w black-blood-sequences with fat suppression at 1.5 T. The scan was centered on the carotid bulb of the carotid arteries and on the most stenotic lesion of the ipsilateral femoral artery, respectively. Plaques were classified according to the American Heart Association (AHA) lesion type classification and area measurements of lumen, wall and the major plaque components, such as calcification, necrotic core and hemorrhage were determined in consensus by two blinded reviewers using dedicated software (Cascade, Seattle, USA). Plaque components were recorded as maximum percentages of the wall area. Carotid arteries had larger maximum wall and smaller minimum lumen areas (p < 0.001) than femoral arteries, whereas no significant difference was find with respect to the max. NWI (p = 0.87). Prevalence of lipid-rich AHA lesion type IV/V and complicated AHA lesion type VI with hemorrhage/thrombus/fibrous cap rupture was significantly higher in the carotid arteries compared to the femoral arteries. Plaque composition as percentage of the vessel wall differed significantly between carotid and femoral arteries: Max. %necrotic core and max. %hemorrhage were significantly higher in the carotid arteries compared to the femoral arteries (p = 0.001 and p = 0.02, respectively). Max. %calcification did not differ significantly. Average stenotic degree of carotid arteries at duplex was 49.7 ± 12.5 (%). Non-invasive MR plaque-imaging is able to visualize differences in plaque composition across the vascular tree. We observed significant differences in quantitative and qualitative plaque features between carotid and femoral arteries within the same patient, which in the future could help to improve risk stratification in patients with atherosclerosis.
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17
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Xie G, Zhang N, Xie Y, Nguyen C, Deng Z, Bi X, Fan Z, Liu X, Li D, Fan Z. DANTE-prepared three-dimensional FLASH: A fast isotropic-resolution MR approach to morphological evaluation of the peripheral arterial wall at 3 Tesla. J Magn Reson Imaging 2015; 43:343-51. [PMID: 26139414 DOI: 10.1002/jmri.24986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/11/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To develop and assess a sequence using DANTE dark-blood preparation combined with FLASH readout (DANTE-FLASH) for rapid isotropic-resolution three-dimensional (3D) peripheral vessel wall imaging at 3 Tesla (T). METHODS Numerical simulations were first conducted to optimize imaging parameters for maximizing the wall-lumen contrast. The sequence, implemented at 3T, was then assessed in the bilateral superficial femoral arteries of eight healthy volunteers and three patients who were undergoing non-contrast-enhanced MRA due to known peripheral artery disease. Conventional 2D dark-blood turbo spin echo (DB-TSE) was performed as a reference in all subjects. Image quality on a 5-point scale, apparent wall signal-to-noise ratio, apparent wall-lumen contrast-to-noise ratio, wall thickness, wall area and lumen area were assessed or measured in all healthy subjects. Additionally, the agreement in the depiction of wall thickening or luminal stenosis between DANTE-FLASH and DB-TSE, or MRA was assessed using a 4-point scale in the patient study. RESULTS DANTE-FLASH allowed for a 30-cm-long coverage within 4 min, whereas DB-TSE took approximately 7 min for a 9-cm-long coverage. Good image quality was obtained by DANTE-FLASH (score > 3). The wall thickness, wall area, and lumen area were all comparable (t-test; P = 0.334, 0.224 and 0.136) and showed excellent agreement between DANTE-FLASH and DB-TSE (intra-class correlation = 0.81, 0.85, and 0.98). The atherosclerotic plaques and luminal stenosis identified by DANTE-FLASH were in accordance with the findings by 2D DB-TSE or MRA. CONCLUSION DANTE-FLASH is a 3D dark-blood MR sequence allowing for rapid isotropic-resolution imaging of the peripheral vessel wall at 3T.
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Affiliation(s)
- Guoxi Xie
- Shenzhen Key Lab for MRI, BCMIIS, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, China.,Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Christopher Nguyen
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Zixin Deng
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, California, USA
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Xin Liu
- Shenzhen Key Lab for MRI, BCMIIS, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
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Chen W, Xu J, Chiu B. Fast segmentation of the femoral arteries from 3D MR images: A tool for rapid assessment of peripheral arterial disease. Med Phys 2015; 42:2431-48. [DOI: 10.1118/1.4916803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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19
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Ukwatta E, Yuan J, Qiu W, Rajchl M, Chiu B, Shavakh S, Xu J, Fenster A. Joint segmentation of 3D femoral lumen and outer wall surfaces from MR images. ACTA ACUST UNITED AC 2014; 16:534-41. [PMID: 24505708 DOI: 10.1007/978-3-642-40811-3_67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
We propose a novel algorithm to jointly delineate the femoral artery lumen and outer wall surfaces from 3D black-blood MR images, while enforcing the spatial consistency of the reoriented MR slices along the medial axis of the femoral artery. We demonstrate that the resulting optimization problem of the proposed segmentation can be solved globally and exactly by means of convex relaxation, for which we introduce a novel coupled continuous max-flow (CCOMF) model based on an Ishikawa-type flow configuration and show its duality to the studied convex relaxed optimization problem. Using the proposed CCMF model, the exactness and globalness of its dual convex relaxation problem is proven. Experiment results demonstrate that the proposed method yielded high accuracy (i.e. Dice similarity coefficient > 85%) for both the lumen and outer wall and high reproducibility (intra-class correlation coefficient of 0.95) for generating vessel wall area. The proposed method outperformed the previous method, in terms of computation time, by a factor of pproximately 20.
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Affiliation(s)
- Eranga Ukwatta
- Robarts Research Institute, Western University, London, ON, Canada.
| | - Jing Yuan
- Robarts Research Institute, Western University, London, ON, Canada
| | - Wu Qiu
- Robarts Research Institute, Western University, London, ON, Canada
| | - Martin Rajchl
- Robarts Research Institute, Western University, London, ON, Canada
| | - Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Hong Kong
| | - Shadi Shavakh
- Robarts Research Institute, Western University, London, ON, Canada
| | - Jianrong Xu
- Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Aaron Fenster
- Robarts Research Institute, Western University, London, ON, Canada
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Chi J, Chiu B, Cao Y, Liu X, Wang J, Balu N, Yuan C, Xu J. Assessment of femoral artery atherosclerosis at the adductor canal using 3D black-blood MRI. Clin Radiol 2013; 68:e213-21. [DOI: 10.1016/j.crad.2012.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
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Pollak AW, Kramer CM. MRI in Lower Extremity Peripheral Arterial Disease: Recent Advancements. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:55-60. [PMID: 23336015 PMCID: PMC3547388 DOI: 10.1007/s12410-012-9175-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Evaluation of peripheral arterial disease by cardiovascular magnetic resonance imaging continues to develop. Of the clinical diagnostics tests currently available, magnetic resonance angiography is well established as one of the preferred techniques for determining areas of arterial occlusive disease affecting the lower extremities. Despite this, there have been new developments in non-gadolinium based contrast-enhanced studies as well as testing done at higher field strength scanners. In the research arena, magnetic resonance spectroscopy, calf muscle perfusion imaging and atherosclerotic plaque evaluation all have made significant advancements over the last year. These techniques are gaining traction as surrogate endpoints in clinical trials of novel therapeutics aimed at alleviating symptoms in patients with peripheral arterial disease.
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Affiliation(s)
- Amy W. Pollak
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Christopher M. Kramer
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, University of Virginia, Charlottesville, VA
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Pollak AW, Norton PT, Kramer CM. Multimodality imaging of lower extremity peripheral arterial disease: current role and future directions. Circ Cardiovasc Imaging 2013; 5:797-807. [PMID: 23169982 DOI: 10.1161/circimaging.111.970814] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Amy W Pollak
- Departments of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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McDermott MM, Liu K, Carroll TJ, Kibbe M, Ferrucci L, Guralnik JM, Morasch M, Pearce W, Carr J, Yuan C, Kramer CM, Tian L, Liao Y, Li D, Criqui MH. Plaque Characteristics in the Superficial Femoral Artery Correlate with Walking Impairment Questionnaire Scores in Peripheral Arterial Disease: The Walking and Leg Circulation Study (WALCS) III. JOURNAL OF SURGICAL RADIOLOGY 2012; 3:148-157. [PMID: 29188081 PMCID: PMC5703222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE We studied associations of magnetic resonance imaging (MRI)-measured plaque area and relative percent lumen reduction in the proximal superficial femoral artery with Walking Impairment Questionnaire (WIQ) scores and quality of life in people with lower extremity peripheral arterial disease (PAD). METHODS Four-hundred forty-two participants with PAD underwent cross-sectional imaging of the proximal superficial femoral artery with MRI, and completed the WIQ and the Short-Form-12 mental and physical functioning questionnaires. Questionnaires were scored on a 0-100 scale (100=best). Results adjust for age, sex, race, the ankle brachial index (ABI), comorbidities, and other covariates. RESULTS Adjusting for age, sex, race, ABI, comorbidities, and other covariates, higher mean plaque area was associated with poorer WIQ distance scores (1st quintile (least plaque)-44.8, 2nd quintile-43.3, 3rd quintile-38.9, 4th quintile-34.6, 5th quintile (greatest plaque)-30.6, p trend <0.001) and poorer WIQ speed scores (1st quintile-40.6, 2nd quintile-39.6, 3rd quintile-39.5, 4th quintile-32.8, 5th quintile-33.0, p trend =0.019). Similar associations of higher maximum plaque area, mean lumen reduction, and maximum lumen reduction with poorer WIQ distance and speed scores were observed. Plaque measures were not associated with WIQ stair climbing scores or SF-12 scores. CONCLUSION Among participants with PAD, greater plaque burden and smaller lumen area in the proximal superficial femoral artery are associated with poorer walking endurance and slower walking speed as measured by the WIQ, even after adjusting for the ABI.
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Affiliation(s)
- Mary M. McDermott
- Department of Medicine, Northwestern University’s Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine
| | - Timothy J. Carroll
- Department of Radiology, Northwestern University’s Feinberg School of Medicine
- Department of Biomedical Engineering and Radiology, Northwestern University
| | - Melina Kibbe
- Department of Surgery, Northwestern University
- Division of Vascular Surgery, Jesse Brown VA Medical Center
| | - Luigi Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging
| | - Jack M. Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | | | | | - James Carr
- Department of Radiology, Northwestern University’s Feinberg School of Medicine
| | - Chun Yuan
- Department of Radiology, Electrical Engineering, and Bioengineering, University of Washington, Seattle
- Department of Radiology, University of Washington School of Medicine
| | | | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine
| | - Yihua Liao
- Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine
| | | | - Michael H. Criqui
- Department of Family and Preventive Medicine, University of California at San Diego
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Bourque JM, Schietinger BJ, Kennedy JL, Pearce EA, Christopher JM, Taylor AM, McNamara CA, Kramer CM. Usefulness of cardiovascular magnetic resonance imaging of the superficial femoral artery for screening patients with diabetes mellitus for atherosclerosis. Am J Cardiol 2012; 110:50-6. [PMID: 22459304 DOI: 10.1016/j.amjcard.2012.02.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/15/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
Abstract
Cardiovascular magnetic resonance (CMR) of the superficial femoral artery (SFA) allows direct and noninvasive visualization of atherosclerotic plaque burden. We examined atherosclerosis in 3 groups of patients without history or symptoms of peripheral arterial disease with varying expected burdens: those with diabetes mellitus (DM) and known coronary artery disease (CAD) (n = 24), those with DM and a high prevalence of CAD risk factors (n = 20), and controls of similar age without DM or CAD and few CAD risk factors (n = 15). We also assessed the diagnostic accuracy of this technique to differentiate among these 3 groups. T1-weighted spin-echocardiographic images were used to measure mean wall thickness (WT) and total wall volume indexed to total vessel volume. Diagnostic accuracy was assessed by area under receiver operating characteristics curve analysis. Patients with DM plus risk factors and DM plus CAD had higher mean WT (1.28 and 1.37 mm) and mean indexed wall volume (0.53 and 0.56) compared to controls (mean WT 1.16 mm and mean indexed wall volume 0.45; p <0.010 for all comparisons). Mean WT and indexed wall volume showed good diagnostic accuracy in discriminating controls from those with DM plus CAD (areas under curve 0.85 and 0.87, respectively, p <0.001), whereas only indexed wall volume discriminated DM plus risk factors from controls (area under curve 0.82, p <0.001). Neither could discriminate between DM plus risk factors and DM plus CAD. In conclusion, patients with DM plus risk factors and DM plus CAD had significantly greater atherosclerotic burden in the SFA on CMR imaging than controls of similar age, with good diagnostic accuracy in differentiating these groups. The high reproducibility and reliability of CMR of the SFA may facilitate improved assessment of atherosclerosis prevalence and progression/regression in studies of novel therapies.
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Chiu B, Sun J, Zhao X, Wang J, Balu N, Chi J, Xu J, Yuan C, Kerwin WS. Fast plaque burden assessment of the femoral artery using 3D black-blood MRI and automated segmentation. Med Phys 2011; 38:5370-84. [PMID: 21992357 DOI: 10.1118/1.3633899] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Vessel wall imaging techniques have been introduced to assess the burden of peripheral arterial disease (PAD) in terms of vessel wall thickness, area or volume. Recent advances in a 3D black-blood MRI sequence known as the 3D motion-sensitized driven equilibrium (MSDE) prepared rapid gradient echo sequence (3D MERGE) have allowed the acquisition of vessel wall images with up to 50 cm coverage, facilitating noninvasive and detailed assessment of PAD. This work introduces an algorithm that combines 2D slice-based segmentation and 3D user editing to allow for efficient plaque burden analysis of the femoral artery images acquired using 3D MERGE. METHODS The 2D slice-based segmentation approach is based on propagating segmentation results of contiguous 2D slices. The 3D image volume was then reformatted using the curved planar reformation (CPR) technique. User editing of the segmented contours was performed on the CPR views taken at different angles. The method was evaluated on six femoral artery images. Vessel wall thickness and area obtained before and after editing on the CPR views were assessed by comparison with manual segmentation. Difference between semiautomatically and manually segmented contours were compared with the difference of the corresponding measurements between two repeated manual segmentations. RESULTS The root-mean-square (RMS) errors of the mean wall thickness (t(mean)) and the wall area (WA) of the edited contours were 0.35 mm and 7.1 mm(2), respectively, which are close to the RMS difference between two repeated manual segmentations (RMSE: 0.33 mm in t(mean), 6.6 mm(2) in WA). The time required for the entire semiautomated segmentation process was only 1%-2% of the time required for manual segmentation. CONCLUSIONS The difference between the boundaries generated by the proposed algorithm and the manually segmented boundary is close to the difference between repeated manual segmentations. The proposed method provides accurate plaque burden measurements, while considerably reducing the analysis time compared to manual review.
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Affiliation(s)
- Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Hong Kong.
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McDermott MM, Liu K, Carroll TJ, Tian L, Ferrucci L, Li D, Carr J, Guralnik JM, Kibbe M, Pearce WH, Yuan C, McCarthy W, Kramer CM, Tao H, Liao Y, Clark ET, Xu D, Berry J, Orozco J, Sharma L, Criqui MH. Superficial femoral artery plaque and functional performance in peripheral arterial disease: walking and leg circulation study (WALCS III). JACC Cardiovasc Imaging 2011; 4:730-9. [PMID: 21757163 DOI: 10.1016/j.jcmg.2011.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/29/2011] [Accepted: 04/07/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We studied associations of magnetic resonance imaging measurements of plaque area and relative percent lumen reduction in the proximal superficial femoral artery with functional performance among participants with peripheral arterial disease. BACKGROUND The clinical significance of directly imaged plaque characteristics in lower extremity arteries is not well established. METHODS A total of 454 participants with an ankle brachial index <1.00 underwent magnetic resonance cross-sectional imaging of the proximal superficial femoral artery and completed a 6-min walk test, measurement of 4-m walking velocity at usual and fastest pace, and measurement of physical activity with a vertical accelerometer. RESULTS Adjusting for age, sex, race, body mass index, smoking, statin use, comorbidities, and other covariates, higher mean plaque area (1st quintile [least plaque]: 394 m, 2nd quintile: 360 m, 3rd quintile: 359 m, 4th quintile: 329 m, 5th quintile [greatest plaque]: 311 m; p trend <0.001) and smaller mean percent lumen area (1st quintile [greatest plaque]: 319 m, 2nd quintile: 330 m, 3rd quintile: 364 m, 4th quintile: 350 m, 5th quintile: 390 m; p trend <0.001) were associated with shorter distance achieved in the 6-min walk test. Greater mean plaque area was also associated with slower usual-paced walking velocity (p trend = 0.006) and slower fastest-paced 4-m walking velocity (p trend = 0.003). Associations of mean plaque area and mean lumen area with 6-min walk distance remained statistically significant even after additional adjustment for the ankle brachial index and leg symptoms. CONCLUSIONS Among participants with peripheral arterial disease, greater plaque burden and smaller lumen area in the proximal superficial femoral artery are associated independently with poorer functional performance, even after adjusting for the ankle brachial index and leg symptoms.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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West AM, Anderson JD, Meyer CH, Epstein FH, Wang H, Hagspiel KD, Berr SS, Harthun NL, DiMaria JM, Hunter JR, Christopher JM, Chew JD, Winberry GB, Kramer CM. The effect of ezetimibe on peripheral arterial atherosclerosis depends upon statin use at baseline. Atherosclerosis 2011; 218:156-62. [PMID: 21570685 PMCID: PMC3157540 DOI: 10.1016/j.atherosclerosis.2011.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/22/2011] [Accepted: 04/04/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both statins and ezetimibe lower LDL-C, but ezetimibe's effect on atherosclerosis is controversial. We hypothesized that lowering LDL-C cholesterol by adding ezetimibe to statin therapy would regress atherosclerosis measured by magnetic resonance imaging (MRI) in the superficial femoral artery (SFA) in peripheral arterial disease (PAD). METHODS Atherosclerotic plaque volume was measured in the proximal 15-20 cm of the SFA in 67 PAD patients (age 63 ± 10, ABI 0.69 ± 0.14) at baseline and annually × 2. Statin-naïve patients (n=34) were randomized to simvastatin 40 mg (S, n=16) or simvastatin 40 mg+ezetimibe 10mg (S+E, n=18). Patients already on statins but with LDL-C >80 mg/dl had open-label ezetimibe 10mg added (E, n=33). Repeated measures models estimated changes in plaque parameters over time and between-group differences. RESULTS LDL-C was lower at year 1 in S+E (67 ± 7 mg/dl) than S (91 ± 8 mg/dl, p<0.05), but similar at year 2 (68 ± 10 mg/dl vs. 83 ± 11 mg/dl, respectively). Plaque volume did not change from baseline to year 2 in either S+E (11.5 ± 1.4-10.5 ± 1.3 cm(3), p=NS) or S (11.0 ± 1.5-10.5 ± 1.4 cm(3), p=NS). In E, plaque progressed from baseline to year 2 (10.0 ± 0.8-10.8 ± 0.9, p<0.01) despite a 22% decrease in LDL-C. CONCLUSIONS Statin initiation with or without ezetimibe in statin-naïve patients halts progression of peripheral atherosclerosis. When ezetimibe is added to patients previously on statins, peripheral atherosclerosis progressed. Thus, ezetimibe's effect on peripheral atherosclerosis may depend upon relative timing of statin therapy.
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Affiliation(s)
- Amy M. West
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Justin D. Anderson
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Craig H. Meyer
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Frederick H. Epstein
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Hongkun Wang
- Department of Public Health Sciences, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC
| | - Klaus D. Hagspiel
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Stuart S. Berr
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Nancy L. Harthun
- Department of Surgery and the Cardiovascular Imaging Center, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Joseph M. DiMaria
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Jennifer R. Hunter
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - John M. Christopher
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Joshua D. Chew
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Gabriel B. Winberry
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
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Krucoff MW, Jones WS, Patel MR. Learning to Walk Before We Run. J Am Coll Cardiol 2011; 58:1077-9. [DOI: 10.1016/j.jacc.2011.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/07/2011] [Indexed: 10/17/2022]
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Kawaji K, Nguyen TD, Zou Z, Reig B, Winchester PA, Shih A, Spincemaille P, Prince MR, Wang Y. Three-dimensional flow-independent balanced steady-state free precession vessel wall MRI of the popliteal artery: preliminary experience and comparison with flow-dependent black-blood techniques. J Magn Reson Imaging 2011; 34:696-701. [PMID: 21769963 DOI: 10.1002/jmri.22663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 05/02/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To examine the feasibility of flow-independent T2-prepared inversion recovery (T2IR) black-blood (BB) magnetization preparation for three-dimensional (3D) balanced steady-state free precession (SSFP) vessel wall MRI of the popliteal artery, and to evaluate its performance relative to flow-dependent double inversion recovery (DIR), spatial presaturation (SPSAT), and motion-sensitizing magnetization preparation (MSPREP) BB techniques in healthy volunteers. MATERIALS AND METHODS Eleven subjects underwent 3D MRI at 1.5 Tesla with four techniques performed in a randomized order. Wall and lumen signal-to-noise ratio (SNR), wall-to-lumen contrast-to-noise ratio (CNR), vessel wall area, and lumen area were measured at proximal, middle, and distal locations of the imaged popliteal artery. Image quality scores based on wall visualization and degree of intraluminal artifacts were also obtained. RESULTS In the proximal region, DIR and SPSAT had higher wall SNR and wall-to-lumen CNR than both MSPREP and T2IR. In the middle and distal regions, DIR and SPSAT failed to provide effective blood suppression, whereas MSPREP and T2IR provided adequate black blood contrast with comparable wall-to-lumen CNR and image quality. CONCLUSION The feasibility of 3D SSFP imaging of the popliteal vessel wall using flow-independent T2IR was demonstrated with effective blood suppression and good vessel wall visualization. Although DIR and SPSAT are effective for thin slab imaging, MSPREP and T2IR are better suited for 3D thick slab imaging.
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Affiliation(s)
- Keigo Kawaji
- Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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Brown R, Karmonik C, Brunner G, Lumsden A, Ballantyne C, Johnson S, Wang Y, Morrisett J. Simultaneous bilateral magnetic resonance imaging of the femoral arteries in peripheral arterial disease patients. J Magn Reson Imaging 2011; 34:150-6. [PMID: 21598344 DOI: 10.1002/jmri.22591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 03/07/2011] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To image the femoral arteries in peripheral arterial disease (PAD) patients using a bilateral receive coil. MATERIALS AND METHODS An eight-channel surface coil array for bilateral MRI of the femoral arteries at 3T was constructed and evaluated. RESULTS The bilateral array enabled imaging of a 25-cm segment of the superficial femoral arteries (SFA) from the profunda to the popliteal. The array provided improved the signal-to-noise ratio (SNR) at the periphery and similar SNR in the middle of a phantom compared to three other commercially available coils (4-channel torso, quadrature head, whole body). Multicontrast bilateral images of the in vivo SFA with 1 mm in-plane resolution made it possible to directly compare lesions in the index SFA to the corresponding anatomical site in the contralateral vessel without repositioning the patient or coil. A set of bilateral time-of-flight, T1-weighted, T2-weighted, and proton density-weighted images was acquired in a clinically acceptable exam time of ≈45 minutes. CONCLUSION The developed bilateral coil is well suited for monitoring dimensional changes in atherosclerotic lesions of the SFA.
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Affiliation(s)
- Ryan Brown
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
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Chien A, Sayre J, Dong B, Ye J, Viñuela F. 3D quantitative evaluation of atherosclerotic plaque based on rotational angiography. AJNR Am J Neuroradiol 2011; 32:1249-54. [PMID: 21596803 DOI: 10.3174/ajnr.a2483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Atherosclerosis is a systemic disease that has been shown to cause various cardiovascular diseases and stroke. However, technologies to evaluate the volume of atherosclerotic plaque are limited. We present a method for determination of 3D plaque volume based on RA. MATERIALS AND METHODS 3DRA images obtained from patients were used to evaluate the plaque. Six patients who were diagnosed with atherosclerotic lesions were included. The PR model developed for 3DRA was applied to analyze the geometry of the vessel and calculate the plaque volume. To validate the present method, we tested computer-generated phantoms with different degrees of stenosis. RESULTS Application of PR to clinical cases allowed the estimation of plaque morphology and quantification of plaque volume. Technique validation showed that on average, PR can rebuild 92% of the plaque and provide satisfactory determination of plaque volume. CONCLUSIONS A new approach to obtain plaque volume based on 3DRA is presented. The initial tests in 6 clinical cases and validation with different phantoms showed that this method is feasible. Further validation in a larger clinical series is required to assess the ultimate value of the present technique.
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Affiliation(s)
- A Chien
- Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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McDermott MM, Liu K, Carr J, Criqui MH, Tian L, Li D, Ferrucci L, Guralnik JM, Kramer CM, Yuan C, Kibbe M, Pearce WH, Berry J, McCarthy W, Liao Y, Xu D, Orozco J, Carroll TJ. Superficial femoral artery plaque, the ankle-brachial index, and leg symptoms in peripheral arterial disease: the walking and leg circulation study (WALCS) III. Circ Cardiovasc Imaging 2011; 4:246-52. [PMID: 21436300 DOI: 10.1161/circimaging.110.962183] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical significance of magnetic resonance-imaged plaque characteristics in the superficial femoral artery (SFA) is not well established. We studied associations of the ankle-brachial index (ABI) and leg symptoms with MRI-measured plaque area and percent lumen area in the SFA in participants with and without lower-extremity peripheral arterial disease (PAD). METHODS AND RESULTS Four hundred twenty-seven participants (393 with PAD) underwent plaque imaging of the first 30 mm of the SFA. Twelve 2.5-mm cross-sectional images of the SFA were obtained. Outcomes were normalized plaque area, adjusted for artery size (0 to 1 scale, 1=greatest plaque), and lumen area, expressed as a percent of the total artery area. Adjusting for age, sex, race, smoking, statins, cholesterol, and other covariates, lower ABI values were associated with higher normalized mean plaque area (ABI <0.50:0.79; ABI 0.50 to 0.69:0.73; ABI 0.70 to 0.89:0.65; ABI 0.90 to 0.99:0.62; ABI 1.00 to 1.09:0.48; ABI 1.10 to 1.30:0.47 (P trend <0.001)) and smaller mean percent lumen area (P trend <0.001). Compared with PAD participants with intermittent claudication, asymptomatic PAD participants had lower normalized mean plaque area (0.72 versus 0.65, P=0.005) and larger mean percent lumen area (0.30 versus 0.36, P=0.01), adjusting for the ABI and other confounders. CONCLUSIONS Lower ABI values are associated with greater MRI-measured plaque burden and smaller lumen area in the first 30 mm of the SFA. Compared with PAD participants with claudication, asymptomatic PAD participants have smaller plaque area and larger lumen area in the SFA. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00520312.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA.
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Abstract
Vessel wall imaging of large vessels has the potential to identify culprit atherosclerotic plaques that lead to cardiovascular events. Comprehensive assessment of atherosclerotic plaque size, composition, and biological activity is possible with magnetic resonance imaging (MRI). Magnetic resonance imaging of the atherosclerotic plaque has demonstrated high accuracy and measurement reproducibility for plaque size. The accuracy of in vivo multicontrast MRI for identification of plaque composition has been validated against histological findings. Magnetic resonance imaging markers of plaque biological activity such as neovasculature and inflammation have been demonstrated. In contrast to other plaque imaging modalities, MRI can be used to study multiple vascular beds noninvasively over time. In this review, we compare the status of in vivo plaque imaging by MRI to competing imaging modalities. Recent MR technological improvements allow fast, accurate, and reproducible plaque imaging. An overview of current MRI techniques required for carotid plaque imaging including hardware, specialized pulse sequences, and processing algorithms are presented. In addition, the application of these techniques to coronary, aortic, and peripheral vascular beds is reviewed.
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Xie J, Bi X, Fan Z, Bhat H, Shah S, Zuehlsdorff S, Li D. 3D flow-independent peripheral vessel wall imaging using T(2)-prepared phase-sensitive inversion-recovery steady-state free precession. J Magn Reson Imaging 2010; 32:399-408. [PMID: 20677269 PMCID: PMC2915467 DOI: 10.1002/jmri.22272] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To develop a 3D flow-independent peripheral vessel wall imaging method using T(2)-prepared phase-sensitive inversion-recovery (T(2)PSIR) steady-state free precession (SSFP). MATERIALS AND METHODS A 3D T(2)-prepared and nonselective inversion-recovery SSFP sequence was designed to achieve flow-independent blood suppression for vessel wall imaging based on T(1) and T(2) properties of the vessel wall and blood. To maximize image contrast and reduce its dependence on the inversion time (TI), phase-sensitive reconstruction was used to restore the true signal difference between vessel wall and blood. The feasibility of this technique for peripheral artery wall imaging was tested in 13 healthy subjects. Image signal-to-noise ratio (SNR), wall/lumen contrast-to-noise ratio (CNR), and scan efficiency were compared between this technique and conventional 2D double inversion recovery - turbo spin echo (DIR-TSE) in eight subjects. RESULTS 3D T(2)PSIR SSFP provided more efficient data acquisition (32 slices and 64 mm in 4 minutes, 7.5 seconds per slice) than 2D DIR-TSE (2-3 minutes per slice). SNR of the vessel wall and CNR between vessel wall and lumen were significantly increased as compared to those of DIR-TSE (P < 0.001). Vessel wall and lumen areas of the two techniques are strongly correlated (intraclass correlation coefficients: 0.975 and 0.937, respectively; P < 0.001 for both). The lumen area of T(2)PSIR SSFP is slightly larger than that of DIR-TSE (P = 0.008). The difference in vessel wall area between the two techniques is not statistically significant. CONCLUSION T(2)PSIR SSFP is a promising technique for peripheral vessel wall imaging. It provides excellent blood signal suppression and vessel wall/lumen contrast. It can cover a 3D volume efficiently and is flow- and TI-independent.
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Affiliation(s)
- Jingsi Xie
- Department of Radiology and Biomedical Engineering, Northwestern University, Chicago, IL
| | - Xiaoming Bi
- Department of Siemens Healthcare, Chicago, IL, USA
| | - Zhaoyang Fan
- Department of Radiology and Biomedical Engineering, Northwestern University, Chicago, IL
| | - Himanshu Bhat
- Department of Radiology and Biomedical Engineering, Northwestern University, Chicago, IL
| | - Saurabh Shah
- Department of Siemens Healthcare, Chicago, IL, USA
| | | | - Debiao Li
- Department of Radiology and Biomedical Engineering, Northwestern University, Chicago, IL
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Li F, McDermott MM, Li D, Carroll TJ, Hippe DS, Kramer CM, Fan Z, Zhao X, Hatsukami TS, Chu B, Wang J, Yuan C. The association of lesion eccentricity with plaque morphology and components in the superficial femoral artery: a high-spatial-resolution, multi-contrast weighted CMR study. J Cardiovasc Magn Reson 2010; 12:37. [PMID: 20591197 PMCID: PMC2904754 DOI: 10.1186/1532-429x-12-37] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 07/01/2010] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Atherosclerotic plaque morphology and components are predictors of subsequent cardiovascular events. However, associations of plaque eccentricity with plaque morphology and plaque composition are unclear. This study investigated associations of plaque eccentricity with plaque components and morphology in the proximal superficial femoral artery using cardiovascular magnetic resonance (CMR). METHODS Twenty-eight subjects with an ankle-brachial index less than 1.00 were examined with 1.5 T high-spatial-resolution, multi-contrast weighted CMR. One hundred and eighty diseased locations of the proximal superficial femoral artery (about 40 mm) were analyzed. The eccentric lesion was defined as [(Maximum wall thickness- Minimum wall thickness)/Maximum wall thickness] >or= 0.5. The arterial morphology and plaque components were measured using semi-automatic image analysis software. RESULTS One hundred and fifteen locations were identified as eccentric lesions and sixty-five as concentric lesions. The eccentric lesions had larger wall but similar lumen areas, larger mean and maximum wall thicknesses, and more calcification and lipid rich necrotic core, compared to concentric lesions. For lesions with the same lumen area, the degree of eccentricity was associated with an increased wall area. Eccentricity (dichotomous as eccentric or concentric) was independently correlated with the prevalence of calcification (odds ratio 3.78, 95% CI 1.47-9.70) after adjustment for atherosclerotic risk factors and wall area. CONCLUSIONS Plaque eccentricity is associated with preserved lumen size and advanced plaque features such as larger plaque burden, more lipid content, and increased calcification in the superficial femoral artery.
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Affiliation(s)
- Feiyu Li
- Department of Radiology, Peking University First Hospital, Beijing, China
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Mary McGrae McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Debiao Li
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Timothy J Carroll
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Christopher M Kramer
- Departments of Radiology and Medicine, University of Virginia, Charlottesville, VA, USA
| | - Zhaoyang Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Xihai Zhao
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, NY, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Brown R, Nguyen TD, Spincemaille P, Cham MD, Choi G, Winchester PA, Prince MR, Wang Y. Effect of blood flow on double inversion recovery vessel wall MRI of the peripheral arteries: quantitation with T2 mapping and comparison with flow-insensitive T2-prepared inversion recovery imaging. Magn Reson Med 2010; 63:736-44. [PMID: 20187182 DOI: 10.1002/mrm.22227] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Blood suppression in the lower extremities using flow-reliant methods such as double inversion recovery may be problematic due to slow blood flow. T(2) mapping using fast spin echo (FSE) acquisition was utilized to quantitate the effectiveness of double inversion recovery blood suppression in 13 subjects and showed that 25 +/- 12% of perceived vessel wall pixels in the popliteal arteries contained artifactual blood signal. To overcome this problem, a flow-insensitive T(2)-prepared inversion recovery sequence was implemented and optimal timing parameters were calculated for FSE acquisition. Black blood vessel wall imaging of the popliteal and femoral arteries was performed using two-dimensional T(2)-prepared inversion recovery-FSE in the same 13 subjects. Comparison with two-dimensional double inversion recovery-FSE showed that T(2)-prepared inversion recovery-FSE reduced wall-mimicking blood artifacts that inflated double inversion recovery-FSE vessel wall area measurements in the popliteal artery.
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Affiliation(s)
- Ryan Brown
- Department of Radiology, Weill Medical College of Cornell University, New York, New York 10016, USA.
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Mihai G, Chung YC, Merchant A, Simonetti OP, Rajagopalan S. T1-weighted-SPACE dark blood whole body magnetic resonance angiography (DB-WBMRA): initial experience. J Magn Reson Imaging 2010; 31:502-9. [PMID: 20099365 DOI: 10.1002/jmri.22049] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility of the dark blood fast spin echo (FSE) T1-weighted-Sampling Perfection with Application of optimized Contrasts using different flip angle Evolution (T1w-SPACE) sequence in assessing whole body arterial wall information from the extracranial carotids to the popliteal artery. MATERIALS AND METHODS Twenty-eight subjects were subjected to noncontrast, dark blood whole body magnetic resonance angiography (DB-WBMRA) using a T1w-SPACE sequence optimized for each of the individual stations: carotid artery, thoracic aorta, abdominal aorta, and thigh/superficial femoral artery (SFA). Image quality/vessel wall visualization and the time required to image the four stations were evaluated. Two observers checked the reproducibility of vessel wall depiction by performing quantitative measurements in registered initial and repeat studies (six subjects) of vessel wall and lumen area at 17 locations along the arterial tree. RESULTS In 25 of the 28 scanned subjects, dark blood arterial images acquired in approximately 1 hour total imaging time allowed whole body arterial vessel wall visualization. Quantitative measurements showed high correlation between the initial and repeat studies for each of the observers as well as high interobserver reproducibility (r > 0.95; P < 0.01). CONCLUSION DB-WBMRA using T1w-SPACE is feasible and can be performed with a high degree of reliability.
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Affiliation(s)
- Georgeta Mihai
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.
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Hayashi K, Mani V, Nemade A, Silvera S, Fayad ZA. Comparison of 3D-diffusion-prepared segmented steady-state free precession and 2D fast spin echo imaging of femoral artery atherosclerosis. Int J Cardiovasc Imaging 2009; 26:309-21. [PMID: 19946750 DOI: 10.1007/s10554-009-9544-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 11/15/2009] [Indexed: 02/06/2023]
Abstract
Magnetic resonance (MR) imaging is a promising modality for the in vivo detection and characterization of atherosclerotic lesions in peripheral arteries. 2D imaging techniques for evaluation of peripheral artery disease (PAD) suffer from poor spatial coverage and have long scan times. The purpose of this study was to compare a diffusion prepared dark blood 3D steady state free precession (3D-DP-SSFP) sequence for evaluating atherosclerotic plaque burden in inguinal and thigh segments of the femoral artery and comparing the results obtained with 2D turbo spin echo (2D-TSE) techniques. A further goal of the study was to examine the inter observer reproducibility of MR plaque burden measures using the 3D DP-SSFP technique. Results of the study indicated higher signal to noise ratios for the 3D-DP-SSFP technique and higher CNR (better vessel-wall delineation) compared to the 2D-TSE technique. Furthermore, a good correlation between 3D-DP-SSFP and 2D-TSE techniques for the inguinal segment but poorer correlation for the thigh segment was observed. Inter-observer reproducibility for the 3D plaque burden measures was excellent. 3D-DP-SSFP may be a useful and reproducible technique for evaluating atherosclerosis in peripheral arteries.
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Affiliation(s)
- Katsumi Hayashi
- Imaging Science Laboratories, Room BM24, Department of Radiology, Box 1234, Mount Sinai School of Medicine, One Gustave L Levy Place, New York, NY 10029, USA
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Abstract
OBJECTIVES To evaluate the potential use of a novel 3D turbo spin-echo (TSE) T2-weighted (T2w) technique for assessing the vessel wall in the superficial femoral artery at 3.0 T. BACKGROUND Magnetic resonance imaging can be used for the noninvasive assessment of atherosclerotic plaque burden in the peripheral circulation. Although black-blood 2D TSE techniques have been used for femoral arterial wall imaging, these techniques require prolonged imaging time to cover a large field of view required to cover the leg. Recently, variable-flip-angle 3D TSE T2w (SPACE) has been introduced as a fast vessel wall imaging technique with submillimeter spatial resolution. A systematic investigation of the application of this technique to femoral arterial wall imaging has yet to be performed. METHODS Fifteen healthy volunteers and 3 patients with peripheral arterial disease (PAD) underwent 3D SPACE imaging of the superficial femoral artery at 3.0 T, with the conventional 2D TSE T2w imaging as a reference. Muscle-lumen contrast to noise ratio (CNR) and wall/lumen volumes (WV, LV) were measured at the matched locations on the 3D and 2D image sets. Statistical comparison on a per-subject basis was conducted to determine the difference and agreement between 3D SPACE and the 2D TSE techniques. RESULTS The 3D SPACE data sets enabled vessel visualization from arbitrary orientation through multiplanar reformation technique. Muscle-lumen CNR was significantly higher with 3D SPACE than with the 2D TSE (3.12 +/- 0.84 vs. 2.17 +/- 0.34, P < 0.01). This trend was confirmed when CNR efficiency (CNR(eff)) values were further compared. A similar trend was observed in PAD patients (SPACE vs. 2D TSE T2w: CNR 2.35 +/- 0.13 vs. 1.77 +/- 0.25; CNR(eff) 15.35 +/- 0.61 vs. 3.59 +/- 2.62. all P < 0.05). Measurements of WV and LV from the 3D and 2D techniques were highly correlated in volunteers and PAD patients (volunteers, WV: linear regression r2 = 0.98, LV: r2 = 0.98, P < 0.001 for both; patients, WV: linear regression r2 = 0.96, LV: r2 = 0.94, P < 0.001 for both). CONCLUSION We established the feasibility of using the 3D SPACE technique for vessel wall imaging in the superficial femoral artery at 3.0T. High, isotropic-resolution SPACE images, with the aid of multiplanar reformation, enable superior vessel wall visualization. Superior blood signal suppression comparable to vessel wall morphologic measurements, and superior time efficiency compared to conventional 2D TSE imaging indicate the great potential of the SPACE method as a noninvasive imaging technique for the assessment of atherosclerotic plaque burden in PAD patients.
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Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Wang H, Berr SS, Harthun NL, Weltman A, Dimaria JM, West AM, Kramer CM. Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism. J Am Coll Cardiol 2009; 54:628-35. [PMID: 19660694 DOI: 10.1016/j.jacc.2009.01.080] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 01/06/2009] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to investigate the pathophysiology of peripheral arterial disease (PAD) by examining magnetic resonance imaging (MRI) and spectroscopic (MRS) correlates of functional capacity. BACKGROUND Despite the high prevalence, morbidity, and cost of PAD, its pathophysiology is incompletely understood. METHODS Eighty-five patients (age 68 +/- 10 years) with mild-to-moderate PAD (ankle-brachial index 0.69 +/- 0.14) had their most symptomatic leg studied by MRI/MRS. Percent wall volume in the superficial femoral artery was measured with black blood MRI. First-pass contrast-enhanced MRI calf muscle perfusion and (31)P MRS phosphocreatine recovery time constant (PCr) were measured at peak exercise in calf muscle. All patients underwent magnetic resonance angiography (MRA), treadmill testing with maximal oxygen consumption measurement, and a 6-min walk test. RESULTS Mean MRA index of number and severity of stenoses was 0.84 +/- 0.68 (normal 0), % wall volume 74 +/- 11% (normal 46 +/- 7%), tissue perfusion 0.039 +/- 0.015 s(-1) (normal 0.065 +/- 0.013 s(-1)), and PCr 87 +/- 54 s (normal 34 +/- 16 s). MRA index, % wall volume, and ankle-brachial index correlated with most functional measures. PCr was the best correlate of treadmill exercise time, whereas calf muscle perfusion was the best correlate of 6-min walk distance. No correlation was noted between PCr and tissue perfusion. CONCLUSIONS Functional limitations in PAD are multifactorial. As measured by MRI and spectroscopy, atherosclerotic plaque burden, stenosis severity, tissue perfusion, and energetics all play a role. However, cellular metabolism is uncoupled from tissue perfusion. These findings suggest a potential role for therapies that regress plaque, increase tissue perfusion, and/or improve cellular metabolism. (Comprehensive Magnetic Resonance of Peripheral Arterial Disease; NCT00587678).
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Affiliation(s)
- Justin D Anderson
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA 22908, USA
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Barnes SRS, Haacke EM. Susceptibility-weighted imaging: clinical angiographic applications. Magn Reson Imaging Clin N Am 2009; 17:47-61. [PMID: 19364599 DOI: 10.1016/j.mric.2008.12.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
By combining filtered phase and magnitude information to create a novel and intrinsic source of contrast, susceptibility-weighted imaging (SWI) has shown great promise in clinical angiography and venography. SWI has contributed to new insights into traumatic brain injury, the role of calcification in atherosclerosis, and the possible relationship between blood settling and deep venous thrombosis. A further contribution from SWI to deep venous thrombosis research (and also stroke) involves its application to the noninvasive measurement of oxygen saturation in the brain and in other tissues. Altogether, SWI offers manifold and diverse avenues for further research using angiographic and venographic techniques.
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Affiliation(s)
- Samuel R S Barnes
- Department of Radiology, Loma Linda University Medical Center, 11234 Anderson Street, Room B623, Loma Linda, CA 92350, USA
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Yang Q, Liu J, Barnes SR, Wu Z, Li K, Neelavalli J, Hu J, Haacke EM. Imaging the vessel wall in major peripheral arteries using susceptibility-weighted imaging. J Magn Reson Imaging 2009; 30:357-65. [PMID: 19629989 PMCID: PMC2730889 DOI: 10.1002/jmri.21859] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To demonstrate a novel contrast mechanism for imaging the vessel wall and vessel wall calcification using susceptibility-weighted imaging (SWI). MATERIALS AND METHODS Eighteen subjects were imaged with multidetector computed tomography (MDCT) and high-resolution SWI at 3T. The SWI imaging parameters were optimized to allow for the best visualization of the femoral artery lumen and the arterial wall in magnitude and phase images, respectively. SWI-filtered phase data were used to evaluate the diamagnetic susceptibility of vessel wall and of putative vessel wall calcification. Imaging was performed using TE = 15.6 msec (in-phase for fat); TR = 25 msec, flip angle (FA) = 10 degrees , bandwidth (BW) = 80 Hz/pixel, resolution = 0.5 x 0.5 mm in-plane and 1.0 mm through-plane, an acquisition matrix of 512 x 384 x 64 (for read, phase, and slice-select directions), and a total scan time of 8 minutes. RESULTS Nineteen calcifications were identified in CT and SWI and they correlated well in both size and position. The contrast-to-noise ratio between the blood signal in the lumen of the artery and arterial wall was 11.7:1 and 7.4:1 in magnitude and in phase images, respectively. CONCLUSION SWI provides a novel means to visualize vessel wall and recognize the presence of calcification.
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Affiliation(s)
- Qi Yang
- Radiology Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liu
- Radiology Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Samuel R.S. Barnes
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Zhen Wu
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Kuncheng Li
- Radiology Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jaladhar Neelavalli
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, USA
| | - E. Mark Haacke
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
- The MRI Institute for Biomedical Research, Detroit, Michigan, USA
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Abstract
This review examines the state of the art in vessel wall imaging by magnetic resonance imaging (MRI) with an emphasis on the biomechanical assessment of atherosclerotic plaque. Three areas of advanced techniques are discussed. First, alternative contrast mechanisms, including susceptibility, magnetization transfer, diffusion, and perfusion, are presented as to how they facilitate accurate determination of plaque constituents underlying biomechanics. Second, imaging technologies including hardware and sequences, are reviewed as to how they provide the resolution and signal-to-noise ratio necessary for determining plaque structure. Finally, techniques for combining MRI data into an overall assessment of plaque biomechanical properties, including wall shear stress and internal plaque strain, are presented. The paper closes with a discussion of the extent to which these techniques have been applied to different arteries commonly targeted by vessel wall MRI.
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Affiliation(s)
- William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA 98109, USA.
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IRM haute résolution de l’athérosclérose carotidienne :au-delà de la lumière artérielle. ACTA ACUST UNITED AC 2008; 89:293-301. [DOI: 10.1016/s0221-0363(08)93003-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lower extremity peripheral vein bypass graft wall thickness changes demonstrated at 1 and 6 months after surgery with ultra-high spatial resolution black blood inner volume three-dimensional fast spin echo magnetic resonance imaging. Int J Cardiovasc Imaging 2007; 24:529-33. [DOI: 10.1007/s10554-007-9287-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION Peripheral arterial disease (PAD) is characterized by lower limb arterial obstruction due to atherosclerosis and is increasingly common. Presently used methods for diagnosis and follow-up as well as for assessment of novel therapies are limited. MATERIALS AND METHODS Three distinct magnetic resonance examinations were developed. The first was high-resolution black-blood atherosclerotic plaque imaging of the superficial femoral artery using a surface coil and flow saturation. Second, first-pass contrast-enhanced dual-contrast perfusion imaging of the calf muscle was performed at peak exercise using a magnetic resonance (MR)-compatible pedal ergometer. Lastly, (31)P MR spectroscopy was also performed at peak exercise to measure phosphocreatine (PCr) recovery kinetics. RESULTS Seventeen patients (age, 63 +/- 10 yrs) with mild to moderate PAD were studied with black-blood atherosclerotic plaque imaging. Mean atherosclerotic plaque volume measured was 7.27 +/- 3.73 cm(3). Eleven patients (age, 61 +/- 11 yrs) with mild to moderate symptomatic PAD and 22 normal control subjects were studied with first-pass contrast-enhanced perfusion imaging. Perfusion index was stepwise increased from patients to normal subjects with matched workload to normal subjects at maximal exercise. For PCr recovery kinetics, 20 patients with mild to moderate PAD and 14 controls were studied. The median recovery time constant of PCr was 34.7 seconds in the controls and 91.0 seconds in the PAD patients (P < 0.0001). CONCLUSIONS Three distinct MR examinations of different aspects of peripheral arterial disease have been developed and tested and shown to differentiate patients with mild to moderate PAD from normal controls. Taken together, these tests are potential quantitative end points for clinical trials of novel therapies in PAD.
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Affiliation(s)
- Christopher M Kramer
- Department of Radiology, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Abstract
Atherosclerosis is a prevalent disease affecting millions of Americans. Despite our advances in diagnosis and treatment, atherosclerosis is the leading cause of death in America. High-resolution magnetic resonance imaging has overcome the limitations of current angiographic techniques and has emerged as a leading noninvasive imaging modality for atherosclerotic disease. Atherosclerosis of the arterial wall of the human carotid, aortic, peripheral and coronary arteries have all been successfully evaluated. In addition, the power of magnetic resonance imaging to differentiate the major components of atherosclerotic plaque has been validated. The ability to image the vessel wall and risk stratify atherosclerotic plaque will create management decisions not previously faced, and has the potential to change the way atherosclerosis is treated.
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Affiliation(s)
- Christopher M Kramer
- University of Virginia Health System, Department of Medicine, Lee Street, Box 800170, Charlottesville, VA 22908, USA.
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