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Vuong TNAM, Bartolf‐Kopp M, Andelovic K, Jungst T, Farbehi N, Wise SG, Hayward C, Stevens MC, Rnjak‐Kovacina J. Integrating Computational and Biological Hemodynamic Approaches to Improve Modeling of Atherosclerotic Arteries. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307627. [PMID: 38704690 PMCID: PMC11234431 DOI: 10.1002/advs.202307627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/12/2024] [Indexed: 05/07/2024]
Abstract
Atherosclerosis is the primary cause of cardiovascular disease, resulting in mortality, elevated healthcare costs, diminished productivity, and reduced quality of life for individuals and their communities. This is exacerbated by the limited understanding of its underlying causes and limitations in current therapeutic interventions, highlighting the need for sophisticated models of atherosclerosis. This review critically evaluates the computational and biological models of atherosclerosis, focusing on the study of hemodynamics in atherosclerotic coronary arteries. Computational models account for the geometrical complexities and hemodynamics of the blood vessels and stenoses, but they fail to capture the complex biological processes involved in atherosclerosis. Different in vitro and in vivo biological models can capture aspects of the biological complexity of healthy and stenosed vessels, but rarely mimic the human anatomy and physiological hemodynamics, and require significantly more time, cost, and resources. Therefore, emerging strategies are examined that integrate computational and biological models, and the potential of advances in imaging, biofabrication, and machine learning is explored in developing more effective models of atherosclerosis.
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Affiliation(s)
| | - Michael Bartolf‐Kopp
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
| | - Kristina Andelovic
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
| | - Tomasz Jungst
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
- Department of Orthopedics, Regenerative Medicine Center UtrechtUniversity Medical Center UtrechtUtrecht3584Netherlands
| | - Nona Farbehi
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydney2052Australia
- Tyree Institute of Health EngineeringUniversity of New South WalesSydneyNSW2052Australia
- Garvan Weizmann Center for Cellular GenomicsGarvan Institute of Medical ResearchSydneyNSW2010Australia
| | - Steven G. Wise
- School of Medical SciencesUniversity of SydneySydneyNSW2006Australia
| | - Christopher Hayward
- St Vincent's HospitalSydneyVictor Chang Cardiac Research InstituteSydney2010Australia
| | | | - Jelena Rnjak‐Kovacina
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydney2052Australia
- Tyree Institute of Health EngineeringUniversity of New South WalesSydneyNSW2052Australia
- Australian Centre for NanoMedicine (ACN)University of New South WalesSydneyNSW2052Australia
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Xie H, Zhang Y, Wu Z, Bao Z, Lin L, Ye J. Locating Three-Dimensional Position of Deep-Seated SERS Phantom Lesions in Thick Tissues Using Tomographic Transmission Raman Spectroscopy. ACS APPLIED MATERIALS & INTERFACES 2023; 15:44665-44675. [PMID: 37704185 DOI: 10.1021/acsami.3c07792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Locating distinct objects within a thick scattering medium remains a long-standing challenge in the fields of materials science, health, and engineering. Transmission Raman spectroscopy (TRS) with the use of surface-enhanced Raman scattering (SERS) nanoparticles has proven to be an effective approach to detect deep-seated lesions inside thick biological tissues. However, it has not yet been proven to spatially locate deep lesions in three dimensions using optical modalities. Herein, we present the concept of tomographic TRS and report its successful use for accurately locating SERS nanoparticles in elongated rod-like thick tissues. Our work starts with theoretical simulations of Raman photon propagation in tissues. We discovered a linear relationship between the Raman spectral peak ratio and propagation distance of Raman photons in tissues, allowing us to predict the location of lesions tagged by SERS NPs. Based on this, we propose a two-step tomographic TRS strategy, which includes axial scanning and ring scanning. We demonstrate the robustness of our approach using ex vivo thick tissue (4.5 cm in thickness) and locate an embedded SERS phantom lesion, with a ring scanning step of 10-30°. We successfully locate multiple SERS phantom lesions in the ex vivo porcine muscle stack with high accuracy (absolute error of <2 mm). Our method is rapid, efficient, and of low cost compared to current tomographic medical imaging techniques. This work advances Raman techniques for three-dimensional positioning and offers new insights toward practical diagnosis applications.
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Affiliation(s)
- Haoqiang Xie
- State Key Laboratory of Systems Medicine for Cancer, School of biomedical engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Yumin Zhang
- State Key Laboratory of Systems Medicine for Cancer, School of biomedical engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Zongyu Wu
- State Key Laboratory of Systems Medicine for Cancer, School of biomedical engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Zhouzhou Bao
- Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P. R. China
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P. R. China
| | - Li Lin
- State Key Laboratory of Systems Medicine for Cancer, School of biomedical engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Jian Ye
- State Key Laboratory of Systems Medicine for Cancer, School of biomedical engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, P.R. China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P. R. China
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3
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Zhang Y, Chen R, Liu F, Miao P, Lin L, Ye J. In Vivo Surface-Enhanced Transmission Raman Spectroscopy under Maximum Permissible Exposure: Toward Photosafe Detection of Deep-Seated Tumors. SMALL METHODS 2023; 7:e2201334. [PMID: 36572635 DOI: 10.1002/smtd.202201334] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/19/2022] [Indexed: 06/18/2023]
Abstract
The detection of deep-seated lesions is of great significance for biomedical applications. However, due to the strong photon absorption and scattering of biological tissues, it is challenging to realize in vivo deep optical detections, particularly for those using the safe laser irradiance below clinical maximum permissible exposure (MPE). In this work, the combination of ultra-bright surface-enhanced Raman scattering (SERS) nanotags and transmission Raman spectroscopy (TRS) is reported to achieve the non-invasive and photosafe detection of "phantom" lesions deeply hidden in biological tissues, under the guidance of theoretical calculations showing the importance of SERS nanotags' brightness and the expansion of laser beam size. Using a home-built TRS system with a laser power density of 0.264 W cm-2 (below the MPE criteria), we successfully demonstrated the detection of SERS nanotags through up to 14-cm-thick ex vivo porcine tissues, as well as in vivo imaging of "phantom" lesions labeled by SERS nanotags in a 1.5-cm-thick unshaved mouse under MPE. This work highlights the potential of transmission Raman-guided identification and non-invasive imaging toward clinically photosafe cancer diagnoses.
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Affiliation(s)
- Yumin Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
| | - Ruoyu Chen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
| | - Fugang Liu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
| | - Peng Miao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
| | - Li Lin
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
| | - Jian Ye
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200240, P. R. China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, P. R. China
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4
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Survey of Approaches for Investigation of Atherosclerosis In Vivo. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2022; 2419:57-72. [PMID: 35237958 DOI: 10.1007/978-1-0716-1924-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although in vitro model systems are useful for investigation of atherosclerosis-associated processes, they represent simplification of complex events that occur in vivo, which involve interactions between many different cell types together with their environment. The use of animal model systems is important for more in-depth insights of the molecular mechanisms underlying atherosclerosis and for identifying potential targets for agents that can prevent plaque formation and even reverse existing disease. This chapter will provide a survey of such animal models and associated techniques that are routinely used for research of atherosclerosis in vivo.
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Lee E, Kim HW, Bae H, Yu D, Choi J. Radiography and ct features of atherosclerosis in two miniature schnauzer dogs. J Vet Sci 2021; 21:e89. [PMID: 33263236 PMCID: PMC7710456 DOI: 10.4142/jvs.2020.21.e89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
Two miniature Schnauzer dogs with chronic pancreatitis were investigated. Both dogs showed systemic hypertension and increased concentrations of triglycerides and C-reactive protein. Abdominal radiography revealed cylindrical calcification in the retroperitoneum, and computed tomography (CT) showed extensive calcification of the abdominal and peripheral arteries in both dogs. Metastases and other dystrophic conditions that can cause arterial calcification were excluded based on the laboratory tests, and the dogs were diagnosed with atherosclerosis ante mortem. Atherosclerosis should be considered when extensive arterial calcification is observed on abdominal radiography or CT in miniature Schnauzers.
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Affiliation(s)
- Eunji Lee
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Hyun Woo Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Hyeona Bae
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - DoHyeon Yu
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea.
| | - Jihye Choi
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea.
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Cheng M, Liu Q, Liu W, Yuan F, Feng J, Jin Y, Tu L. Engineering micelles for the treatment and diagnosis of atherosclerosis. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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7
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Peng C, Wu H, Kim S, Dai X, Jiang X. Recent Advances in Transducers for Intravascular Ultrasound (IVUS) Imaging. SENSORS (BASEL, SWITZERLAND) 2021; 21:3540. [PMID: 34069613 PMCID: PMC8160965 DOI: 10.3390/s21103540] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022]
Abstract
As a well-known medical imaging methodology, intravascular ultrasound (IVUS) imaging plays a critical role in diagnosis, treatment guidance and post-treatment assessment of coronary artery diseases. By cannulating a miniature ultrasound transducer mounted catheter into an artery, the vessel lumen opening, vessel wall morphology and other associated blood and vessel properties can be precisely assessed in IVUS imaging. Ultrasound transducer, as the key component of an IVUS system, is critical in determining the IVUS imaging performance. In recent years, a wide range of achievements in ultrasound transducers have been reported for IVUS imaging applications. Herein, a comprehensive review is given on recent advances in ultrasound transducers for IVUS imaging. Firstly, a fundamental understanding of IVUS imaging principle, evaluation parameters and IVUS catheter are summarized. Secondly, three different types of ultrasound transducers (piezoelectric ultrasound transducer, piezoelectric micromachined ultrasound transducer and capacitive micromachined ultrasound transducer) for IVUS imaging are presented. Particularly, the recent advances in piezoelectric ultrasound transducer for IVUS imaging are extensively examined according to their different working mechanisms, configurations and materials adopted. Thirdly, IVUS-based multimodality intravascular imaging of atherosclerotic plaque is discussed. Finally, summary and perspectives on the future studies are highlighted for IVUS imaging applications.
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Affiliation(s)
- Chang Peng
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (C.P.); (H.W.)
| | - Huaiyu Wu
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (C.P.); (H.W.)
| | | | - Xuming Dai
- Department of Cardiology, New York-Presbyterian Queens Hospital, Flushing, NY 11355, USA;
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (C.P.); (H.W.)
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Liddy S, Mallia A, Collins CD, Killeen RP, Skehan S, Dodd JD, Subesinghe M, Murphy DJ. Vascular findings on FDG PET/CT. Br J Radiol 2020; 93:20200103. [PMID: 32356457 PMCID: PMC7465845 DOI: 10.1259/bjr.20200103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Since its introduction into clinical practice, 2-deoxy-2-[18F]flu-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has become firmly established in the field of oncological imaging, with a growing body of evidence demonstrating its use in infectious and inflammatory vascular pathologies. This pictorial review illustrates the utility of FDG PET/CT as a diagnostic tool in the investigation of vascular disease and highlights some of the more common incidental vascular findings that PET reporters may encounter on standard oncology FDG PET/CTs, including atherosclerosis, large vessel vasculitis, complications of vascular grafts, infectious aortitis and acute aortic syndromes.
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Affiliation(s)
| | - Andrew Mallia
- Division of Nuclear Medicine, Department of Medical Imaging, Mater Dei Hospital, Msida, Malta
| | | | | | | | - Jonathan D Dodd
- Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland
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9
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Affiliation(s)
- Neil Ruparelia
- Hammersmith Hospital, London, UK.,Imperial College London, London, UK
| | - Robin Choudhury
- John Radcliffe Hospital, Oxford, Oxfordshire, UK .,Radcliffe Department of Medicine Division of Cardiovascular Medicine, Oxford University, Oxford, Oxfordshire, UK
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Choi SSS, Mandelis A. Review of the state of the art in cardiovascular endoscopy imaging of atherosclerosis using photoacoustic techniques with pulsed and continuous-wave optical excitations. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-15. [PMID: 31414585 PMCID: PMC6983488 DOI: 10.1117/1.jbo.24.8.080902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/22/2019] [Indexed: 05/15/2023]
Abstract
Intravascular photoacoustics (IV-PA) is an emerging atherosclerosis imaging modality that provides chemical-specific optical information of arterial walls with acoustic depth penetration and resolution. As lipid composition of atherosclerotic plaques is considered to be one of the primary indicators for plaque vulnerability, many IV-PA applications are calibrated so as to target plaque necrotic cores. Based on the mode of optical excitation and the corresponding signal processing technique, IV-PA is categorized into two different modalities. The pulse-based IV-PA has been the universal IV-PA imaging mode with its high peak power and straightforward time-domain signal processing technique. As an alternative, the low power continuous-wave (CW)-based IV-PA has been under intense development as a radar-like frequency-domain signal processing modality. The two state-of-the-art types of IV-PA are reviewed in terms of their physics and imaging capabilities, with major emphasis on frequency-swept CW-based IV-PA that has been recently introduced in the field.
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Affiliation(s)
- Sung Soo Sean Choi
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
| | - Andreas Mandelis
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
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11
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Gheorghe AG, Jacobsen C, Thomsen R, Linnet K, Lynnerup N, Andersen CB, Fuchs A, Kofoed KF, Banner J. Coronary artery CT calcium score assessed by direct calcium quantification using atomic absorption spectroscopy and compared to macroscopic and histological assessments. Int J Legal Med 2019; 133:1485-1496. [DOI: 10.1007/s00414-018-01998-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/21/2018] [Indexed: 12/16/2022]
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Groenendyk JW, Mehta NN. Applying the ordinal model of atherosclerosis to imaging science: a brief review. Open Heart 2018; 5:e000861. [PMID: 30094037 PMCID: PMC6074639 DOI: 10.1136/openhrt-2018-000861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 05/30/2018] [Accepted: 07/03/2018] [Indexed: 12/28/2022] Open
Abstract
Atherogenesis has been well demonstrated to proceed in an ordinal fashion. Imaging technologies have advanced substantially in recent decades, enabling early detection of atherosclerosis. Some modalities, such as coronary CT, have seen broad clinical adaptation. In contrast, others, such as flow-mediated dilatation, remain predominantly research-based. Optimal and appropriate usage of these technologies remains an area of active investigation. We hypothesise that investigators ought to consider which stage of atherosclerosis is under investigation when choosing imaging modalities. Additionally, when assessing the efficacy of a particular treatment, some imaging modalities may be more appropriate than others. We review the most important available imaging modalities and suggest stages at which each may or may not be well used. Conceptual application of the classic stages of atherosclerosis model to the variety of modern imaging modalities available will result in more effective investigation and treatment of cardiovascular disease.
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Affiliation(s)
- Jacob W Groenendyk
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Pereira T, Betriu A, Alves R. Non-invasive imaging techniques and assessment of carotid vasa vasorum neovascularization: Promises and pitfalls. Trends Cardiovasc Med 2018; 29:71-80. [PMID: 29970286 DOI: 10.1016/j.tcm.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
Carotid adventitia vasa vasorum neovascularization (VVn) is associated with the initial stages of arteriosclerosis and with the formation of unstable plaque. However, techniques to accurately quantify that neovascularization in a standard, fast, non-invasive, and efficient way are still lacking. The development of such techniques holds the promise of enabling wide, inexpensive, and safe screening programs that could stratify patients and help in personalized preventive cardiovascular medicine. In this paper, we review the recent scientific literature pertaining to imaging techniques that could set the stage for the development of standard methods for quantitative assessment of atherosclerotic plaque and carotid VVn. We present and discuss the alternative imaging techniques being used in clinical practice and we review the computational developments that are contributing to speed up image analysis and interpretation. We conclude that one of the greatest upcoming challenges will be the use of machine learning techniques to develop automated methods that assist in the interpretation of images to stratify patients according to their risk.
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Affiliation(s)
- T Pereira
- Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, Catalonia, Spain; Departament de Ciències Mèdiques Bàsiques, University of Lleida, Catalonia, Spain.
| | - A Betriu
- Unit for the Detection and Treatment of Atherothrombotic Diseases, Hospital Universitari Arnau de Vilanova de Lleida, Catalonia, Spain; Vascular and Renal Translational Research Group - IRBLleida, Catalonia, Spain
| | - R Alves
- Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, Catalonia, Spain; Departament de Ciències Mèdiques Bàsiques, University of Lleida, Catalonia, Spain
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Sheahan M, Ma X, Paik D, Obuchowski NA, St. Pierre S, Newman WP, Rae G, Perlman ES, Rosol M, Keith JC, Buckler AJ. Atherosclerotic Plaque Tissue: Noninvasive Quantitative Assessment of Characteristics with Software-aided Measurements from Conventional CT Angiography. Radiology 2018; 286:622-631. [PMID: 28858564 PMCID: PMC5790306 DOI: 10.1148/radiol.2017170127] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose To (a) evaluate whether plaque tissue characteristics determined with conventional computed tomographic (CT) angiography could be quantitated at higher levels of accuracy by using image processing algorithms that take characteristics of the image formation process coupled with biologic insights on tissue distributions into account by comparing in vivo results and ex vivo histologic findings and (b) assess reader variability. Materials and Methods Thirty-one consecutive patients aged 43-85 years (average age, 64 years) known to have or suspected of having atherosclerosis who underwent CT angiography and were referred for endarterectomy were enrolled. Surgical specimens were evaluated with histopathologic examination to serve as standard of reference. Two readers used lumen boundary to determine scanner blur and then optimized component densities and subvoxel boundaries to best fit the observed image by using semiautomatic software. The accuracy of the resulting in vivo quantitation of calcification, lipid-rich necrotic core (LRNC), and matrix was assessed with statistical estimates of bias and linearity relative to ex vivo histologic findings. Reader variability was assessed with statistical estimates of repeatability and reproducibility. Results A total of 239 cross sections obtained with CT angiography and histologic examination were matched. Performance on held-out data showed low levels of bias and high Pearson correlation coefficients for calcification (-0.096 mm2 and 0.973, respectively), LRNC (1.26 mm2 and 0.856), and matrix (-2.44 mm2 and 0.885). Intrareader variability was low (repeatability coefficient ranged from 1.50 mm2 to 1.83 mm2 among tissue characteristics), as was interreader variability (reproducibility coefficient ranged from 2.09 mm2 to 4.43 mm2). Conclusion There was high correlation and low bias between the in vivo software image analysis and ex vivo histopathologic quantitative measures of atherosclerotic plaque tissue characteristics, as well as low reader variability. Software algorithms can mitigate the blurring and partial volume effects of routine CT angiography acquisitions to produce accurate quantification to enhance current clinical practice. Clinical trial registration no. NCT02143102 © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on September 15, 2017.
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Affiliation(s)
- Malachi Sheahan
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Xiaonan Ma
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - David Paik
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Nancy A. Obuchowski
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Samantha St. Pierre
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - William P. Newman
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Guenevere Rae
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Eric S. Perlman
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Michael Rosol
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - James C. Keith
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
| | - Andrew J. Buckler
- From the Louisiana State University Health Sciences Center, New Orleans, La (M.S., W.P.N., G.R.); Elucid Bioimaging, 225 Main St, Wenham, MA 01984 (X.M., D.P., S.S.P., M.R., J.C.K., A.J.B.); Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); and Perlman Advisory Group, Boynton Beach, Fla (E.S.P.)
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15
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Wei X, Ying M, Dehaini D, Su Y, Kroll AV, Zhou J, Gao W, Fang RH, Chien S, Zhang L. Nanoparticle Functionalization with Platelet Membrane Enables Multifactored Biological Targeting and Detection of Atherosclerosis. ACS NANO 2018; 12:109-116. [PMID: 29216423 PMCID: PMC5859122 DOI: 10.1021/acsnano.7b07720] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Cardiovascular disease represents one of the major causes of death across the global population. Atherosclerosis, one of its most common drivers, is characterized by the gradual buildup of arterial plaque over time, which can ultimately lead to life-threatening conditions. Given the impact of the disease on public health, there is a great need for effective and noninvasive imaging modalities that can provide valuable information on its biological underpinnings during development. Here, we leverage the role of platelets in atherogenesis to design nanocarriers capable of targeting multiple biological elements relevant to plaque development. Biomimetic nanoparticles are prepared by coating platelet membrane around a synthetic nanoparticulate core, the product of which is capable of interacting with activated endothelium, foam cells, and collagen. The effects are shown to be exclusive to platelet membrane-coated nanoparticles. These biomimetic nanocarriers are not only capable of efficiently localizing to well-developed atherosclerotic plaque, but can also target subclinical regions of arteries susceptible to plaque formation. Using a commonly employed magnetic resonance imaging contrast agent, live detection is demonstrated using an animal model of atherosclerosis. Ultimately, this strategy may be leveraged to better assess the development of atherosclerosis, offering additional information to help clinicians better manage the disease.
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16
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Hwang YN, Lee JH, Kim GY, Shin ES, Kim SM. Characterization of coronary plaque regions in intravascular ultrasound images using a hybrid ensemble classifier. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 153:83-92. [PMID: 29157464 DOI: 10.1016/j.cmpb.2017.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 09/18/2017] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to propose a hybrid ensemble classifier to characterize coronary plaque regions in intravascular ultrasound (IVUS) images. METHODS Pixels were allocated to one of four tissues (fibrous tissue (FT), fibro-fatty tissue (FFT), necrotic core (NC), and dense calcium (DC)) through processes of border segmentation, feature extraction, feature selection, and classification. Grayscale IVUS images and their corresponding virtual histology images were acquired from 11 patients with known or suspected coronary artery disease using 20 MHz catheter. A total of 102 hybrid textural features including first order statistics (FOS), gray level co-occurrence matrix (GLCM), extended gray level run-length matrix (GLRLM), Laws, local binary pattern (LBP), intensity, and discrete wavelet features (DWF) were extracted from IVUS images. To select optimal feature sets, genetic algorithm was implemented. A hybrid ensemble classifier based on histogram and texture information was then used for plaque characterization in this study. The optimal feature set was used as input of this ensemble classifier. After tissue characterization, parameters including sensitivity, specificity, and accuracy were calculated to validate the proposed approach. A ten-fold cross validation approach was used to determine the statistical significance of the proposed method. RESULTS Our experimental results showed that the proposed method had reliable performance for tissue characterization in IVUS images. The hybrid ensemble classification method outperformed other existing methods by achieving characterization accuracy of 81% for FFT and 75% for NC. In addition, this study showed that Laws features (SSV and SAV) were key indicators for coronary tissue characterization. CONCLUSIONS The proposed method had high clinical applicability for image-based tissue characterization.
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Affiliation(s)
- Yoo Na Hwang
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus (10326) 32, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Ju Hwan Lee
- Department of Medical Devices Industry, Dongguk University-Seoul (04620) 26, Pil-dong 3-ga, Jung-gu, Seoul, Republic of Korea
| | - Ga Young Kim
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus (10326) 32, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Eun Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine (44033) 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, Republic of Korea
| | - Sung Min Kim
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus (10326) 32, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea; Department of Medical Devices Industry, Dongguk University-Seoul (04620) 26, Pil-dong 3-ga, Jung-gu, Seoul, Republic of Korea.
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17
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St Pierre S, Siegelman J, Obuchowski NA, Ma X, Paik D, Buckler AJ. Measurement Accuracy of Atherosclerotic Plaque Structure on CT Using Phantoms to Establish Ground Truth. Acad Radiol 2017; 24:1203-1215. [PMID: 28551396 PMCID: PMC5591770 DOI: 10.1016/j.acra.2017.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to characterize analytic performance of software-aided arterial vessel structure measurements across a range of scanner settings for computed tomography angiography where ground truth is known. We characterized performance for measurands that may be efficiently measured for clinical cases without use of software, as well as those that may be done manually but which is generally not done due to the effort level required unless software is employed. MATERIALS AND METHODS Four measurands (lumen area, stenosis, wall area, wall thickness) were evaluated using tissue-mimicking phantoms to estimate bias, heteroscedasticity, and limits of quantitation both pooled across scanner settings and individually for eight different settings. Reproducibility across scanner settings was also estimated. RESULTS Measurements of lumen area have a near constant bias of +1.3 mm for measurements ranging from 3 mm2 to 40 mm2; stenosis bias is +7% across a 30%-70% range; wall area bias is +14% across a 50-450 mm2 range; and wall thickness bias is +1.2 mm across a 3-9 mm range. All measurements possess properties that make them suitable for measuring longitudinal change. Lumen area demonstrates the most sensitivity to scanner settings (bias from as low as +.1 mm to as high as +2.7 mm); wall thickness demonstrates negligible sensitivity. CONCLUSIONS Variability across scanner settings for lumen measurands was generally higher than bias for a given setting. The converse was true for the wall measurands, where variability due to scanner settings was very low. Both bias and variability due to scanner settings of vessel structure were within clinically useful levels.
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Affiliation(s)
| | | | - Nancy A Obuchowski
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
| | - David Paik
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
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18
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Novel combined index of cardiometabolic risk related to periarterial fat improves the clinical prediction for coronary artery disease complexity. Atherosclerosis 2017; 268:76-83. [PMID: 29195108 DOI: 10.1016/j.atherosclerosis.2017.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/07/2017] [Accepted: 09/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular (CV) risk assessment based on conventional risk factors has a limited performance in the prediction of obstructive coronary artery disease (CAD). Therefore, our aim was to provide a complete assessment on the associations between single or combined cardiovascular ultrasound indexes and the complexity of CAD in high and very-high risk patients. METHODS Two hundred fifteen patients scheduled for elective coronary angiography were enrolled in the study (F/M: 80/135 pts; age: 61.8 ± 7.9 years). Detailed clinical characteristics, including several obesity parameters, and the following ultrasound indexes were obtained: carotid intima-media thickness (IMT) and extra-media thickness (EMT), epicardial fat thickness (EFT) and intra-abdominal fat thickness (IAT). CAD severity and complexity were assessed based on the well-evidenced SYNTAX score (SS) algorithm. RESULTS The study patients (79% with a very high CV risk) had central obesity (77%), and arterial hypertension (81%), one-third (37%) had diabetes and most of the individuals (74%) were current or previous smokers. In the study group, male sex, higher number of CV risk factors, diabetes and increased carotid vascular indexes (IMT or EMT ≥ 900 μm) were associated with significantly higher SS (p < 0.05). Paradoxically, obese patients revealed a significantly lower SS compared to non-obese individuals (3.65 ± 6.66 vs. 5.93 ± 8.8; p < 0.01), which was not explained by the number of CV risk factors or age. All the ultrasound indexes (except for visceral fat - IAT) revealed significant associations with the SS and the highest correlation coefficient was found for PATIMA combined index (r = 0.45; p < 0.01). Hence, none of the obesity-related clinical indexes showed any associations with CAD complexity. Multivariate regression analysis showed that male sex, chronic kidney disease and the PATIMA index were independently associated with the Syntax Score. The ROC analysis showed that the highest sensitivity (71% and 82%) and specificity (77% and 72%) in prediction of either SS > 1 or SS > 7 were found for the combined PATIMA index (negative predictive value = 92% for SS > 7). CONCLUSIONS We present the first study showing that a combination of ultrasound indexes related to periarterial fat and vascular wall (PATIMA index) is associated with more complex CAD in high and very-high risk patients. PATIMA index revealed improved predictive value compared to other single ultrasound indexes and clinical risk assessment.
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19
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Hjelmgren O, Johansson L, Prahl U, Schmidt C, Bergström GML. Inverse association between size of the lipid-rich necrotic core and vascularization in human carotid plaques. Clin Physiol Funct Imaging 2017; 38:326-331. [DOI: 10.1111/cpf.12418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/19/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Ola Hjelmgren
- The Wallenberg Laboratory; Department of Molecular and Clinical Medicine; Institute of Medicine; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- Department of Clinical Physiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Lars Johansson
- Department of Radiology; Uppsala University; Uppsala Sweden
| | - Ulrica Prahl
- The Wallenberg Laboratory; Department of Molecular and Clinical Medicine; Institute of Medicine; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - Caroline Schmidt
- The Wallenberg Laboratory; Department of Molecular and Clinical Medicine; Institute of Medicine; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - Göran M. L. Bergström
- The Wallenberg Laboratory; Department of Molecular and Clinical Medicine; Institute of Medicine; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- Department of Clinical Physiology; Sahlgrenska University Hospital; Gothenburg Sweden
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20
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Vallet-Courbin A, Larivière M, Hocquellet A, Hemadou A, Parimala SN, Laroche-Traineau J, Santarelli X, Clofent-Sanchez G, Jacobin-Valat MJ, Noubhani A. A Recombinant Human Anti-Platelet scFv Antibody Produced in Pichia pastoris for Atheroma Targeting. PLoS One 2017; 12:e0170305. [PMID: 28125612 PMCID: PMC5268420 DOI: 10.1371/journal.pone.0170305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022] Open
Abstract
Cells of the innate and adaptive immune system are key factors in the progression of atherosclerotic plaque, leading to plaque instability and rupture, potentially resulting in acute atherothrombotic events such as coronary artery disease, cerebrovascular disease and peripheral arterial disease. Here, we describe the cloning, expression, purification, and immunoreactivity assessment of a recombinant single-chain variable fragment (scFv) derived from a human anti-αIIbβ3 antibody (HuAb) selected to target atheromatous lesions for the presence of platelets. Indeed, platelets within atheroma plaques have been shown to play a role in inflammation, in platelet-leucocyte aggregates and in thrombi formation and might thus be considered relevant biomarkers of atherosclerotic progression. The DNA sequence that encodes the anti-αIIbβ3 TEG4 scFv previously obtained from a phage-display selection on activated platelets, was inserted into the eukaryote vector (pPICZαA) in fusion with a tag sequence encoding 2 cysteines useable for specific probes grafting experiments. The recombinant protein was expressed at high yields in Pichia pastoris (30 mg/L culture). The advantage of P. pastoris as an expression system is the production and secretion of recombinant proteins in the supernatant, ruling out the difficulties encountered when scFv are produced in the cytoplasm of bacteria (low yield, low solubility and reduced affinity). The improved conditions allowed for the recovery of highly purified and biologically active scFv fragments ready to be grafted in a site-directed way to nanoparticles for the imaging of atherosclerotic plaques involving inflammatory processes and thus at high risk of instability.
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Affiliation(s)
| | - Mélusine Larivière
- Centre de Résonance Magnétique de Systèmes Biologiques, Centre Nationale de Recherche Scientifique et Université de Bordeaux, Bordeaux, France
| | | | - Audrey Hemadou
- Centre de Résonance Magnétique de Systèmes Biologiques, Centre Nationale de Recherche Scientifique et Université de Bordeaux, Bordeaux, France
| | | | - Jeanny Laroche-Traineau
- Centre de Résonance Magnétique de Systèmes Biologiques, Centre Nationale de Recherche Scientifique et Université de Bordeaux, Bordeaux, France
| | | | - Gisèle Clofent-Sanchez
- Centre de Résonance Magnétique de Systèmes Biologiques, Centre Nationale de Recherche Scientifique et Université de Bordeaux, Bordeaux, France
| | - Marie-Josée Jacobin-Valat
- Centre de Résonance Magnétique de Systèmes Biologiques, Centre Nationale de Recherche Scientifique et Université de Bordeaux, Bordeaux, France
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21
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Shi Y, Gao Y, Zou X, Chen L, Li Y. Imaging of carotid artery inflammatory plaques with superparamagnetic nanoparticles and an external magnet collar. J Mater Chem B 2017; 5:797-806. [PMID: 32263848 DOI: 10.1039/c6tb02849g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Stroke is one of the top three fatal diseases in human history.
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Affiliation(s)
- Yimin Shi
- Department of Neurosurgery
- Huashan Hospital
- Fudan University
- Shanghai 200040
- P. R. China
| | - Yongping Gao
- Lab of Low-Dimensional Materials Chemistry
- Key Laboratory for Ultrafine Materials of Ministry of Education
- School of Materials Science and Engineering
- East China University of Science and Technology
- Shanghai 200237
| | - Xiang Zou
- Department of Neurosurgery
- Huashan Hospital
- Fudan University
- Shanghai 200040
- P. R. China
| | - Liang Chen
- Department of Neurosurgery
- Huashan Hospital
- Fudan University
- Shanghai 200040
- P. R. China
| | - Yongsheng Li
- Lab of Low-Dimensional Materials Chemistry
- Key Laboratory for Ultrafine Materials of Ministry of Education
- School of Materials Science and Engineering
- East China University of Science and Technology
- Shanghai 200237
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22
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A Review on Carotid Ultrasound Atherosclerotic Tissue Characterization and Stroke Risk Stratification in Machine Learning Framework. Curr Atheroscler Rep 2016; 17:55. [PMID: 26233633 DOI: 10.1007/s11883-015-0529-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular diseases (including stroke and heart attack) are identified as the leading cause of death in today's world. However, very little is understood about the arterial mechanics of plaque buildup, arterial fibrous cap rupture, and the role of abnormalities of the vasa vasorum. Recently, ultrasonic echogenicity characteristics and morphological characterization of carotid plaque types have been shown to have clinical utility in classification of stroke risks. Furthermore, this characterization supports aggressive and intensive medical therapy as well as procedures, including endarterectomy and stenting. This is the first state-of-the-art review to provide a comprehensive understanding of the field of ultrasonic vascular morphology tissue characterization. This paper presents fundamental and advanced ultrasonic tissue characterization and feature extraction methods for analyzing plaque. Additionally, the paper shows how the risk stratification is achieved using machine learning paradigms. More advanced methods need to be developed which can segment the carotid artery walls into multiple regions such as the bulb region and areas both proximal and distal to the bulb. Furthermore, multimodality imaging is needed for validation of such advanced methods for stroke and cardiovascular risk stratification.
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Rudd JHF, Coughlin PA, Groves AM. Predicting Aortic Aneurysm Expansion by PET. J Nucl Med 2015; 56:971-3. [PMID: 25908831 DOI: 10.2967/jnumed.115.154062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/06/2015] [Indexed: 01/16/2023] Open
Affiliation(s)
- James H F Rudd
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Patrick A Coughlin
- Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ashley M Groves
- Department of Nuclear Medicine, University College Hospital, London, United Kingdom
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24
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Yamak D, Panse P, Pavlicek W, Boltz T, Akay M. Non-calcified coronary atherosclerotic plaque characterization by dual energy computed tomography. IEEE J Biomed Health Inform 2015; 18:939-45. [PMID: 24808227 DOI: 10.1109/jbhi.2013.2295534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary heart disease (CHD) is the most prevalent cause of death worldwide. Atherosclerosis which is the condition of plaque buildup on the inside of the coronary artery wall is the main cause of CHD. Rupture of unstable atherosclerotic coronary plaque is known to be the cause of acute coronary syndrome. Vulnerability of atherosclerotic plaque has been related to a large lipid core covered by a fibrous cap. Non-invasive assessment of plaque characterization is necessary due to prognostic importance of early stage identification. The purpose of this study is to use the additional attenuation data provided by dual energy computed tomography (DECT) for plaque characterization. We propose to train supervised learners on pixel values recorded from DECT monochromatic X-ray and material basis pairs images, for more precise classification of fibrous and lipid plaques. The interaction of the pixel values from different image types is taken into consideration, as single pixel value might not be informative enough to separate fibrous from lipid. Organic phantom plaques scanned in a fabricated beating heart phantom were used as ground truth to train the learners. Our results show that support vector machines, artificial neural networks and random forests provide accurate results both on phantom and patient data.
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26
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Association between serum IgG4 concentrations and the morphology of the aorta in patients who undergo cardiac computed tomography. J Cardiol 2014; 65:150-6. [PMID: 24996385 DOI: 10.1016/j.jjcc.2014.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/14/2014] [Accepted: 04/30/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immunoglobulin G4 (IgG4)-related disease has been suggested to be involved in cardiovascular disorders such as chronic periaortitis. However, it remains unclear whether IgG4-related immuno-inflammation affects the subclinical stages of aortic remodeling. Here, we analyzed the relationship between serum IgG4 concentrations and the morphology of the ascending aorta. METHODS Serum concentrations of IgG4 were measured in 322 patients who underwent 320-slice cardiac computed tomography (CT). We assessed the aortic wall area and intravascular area at the portion between the aortic valve and the bifurcation of the pulmonary artery. RESULTS In total, 174 patients (54.0%) were diagnosed to have coronary artery disease (CAD) by cardiac CT. The intravascular area was significantly larger in patients with CAD than in those without (893mm(2) vs. 811mm(2), p=0.001). The aortic wall area was slightly, but not significantly, larger in patients with CAD than in those without (183mm(2) vs. 176mm(2), p=0.051). Serum concentrations of IgG4 were significantly higher in patients with an aortic wall area of median or greater size (≥181mm(2)) than in those with a smaller area (<181mm(2)) (32.9mg/dL vs. 23.1mg/dL, p=0.026). In logistic regression analysis using age, gender, and CAD as covariates, the fourth quartile of IgG4 (≥55.4mg/dL) was significantly associated with an aortic wall area of median or greater size with an odds ratio of 2.09. CONCLUSIONS Serum concentrations of IgG4 were found to be significantly associated with the aortic wall area. These findings collectively suggest that immuno-inflammatory processes may play a role in the subclinical stages of aortic remodeling.
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27
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A study of plaque vascularization and inflammation using quantitative contrast-enhanced US and PET/CT. Eur J Radiol 2014; 83:1184-1189. [DOI: 10.1016/j.ejrad.2014.03.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/10/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022]
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Ibrahimi P, Jashari F, Nicoll R, Bajraktari G, Wester P, Henein MY. Coronary and carotid atherosclerosis: how useful is the imaging? Atherosclerosis 2013; 231:323-33. [PMID: 24267246 DOI: 10.1016/j.atherosclerosis.2013.09.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/13/2013] [Accepted: 09/30/2013] [Indexed: 02/08/2023]
Abstract
The recent advancement of imaging modalities has made possible visualization of atherosclerosis disease in all phases of its development. Markers of subclinical atherosclerosis or even the most advanced plaque features are acquired by invasive (IVUS, OCT) and non-invasive imaging modalities (US, MRI, CTA). Determining plaques prone to rupture (vulnerable plaques) might help to identify patients at risk for myocardial infarction or stroke. The most accepted features of plaque vulnerability include: thin cap fibroatheroma, large lipid core, intimal spotty calcification, positive remodeling and intraplaque neovascularizations. Today, research is focusing on finding imaging techniques that are less invasive, less radiation and can detect most of the vulnerable plaque features. While, carotid atherosclerosis can be visualized using noninvasive imaging, such as US, MRI and CT, imaging plaque feature in coronary arteries needs invasive imaging modalities. However, atherosclerosis is a systemic disease with plaque development simultaneously in different arteries and data acquisition in carotid arteries can add useful information for prediction of coronary events.
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Affiliation(s)
- Pranvera Ibrahimi
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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29
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Pedersen SF, Hag AMF, Klausen TL, Ripa RS, Bodholdt RP, Kjaer A. Positron emission tomography of the vulnerable atherosclerotic plaque in man--a contemporary review. Clin Physiol Funct Imaging 2013; 34:413-25. [PMID: 24289282 PMCID: PMC4237171 DOI: 10.1111/cpf.12105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/21/2013] [Indexed: 12/26/2022]
Abstract
Atherosclerosis is the primary underlying cause of cardiovascular disease (CVD). It is the leading cause of morbidity and mortality in the Western world today and is set to become the prevailing disease and major cause of death worldwide by 2020. In the 1950s surgical intervention was introduced to treat symptomatic patients with high-grade carotid artery stenosis due to atherosclerosis – a procedure known as carotid endarterectomy (CEA). By removing the atherosclerotic plaque from the affected carotid artery of these patients, CEA is beneficial by preventing subsequent ipsilateral ischemic stroke. However, it is known that patients with low to intermediate artery stenosis may still experience ischemic events, leading clinicians to consider plaque composition as an important feature of atherosclerosis. Today molecular imaging can be used for characterization, visualization and quantification of cellular and subcellular physiological processes as they take place in vivo; using this technology we can obtain valuable information on atherosclerostic plaque composition. Applying molecular imaging clinically to atherosclerotic disease therefore has the potential to identify atherosclerotic plaques vulnerable to rupture. This could prove to be an important tool for the selection of patients for CEA surgery in a health system increasingly focused on individualized treatment. This review focuses on current advances and future developments of in vivo atherosclerosis PET imaging in man.
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Affiliation(s)
- Sune F Pedersen
- Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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30
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Rajani NK, Joshi FR, Tarkin JM, Rudd JHF. Advances in imaging vascular inflammation. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Tawakol A, Fayad ZA, Mogg R, Alon A, Klimas MT, Dansky H, Subramanian SS, Abdelbaky A, Rudd JH, Farkouh ME, Nunes IO, Beals CR, Shankar SS. Intensification of Statin Therapy Results in a Rapid Reduction in Atherosclerotic Inflammation. J Am Coll Cardiol 2013; 62:909-17. [DOI: 10.1016/j.jacc.2013.04.066] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 03/27/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
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32
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Mäki-Petäjä KM, Elkhawad M, Cheriyan J, Joshi FR, Östör AJ, Hall FC, Rudd JH, Wilkinson IB. Response to letter regarding article, ''anti-tumor necrosis factor-α therapy reduces aortic inflammation and stiffness in patients with rheumatoid arthritis''. Circulation 2013; 128:e11. [PMID: 23980280 DOI: 10.1161/circulationaha.113.002597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kaisa M. Mäki-Petäjä
- Clinical Pharmacology UnitUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
| | - Maysoon Elkhawad
- Clinical Pharmacology UnitUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
| | - Joseph Cheriyan
- Clinical Pharmacology UnitUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
| | - Francis R. Joshi
- Division of Cardiovascular MedicineUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
| | - Andrew J.K. Östör
- Department of RheumatologyUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
| | - Frances C. Hall
- Department of RheumatologyUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
| | - James H.F. Rudd
- Division of Cardiovascular MedicineUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
| | - Ian B. Wilkinson
- Clinical Pharmacology UnitUniversity of CambridgeAddenbrooke’s HospitalCambridge, UK
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Hjelmgren O, Holdfeldt P, Johansson L, Fagerberg B, Prahl U, Schmidt C, Bergström G. Identification of Vascularised Carotid Plaques Using a Standardised and Reproducible Technique to Measure Ultrasound Contrast Uptake. Eur J Vasc Endovasc Surg 2013; 46:21-8. [DOI: 10.1016/j.ejvs.2013.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/26/2013] [Indexed: 01/06/2023]
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Verjans JW, Jaffer FA. Biological imaging of atherosclerosis: moving beyond anatomy. J Cardiovasc Transl Res 2013; 6:681-94. [PMID: 23733542 DOI: 10.1007/s12265-013-9474-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/09/2013] [Indexed: 12/27/2022]
Abstract
Biological or molecular imaging is now providing exciting new strategies to study atherosclerosis in both animals and humans. These technologies hold the promise to provide disease-specific, molecular information within the context of a systemic or organ-specific disease beyond traditional anatomical-based imaging. By integration of biological, chemical, and anatomical imaging knowledge into diagnostic strategies, a more comprehensive and predictive picture of atherosclerosis is likely to emerge. As such, biological imaging is well positioned to study different stages of atherosclerosis and its treatment, including the sequence of atheroma initiation, progression, and plaque rupture. In this review, we describe the evolving concepts in atherosclerosis imaging with a focus on coronary artery disease, and we provide an overview of recent exciting translational developments in biological imaging. The illuminated examples and discussions will highlight how biological imaging is providing new clinical approaches to identify high-risk plaques, and to streamline the development process of new atherosclerosis therapies.
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Affiliation(s)
- Johan W Verjans
- Massachusetts General Hospital, Cardiovascular Research Center, Harvard Medical School, 185 Cambridge Street, Simches Building, Room 3206, Boston, MA, 02114, USA
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Edvardsen T, Plein S, Saraste A, Knuuti J, Maurer G, Lancellotti P. The year 2012 in the European Heart Journal-Cardiovascular Imaging: Part I. Eur Heart J Cardiovasc Imaging 2013; 14:509-14. [PMID: 23671232 DOI: 10.1093/ehjci/jet069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The new multi-modality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was started in 2012. During its first year, the new Journal has published an impressive collection of cardiovascular studies utilizing all cardiovascular imaging modalities. We will summarize the most important studies from its first year in two articles. The present 'Part I' of the review will focus on studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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Molecular Targeting of Imaging and Drug Delivery Probes in Atherosclerosis. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 2013. [DOI: 10.1016/b978-0-12-417150-3.00008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists' view. Eur Heart J 2012; 34:719-28. [PMID: 23242196 DOI: 10.1093/eurheartj/ehs411] [Citation(s) in RCA: 690] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although mortality rates from coronary heart disease in the western countries have declined in the last few decades, morbidity caused by this disease is increasing and a substantial number of patients still suffer acute coronary syndrome (ACS) and sudden cardiac death. Acute coronary syndrome occurs as a result of myocardial ischaemia and its manifestations include acute myocardial infarction and unstable angina. Culprit plaque morphology in these patients varies from thrombosis with or without coronary occlusion to sudden narrowing of the lumen from intraplaque haemorrhage. The coronary artery plaque morphologies primarily responsible for thrombosis are plaque rupture, and plaque erosion, with plaque rupture being the most common cause of acute myocardial infarction, especially in men. Autopsy data demonstrate that women <50 years of age more frequently have erosion, whereas in older women, the frequency of rupture increases with each decade. Ruptured plaques are associated with positive (expansive) remodelling and characterized by a large necrotic core and a thin fibrous cap that is disrupted and infiltrated by foamy macrophages. Plaque erosion lesions are often negatively remodelled with the plaque itself being rich in smooth muscle cells and proteoglycans with minimal to absence of inflammation. Plaque haemorrhage may expand the plaque rapidly, leading to the development of unstable angina. Plaque haemorrhage may occur from plaque rupture (fissure) or from neovascularization (angiogenesis). Atherosclerosis is now recognized as an inflammatory disease with macrophages and T-lymphocytes playing a dominant role. Recently at least two subtypes of macrophages have been identified. M1 is a pro-inflammatory macrophage while M2 seems to play a role in dampening inflammation and promoting tissue repair. A third type of macrophage, termed by us as haemoglobin associated macrophage or M(Hb) which is observed at site of haemorrhage also can be demonstrated in human atherosclerosis. In order to further our understanding of the specific biological events which trigger plaque instability and as well as to monitor the effects of novel anti-atherosclerotic therapies newer imaging modalities in vivo are needed.
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Affiliation(s)
- Erling Falk
- Aarhus University Hospital Skejby, Aarhus, Denmark
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Gadolinium-Based Contrast Agents for Vessel Wall Magnetic Resonance Imaging (MRI) of Atherosclerosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 6:11-24. [PMID: 23539505 DOI: 10.1007/s12410-012-9177-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease due to atherosclerosis is the number one killer in the Western world, and threatens to become the major cause of morbidity and mortality worldwide. It is therefore paramount to develop non-invasive methods for the detection of high-risk, asymptomatic individuals before the onset of clinical symptoms or events. In the recent past, great strides have been made in the understanding of the pathological mechanisms involved in the atherosclerotic cascade down to the molecular details. This has allowed the development of contrast agents that can aid in the in vivo characterization of these processes. Gadolinium chelates are among the contrast media most commonly used in MR imaging. Originally used for MR angiography for the detection and quantification of vascular stenosis, more recently they have been applied to improve characterization of atherosclerotic plaques. In this manuscript, we will briefly review gadolinium-chelates (Gd) based contrast agents for non-invasive MR imaging of atherosclerosis. We will first describe Gd-based non-targeted FDA approved agents, used routinely in clinical practice for the evaluation of neovascularization in other diseases. Secondly, we will describe non-specific and specific targeted contrast agents, which have great potential for dissecting specific biological processes in the atherosclerotic cascade. Lastly, we will briefly compare Gd-based agents to others commonly used in MRI and to other imaging modalities.
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