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Canton G, Baylam Geleri D, Hippe DS, Sun J, Guo Y, Balu N, Chu B, Pimentel K, Akçiçek H, Yaman Akçiçek E, Tirschwell D, Tang G, Kohler T, Shibata D, Ferguson MS, Yuan C, Hatsukami TS. Pathophysiology of carotid atherosclerosis: Calcification, intraplaque haemorrhage and pulse pressure as key players. Eur J Radiol 2024; 178:111647. [PMID: 39068857 DOI: 10.1016/j.ejrad.2024.111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/09/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Intraplaque haemorrhage (IPH) is a well-known risk factor for faster plaque progression (volume increase); however, its etiology is unclear. We aimed at determining what other local plaque- and systemic factors contribute to plaque progression and to the development and progression of IPH. METHODS We examined 98 asymptomatic participants with carotid plaque using serial multi-contrast magnetic resonance imaging. We measured the percent of wall volume (%WV=100 x [wall volume] / [total vessel volume]) and measured IPH and calcification volumes. We used generalized estimating equations-based regression to analyze predictors of %WV change and new IPH while accounting for covariates (sex, age and statin use), and multiple non-independent observations per participant. RESULTS Total follow-up was 1.8 ± 0.8 years on average. The presence of IPH (β: 0.6 %/y, p = 0.033) and calcification (β: 1.2 %/y, p = 0.028) were each associated with faster plaque progression. New IPH, detected on a subsequent scan in 4 % of arteries that did not initially have IPH, was associated with larger calcification (odds ratio [OR]: 2.6 per 1-SD increase, p = 0.038) and higher pulse pressure (OR: 2.3 per 1-SD increase, p = 0.016). Larger calcification was associated with greater increases in pulse pressure (β: 1.4 mm Hg/y per 1-SD increase, p = 0.040). CONCLUSIONS IPH and calcification are each independently associated with faster plaque progression. The association of carotid calcification to increased pulse pressure and new IPH development suggests a possible mechanism by which calcification drives IPH development and plaque progression.
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Affiliation(s)
- Gador Canton
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Duygu Baylam Geleri
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Daniel S Hippe
- Clinical Biostatistics, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Jie Sun
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Yin Guo
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Niranjan Balu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Baocheng Chu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Kristi Pimentel
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Halit Akçiçek
- Radiology Department, University of Utah, Salt Lake City, UT, United States
| | - Ebru Yaman Akçiçek
- Radiology Department, University of Utah, Salt Lake City, UT, United States
| | - David Tirschwell
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Gale Tang
- Division of Vascular Surgery, Department of Surgery University of Washington, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Ted Kohler
- Division of Vascular Surgery, Department of Surgery University of Washington, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Dean Shibata
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Marina S Ferguson
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Chun Yuan
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States; Radiology Department, University of Utah, Salt Lake City, UT, United States
| | - Thomas S Hatsukami
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, United States.
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He L, Yang Z, Wang Y, Chen W, Diao L, Wang Y, Yuan W, Li X, Zhang Y, He Y, Shen E. A deep learning algorithm to identify carotid plaques and assess their stability. Front Artif Intell 2024; 7:1321884. [PMID: 38952409 PMCID: PMC11215125 DOI: 10.3389/frai.2024.1321884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/23/2024] [Indexed: 07/03/2024] Open
Abstract
Background Carotid plaques are major risk factors for stroke. Carotid ultrasound can help to assess the risk and incidence rate of stroke. However, large-scale carotid artery screening is time-consuming and laborious, the diagnostic results inevitably involve the subjectivity of the diagnostician to a certain extent. Deep learning demonstrates the ability to solve the aforementioned challenges. Thus, we attempted to develop an automated algorithm to provide a more consistent and objective diagnostic method and to identify the presence and stability of carotid plaques using deep learning. Methods A total of 3,860 ultrasound images from 1,339 participants who underwent carotid plaque assessment between January 2021 and March 2023 at the Shanghai Eighth People's Hospital were divided into a 4:1 ratio for training and internal testing. The external test included 1,564 ultrasound images from 674 participants who underwent carotid plaque assessment between January 2022 and May 2023 at Xinhua Hospital affiliated with Dalian University. Deep learning algorithms, based on the fusion of a bilinear convolutional neural network with a residual neural network (BCNN-ResNet), were used for modeling to detect carotid plaques and assess plaque stability. We chose AUC as the main evaluation index, along with accuracy, sensitivity, and specificity as auxiliary evaluation indices. Results Modeling for detecting carotid plaques involved training and internal testing on 1,291 ultrasound images, with 617 images showing plaques and 674 without plaques. The external test comprised 470 ultrasound images, including 321 images with plaques and 149 without. Modeling for assessing plaque stability involved training and internal testing on 764 ultrasound images, consisting of 494 images with unstable plaques and 270 with stable plaques. The external test was composed of 279 ultrasound images, including 197 images with unstable plaques and 82 with stable plaques. For the task of identifying the presence of carotid plaques, our model achieved an AUC of 0.989 (95% CI: 0.840, 0.998) with a sensitivity of 93.2% and a specificity of 99.21% on the internal test. On the external test, the AUC was 0.951 (95% CI: 0.962, 0.939) with a sensitivity of 95.3% and a specificity of 82.24%. For the task of identifying the stability of carotid plaques, our model achieved an AUC of 0.896 (95% CI: 0.865, 0.922) on the internal test with a sensitivity of 81.63% and a specificity of 87.27%. On the external test, the AUC was 0.854 (95% CI: 0.889, 0.830) with a sensitivity of 68.52% and a specificity of 89.49%. Conclusion Deep learning using BCNN-ResNet algorithms based on routine ultrasound images could be useful for detecting carotid plaques and assessing plaque instability.
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Affiliation(s)
- Lan He
- Department of Ultrasound Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, China
| | | | | | | | | | - Yitong Wang
- Department of Ultrasound Medicine, Xinhua Hospital, Dalian University, Dalian, China
| | - Wei Yuan
- Department of Ultrasound Medicine, Caohejing Street Community Health Service Centre, Shanghai, China
| | - Xu Li
- Department of Cardiology, The First Hospital of Soochow University, Suzhou, China
| | - Ying Zhang
- Department of Ultrasound Medicine, Xinhua Hospital, Dalian University, Dalian, China
| | - Yongming He
- Department of Cardiology, The First Hospital of Soochow University, Suzhou, China
| | - E. Shen
- Department of Ultrasound Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Maushagen J, Addin NS, Schuppert C, Ward-Caviness CK, Nattenmüller J, Adamski J, Peters A, Bamberg F, Schlett CL, Wang-Sattler R, Rospleszcz S. Serum metabolite signatures of cardiac function and morphology in individuals from a population-based cohort. Biomark Res 2024; 12:31. [PMID: 38444025 PMCID: PMC10916302 DOI: 10.1186/s40364-024-00578-w] [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: 12/06/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Changes in serum metabolites in individuals with altered cardiac function and morphology may exhibit information about cardiovascular disease (CVD) pathway dysregulations and potential CVD risk factors. We aimed to explore associations of cardiac function and morphology, evaluated using magnetic resonance imaging (MRI) with a large panel of serum metabolites. METHODS Cross-sectional data from CVD-free individuals from the population-based KORA cohort were analyzed. Associations between 3T-MRI-derived left ventricular (LV) function and morphology parameters (e.g., volumes, filling rates, wall thickness) and markers of carotid plaque with metabolite profile clusters and single metabolites as outcomes were assessed by adjusted multinomial logistic regression and linear regression models. RESULTS In 360 individuals (mean age 56.3 years; 41.9% female), 146 serum metabolites clustered into three distinct profiles that reflected high-, intermediate- and low-CVD risk. Higher stroke volume (relative risk ratio (RRR): 0.53, 95%-CI [0.37; 0.76], p-value < 0.001) and early diastolic filling rate (RRR: 0.51, 95%-CI [0.37; 0.71], p-value < 0.001) were most strongly protectively associated against the high-risk profile compared to the low-risk profile after adjusting for traditional CVD risk factors. Moreover, imaging markers were associated with 10 metabolites in linear regression. Notably, negative associations of stroke volume and early diastolic filling rate with acylcarnitine C5, and positive association of function parameters with lysophosphatidylcholines, diacylphosphatidylcholines, and acylalkylphosphatidylcholines were observed. Furthermore, there was a negative association of LV wall thickness with alanine, creatinine, and symmetric dimethylarginine. We found no significant associations with carotid plaque. CONCLUSIONS Serum metabolite signatures are associated with cardiac function and morphology even in individuals without a clinical indication of CVD.
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Affiliation(s)
- Juliane Maushagen
- Institute of Epidemiology, Helmholtz Munich, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Medical Faculty, Ludwig- Maximilians-Universität (LMU), München, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Nuha Shugaa Addin
- Institute of Epidemiology, Helmholtz Munich, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Medical Faculty, Ludwig- Maximilians-Universität (LMU), München, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Christopher Schuppert
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, U.S. EPA, Chapel Hill, NC, USA
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jerzy Adamski
- Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, 117597, Singapore, Singapore
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Munich, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Medical Faculty, Ludwig- Maximilians-Universität (LMU), München, Germany
- German Center for Diabetes Research, DZD, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Rui Wang-Sattler
- German Center for Diabetes Research, DZD, Neuherberg, Germany
- Institute of Translational Genomics, Helmholtz Munich, Neuherberg, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Munich, Neuherberg, Germany.
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Medical Faculty, Ludwig- Maximilians-Universität (LMU), München, Germany.
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
- German Center for Cardiovascular Disease Research (DZHK), Munich Heart Alliance, Munich, Germany.
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Wu J, Xin J, Yang X, Matkovic LA, Zhao X, Zheng N, Li R. Segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black blood magnetic resonance imaging with multi-task learning. Med Phys 2024; 51:1775-1797. [PMID: 37681965 DOI: 10.1002/mp.16728] [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: 03/29/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Early detection of carotid atherosclerosis can prevent the progression of cardiovascular disease. Many (semi-) automatic methods have been designed for the segmentation of carotid vessel wall and the diagnosis of carotid atherosclerosis (i.e., the lumen segmentation, the outer wall segmentation, and the carotid atherosclerosis diagnosis) on black blood magnetic resonance imaging (BB-MRI). However, most of these methods ignore the intrinsic correlation among different tasks on BB-MRI, leading to limited performance. PURPOSE Thus, we model the intrinsic correlation among the lumen segmentation, the outer wall segmentation, and the carotid atherosclerosis diagnosis tasks on BB-MRI by using the multi-task learning technique and propose a gated multi-task network (GMT-Net) to perform three related tasks in a neural network (i.e., carotid artery lumen segmentation, outer wall segmentation, and carotid atherosclerosis diagnosis). METHODS In the proposed method, the GMT-Net is composed of three modules, including the sharing module, the segmentation module, and the diagnosis module, which interact with each other to achieve better learning performance. At the same time, two new adaptive layers, namely, the gated exchange layer and the gated fusion layer, are presented to exchange and merge branch features. RESULTS The proposed method is applied to the CAREII dataset (i.e., 1057 scans) for the lumen segmentation, the outer wall segmentation, and the carotid atherosclerosis diagnosis. The proposed method can achieve promising segmentation performances (0.9677 Dice for the lumen and 0.9669 Dice for the outer wall) and better diagnosis accuracy of carotid atherosclerosis (0.9516 AUC and 0.9024 Accuracy) in the "CAREII test" dataset (i.e., 106 scans). The results show that the proposed method has statistically significant accuracy and efficiency. CONCLUSIONS Even without the intervention of reviewers required for the previous works, the proposed method automatically segments the lumen and outer wall together and diagnoses carotid atherosclerosis with high performance. The proposed method can be used in clinical trials to help radiologists get rid of tedious reading tasks, such as screening review to separate normal carotid arteries from atherosclerotic arteries and to outline vessel wall contours.
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Affiliation(s)
- Jiayi Wu
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University
| | - Jingmin Xin
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Luke A Matkovic
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Nanning Zheng
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Liu C, Cui ZX, Jia S, Cheng J, Cao C, Guo Y, Zhu Y, Liang D, Wang H. Accelerated submillimeter wave-encoded magnetic resonance imaging via deep untrained neural network. Med Phys 2023; 50:7684-7699. [PMID: 37073772 DOI: 10.1002/mp.16425] [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: 11/28/2022] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Wave gradient encoding can adequately utilize coil sensitivity profiles to facilitate higher accelerations in parallel magnetic resonance imaging (pMRI). However, there are limitations in mainstream pMRI and a few deep learning (DL) methods for recovering missing data under wave encoding framework: the former is prone to introduce errors from the auto-calibration signals (ACS) signal acquisition and is time-consuming, while the latter requires a large amount of training data. PURPOSE To tackle the above issues, an untrained neural network (UNN) model incorporating wave-encoded physical properties and deep generative model, named WDGM, was proposed with additional ACS- and training data-free. METHODS Generally, the proposed method can provide powerful missing data interpolation capability using the wave physical encoding framework and designed UNN to characterize the MR image (k-space data) priors. Specifically, the MRI reconstruction combining physical wave encoding and elaborate UNN is modeled as a generalized minimization problem. The designation of UNN is driven by the coil sensitivity maps (CSM) smoothness and k-space linear predictability. And then, the iterative paradigm to recover the full k-space signal is determined by the projected gradient descent, and the complex computation is unrolled to the network with optimized parameters by the optimizer. Simulated wave encoding and in vivo experiments are exploited to demonstrate the feasibility of the proposed method. The best quantitative metrics RMSE/SSIM/PSNR of 0.0413, 0.9514, and 37.4862 gave competitive results in all experiments with at least six-fold acceleration, respectively. RESULTS In vivo experiments of human brains and knees showed that the proposed method can achieve comparable reconstruction quality and even has superiority relative to the comparison, especially at a high resolution of 0.67 mm and fewer ACS. In addition, the proposed method has a higher computational efficiency achieving a computation time of 9.6 s/per slice. CONCLUSIONS The model proposed in this work addresses two limitations of MRI reconstruction in the wave encoding framework. The first is to eliminate the need for ACS signal acquisition to perform the time-consuming calibration process and to avoid errors such as motion during the acquisition procedure. Furthermore, the proposed method has clinical application friendly without the need to prepare large training datasets, which is difficult in the clinical. All results of the proposed method demonstrate more confidence in both quantitative and qualitative metrics. In addition, the proposed method can achieve higher computational efficiency.
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Affiliation(s)
- Congcong Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Zhuo-Xu Cui
- Research Center for Medical AI, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Sen Jia
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jing Cheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chentao Cao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yifan Guo
- Research Center for Medical AI, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yanjie Zhu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
- Research Center for Medical AI, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Haifeng Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
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Shao S, Shi H, Wang G, Li R, Sun Q, Yao B, Watase H, Hippe DS, Yuan C, Zhao X. Differences in left and right carotid plaque vulnerability in patients with bilateral carotid plaques: a CARE-II study. Stroke Vasc Neurol 2023; 8:284-291. [PMID: 36596656 PMCID: PMC10512039 DOI: 10.1136/svn-2022-001937] [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: 08/11/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Atherosclerosis is a very complex process influenced by various systemic and local factors. Therefore, in patients with bilateral carotid plaques (BCPs), there may be differences in carotid plaque vulnerability between the sides. We aimed to investigate the differences in BCP characteristics in patients with BCPs using magnetic resonance vessel wall imaging (MR-VWI). METHODS Participants with BCPs were selected for subanalysis from a multicentre study of Chinese Atherosclerosis Risk Evaluation II. We measured carotid plaque burden, identified each plaque component and measured their volume or area bilaterally on MR-VWI. Paired comparisons of the burden and components of BCPs were performed. RESULTS In all, 540 patients with BCPs were eligible for analysis. Compared with the right carotid artery (CA), larger mean lumen area (p<0.001), larger mean wall area (p=0.025), larger mean total vessel area (p<0.001) and smaller normalised wall index (p=0.006) were found in the left CA. Regarding plaque components, only the prevalence of lipid-rich necrotic core (LRNC) in the left CA was higher (p=0.026). For patients with a vulnerable plaque component coexisting on both sides, only the intraplaque haemorrhage (IPH) volume (p=0.011) was significantly greater in the left CA than in the right CA. CONCLUSIONS There were asymmetries in plaque growth and evolution between BCPs. The left carotid plaques were more likely to have larger plaque burden, higher prevalence of LRNC and greater IPH volume, which may contribute to the lateralisation of ischaemic stroke in the cerebral hemispheres.
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Affiliation(s)
- Sai Shao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Honglu Shi
- Department of Medical Imaging and Intervention, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Guangbin Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Bin Yao
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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Strecker C, Kopczak A, Saam T, Sepp D, Hennemuth A, Mayerhofer E, Poli S, Ziemann U, Poppert H, Schindler A, Harloff A. Carotid geometry is independently associated with complicated carotid artery plaques. Front Cardiovasc Med 2023; 10:1177998. [PMID: 37378412 PMCID: PMC10291134 DOI: 10.3389/fcvm.2023.1177998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Complicated carotid artery plaques (cCAPs) are associated with an increased risk of rupture and subsequent stroke. The geometry of the carotid bifurcation determines the distribution of local hemodynamics and could thus contribute to the development and composition of these plaques. Therefore, we studied the role of carotid bifurcation geometry in the presence of cCAPs. Methods We investigated the association of individual vessel geometry with carotid artery plaque types in the Carotid Plaque Imaging in Acute Stroke (CAPIAS) study. After excluding arteries without plaque or with insufficient MRI quality, 354 carotid arteries from 182 patients were analyzed. Individual parameters of carotid geometry [i.e., internal carotid artery (ICA)/common carotid artery (CCA) ratio, bifurcation angle, and tortuosity) were derived from time-of-flight MR images. The lesion types of carotid artery plaques were determined according to the American Heart Association classification of lesions by multi-contrast 3T-MRI. The association between carotid geometry and a cCAP was studied using logistic regression after adjusting for age, sex, wall area, and cardiovascular risk factors. Results Low ICA/CCA ratios (OR per SD increase 0.60 [95%CI: 0.42-0.85]; p = 0.004) and low bifurcation angles (OR 0.61 [95%CI: 0.42-0.90]; p = 0.012) were significantly associated with the presence of cCAPs after adjusting for age, sex, cardiovascular risk factors, and wall area. Tortuosity had no significant association with cCAPs. Only ICA/CCA ratio remained significant in a model containing all three geometric parameters (OR per SD increase 0.65 [95%CI: 0.45-0.94]; p = 0.023). Conclusions A steep tapering of the ICA relative to the CCA and, to a lesser extent, a low angle of the carotid bifurcation were associated with the presence of cCAPs. Our findings highlight the contribution of bifurcation geometry to plaque vulnerability. Thus, assessment of carotid geometry could be helpful in identifying patients at risk of cCAPs.
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Affiliation(s)
- Christoph Strecker
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | | | - Dominik Sepp
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Anja Hennemuth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ernst Mayerhofer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Sven Poli
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Poppert
- Department of Neurology, Helios Klinikum München West, Munich, Germany
| | - Andreas Schindler
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Li RY, Yu JW, Chen XH, Han QQ, Ge H, Li C, Ju S, Zhao DL. Association of pre-diabetes and type 2 diabetes mellitus with intracranial plaque characteristics in patients with acute ischemic stroke. Br J Radiol 2023; 96:20220802. [PMID: 36350061 PMCID: PMC9975357 DOI: 10.1259/bjr.20220802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the association of pre-diabetes(i.e., the early stages of glucometabolic disturbance) and Type 2 diabetes mellitus (T2DM) with intracranial plaque characteristics in patients with acute ischemic stroke using three-dimensional high-resolution MR imaging. METHODS One hundred and forty-three symptomatic patients with acute ischemic stroke attribute to intracranial atherosclerotic plaque were prospectively enrolled. All participants were further divided into three groups: normal glucose metabolism(non-diabetes) group(n = 41), pre-diabetes group(n = 45), and T2DM group(n = 57) according to glucometabolic status. Culprit plaque characteristics (such as plaque burden, normalized wall index and enhancement ratio), total plaque number, and global plaque enhancement score were analyzed and compared among the three glucometabolic groups. The association between pre-diabetes and T2DM with intracranial plaque characteristics was assessed by logistic regression and multivariate linear regression. RESULTS Plaque number was higher in patients with pre-diabetes and T2DM compared with those with non-diabetes(3.71 ± 1.83 and 3.75 ± 1.71 vs 2.24 ± 1.46, p = 0.006). Multivariate logistic regression showed a significant association of multiple intracranial plaques with pre-diabetes(OR 3.524, 95% CI 1.082 ~ 11.479, p = 0.037), T2DM(OR 3.760, 95% CI 1.098 ~ 12.872, p = 0.035) and luminal stenotic rate. Both pre-diabetes and T2DM were significantly associated with culprit plaque enhancement ratio(β = 0.527 and β = 0.536; respectively; p < 0.001) and global plaque enhancement score(β = 0.264 and β = 0.373; respectively; p < 0.05). CONCLUSIONS Patients with pre-diabetes and T2DM had similar intracranial atherosclerotic plaque vulnerability, as demonstrated by multiple plaques, increased culprit plaque enhancement ratio and global plaque enhancement score. ADVANCES IN KNOWLEDGE Pre-diabetes might be a risk factor for intracranial plaque vulnerability. It is necessary to monitor a slight increase in blood glucose in non-diabetes patients with acute ischemic stroke.
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Affiliation(s)
- Rui-Ying Li
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Jia-Wei Yu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Xiao-Hui Chen
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | | | - Hong Ge
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Cheng Li
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Shenghong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Deng-Ling Zhao
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
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Shugaa Addin N, Schlett CL, Bamberg F, Thorand B, Linseisen J, Seissler J, Peters A, Rospleszcz S. Subclinical Cardiovascular Disease Markers in Relation to Serum and Dietary Magnesium in Individuals from the General Population: The KORA-MRI Study. Nutrients 2022; 14:nu14234954. [PMID: 36500983 PMCID: PMC9741061 DOI: 10.3390/nu14234954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Several studies have implied a role of magnesium in the development of cardiovascular disease (CVD). Thus, magnesium might serve as a potential risk marker for early CVD. Therefore, we investigated the association of serum magnesium and dietary magnesium intake with markers of subclinical CVD in a population-based study. We used cross-sectional data from the sub-study of the Cooperative Health Research in the Region of Augsburg (KORA-FF4). Markers of subclinical CVD, namely, left and right ventricular structure and function and carotid plaque and carotid wall thickness, were derived by magnetic resonance imaging (MRI). Multivariable-adjusted regression models were applied to assess the relationship between serum and dietary magnesium and MRI-derived subclinical CVD markers. Among 396 included participants (mean age: 56.3 ± 9.2 years; 57.8% male), 181 (45.7%) had low serum magnesium levels (<2.07 mg/dL). Among 311 subjects with complete dietary data (mean age: 56.3 ± 9.1 years; 56.3% male), 154 (49.5%) had low dietary magnesium intake (≤155.2 mg/1000 kcal/day). Serum and dietary magnesium were not correlated (p-value = 0.5). Serum magnesium was significantly associated with presence of carotid plaque (OR 1.62, p-value 0.033). Dietary magnesium was associated with higher left ventricular end-systolic and end-diastolic volume (0.04 mL/m2, 0.06 mL/m2; p-value 0.011, 0.013, respectively), and also with a decrease in left ventricular remodeling index and mean diastolic wall thickness (−0.001 g/mL/m2, −0.002 mm/m2; p-value 0.004, 0.029, respectively). In summary, there was no consistent association of serum and dietary magnesium with imaging markers of subclinical CVD.
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Affiliation(s)
- Nuha Shugaa Addin
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 85764 München, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
| | - Jakob Linseisen
- Epidemiology, University Hospital of Augsburg, University of Augsburg, 86159 Augsburg, Germany
| | - Jochen Seissler
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- Diabetes Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, 80336 München, Germany
| | - Annette Peters
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 85764 München, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, 80802 München, Germany
| | - Susanne Rospleszcz
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 85764 München, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, 80802 München, Germany
- Correspondence: ; Tel.: +49-089-3187-4234
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Liu J, Wang C, Wang J, Zhang C, Wu Y, Balu N, Qi H, Zhang Q, Yuan C, Chen H. Motion detection and correction for carotid MRI using a markerless optical system. Magn Reson Imaging 2022; 94:161-167. [PMID: 36191857 DOI: 10.1016/j.mri.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 04/29/2022] [Accepted: 09/27/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Motion related artifact is a challenge for MRI, especially when imaging regions like the carotid artery where complex motion (abrupt and bulk motion) may occur. This study aims to develop a non-contact motion detection and correction system for carotid MRI using a markerless optical tracking system. METHODS The proposed markerless optical tracking system consisted of a cross-line laser, an MRI-compatible camera and plastic holders mounted inside the scanner bore. The neck motion of the subject can be captured by monitoring the change of the projected laser position in real-time. The system was used to correct both abrupt motion and bulk motion for carotid MRI. The abrupt motion (e.g. coughing) was compensated by discarding the corrupted k-space lines and re-estimating the missing lines using SPIRiT algorithm. The bulk motion was corrected by phase adjustment of k-space lines according to the measured 1D-translational bulk motion (along anterior-posterior direction) and optimized in-plane translation parameters. Ten volunteers underwent carotid MRI with real-time neck motion detection and retrospective motion correction. Artery sharpness, vessel wall thickness and overall image quality score were compared between the motion-corrupted image and motion-corrected images of different correction strategies. RESULTS Both the abrupt motion and the bulk motion during carotid scanning were successfully detected and corrected. The results of ten volunteers demonstrated significant improvement in carotid artery sharpness, vessel wall thickness measurement, and overall image quality score using the proposed markerless optical tracking system and motion correction strategies. CONCLUSION The proposed markerless structured light based motion detection and correction system can sensitively detect both abrupt and bulk motion during carotid MR scans. By correcting for both abrupt and bulk motion, vessel wall delineation was improved in carotid MR images, which could potentially facilitate carotid plaque identification and atherosclerosis diagnosis in the future.
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Affiliation(s)
- Jin Liu
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Chunyao Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jinnan Wang
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America.
| | - Chen Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yifan Wu
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Niranjan Balu
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America.
| | - Haikun Qi
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America.
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
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11
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Qiao H, Yang Q, Huo R, Han H, Ning Z, Shen R, Song X, Chen H, Chen S, Zhao X. Reliability and Value of 3D Sequential QUantitative T 1 -T 2 -T 2 * MAppings (SQUMA) MR Multi-Parametric Imaging in Characterizing Carotid Artery Atherosclerosis. J Magn Reson Imaging 2022; 57:1376-1389. [PMID: 36173363 DOI: 10.1002/jmri.28445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND T1 , T2 , and T2 * mappings are seldom performed in a single examination, and their values in evaluating symptomatic atherosclerosis are lacking. PURPOSE To perform three-dimensional (3D) quantitative T1 , T2 , and T2 * mappings (SQUMA) multi-parametric imaging for carotid vessel wall and evaluate its reliability and value in assessing carotid atherosclerosis. STUDY TYPE Prospective. SUBJECTS Eight healthy subjects and 20 patients with symptomatic carotid atherosclerosis. FIELD STRENGTH/SEQUENCE 3 T, SQUMA imaging T1 -, T2 -, and T2 *-mapping, multi-contrast vessel wall imaging including T1 - and T2 -weighted, time-of-flight, and SNAP sequences. ASSESSMENT SQUMA was acquired in all subjects and multi-contrast images were acquired in healthy subjects. T1 , T2 , and T2 * values and lumen area (LA), wall area (WA), mean wall thickness (MeanWT), and normalized wall index (NWI) of carotid arteries were measured. SQUMA and multi-contrast measurements were compared in healthy subjects and differences in SQUMA measurements between healthy subjects and patients were assessed. The discriminative value of SQUMA measurements for symptomatic vessel was determined. STATISTICAL TESTS Paired t or Wilcoxon signed-rank test, independent t or Mann-Whitney U test, area under the receiver operating characteristic curve (AUC), intraclass correlation coefficients, and Bland-Altman plots. Statistically significant level, P < 0.05. RESULTS There were no significant differences in LA (P = 0.340), WA (P = 0.317), MeanWT (P = 0.088), and NWI (P = 0.091) of carotid arteries between SQUMA and multi-contrast vessel wall images. The values of T2 (50.9 ± 2.9 msec vs. 44.5 ± 4.2 msec), T2 * (28.2 ± 4.3 msec vs. 24.7 ± 2.6 msec), WA (23.7 ± 4.6 mm2 vs. 36.2 ± 7.7 mm2 ), MeanWT (0.99 ± 0.05 mm vs. 1.50 ± 0.28 mm), and NWI (40.7 ± 3.0% vs. 53.8 ± 5.4%) of carotid arteries in healthy subjects were significantly different from those in atherosclerotic patients. The combination of quantitative T1 , T2 , and T2 * values and MeanWT showed greatest AUC (0.81; 95% CI: 0.65-0.92) in discriminating symptomatic vessels. DATA CONCLUSION Carotid MR 3D quantitative multi-parametric imaging of SQUMA enables acquisition of T1 , T2 , and T2 * maps, reliably measuring carotid morphology and discriminating carotid symptomatic atherosclerosis. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,School of Medicine, Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Qiansu Yang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Ran Huo
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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12
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Wang J, Wang L, Shen Y, Gong X, Ju Y. Relationship Between Carotid Artery Angle and Plaque Morphology in Acute Cerebral Infarction Patients. Neurologist 2022; 27:240-244. [PMID: 35051966 PMCID: PMC9439691 DOI: 10.1097/nrl.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-resolution magnetic resonance imaging (HRMRI) can be used to clearly distinguish the luminal structure of the carotid artery (CA); measure the lumen, vessel wall, and total blood vessel area; and accurately describe the morphologic features of plaques. METHODS This study used HRMRI to investigate the relationship between geometric features and volume and composition of carotid atherosclerotic plaques. Patients (n=81) who had experienced acute cerebral infarction (CI) within 7±3 days before admission to the Neurology Department of Beijing Tiantan Hospital between November 2011 and June 2012 were enrolled in the study. CA HRMRI was performed to analyze the geometry and morphology of plaques in 160 blood vessels. RESULTS The median left and right internal carotid artery angles (ICAAs) were 32.79 and 31.00 degrees, respectively. Aside from the nonplanar external CA angle, plaque volume and angles did not differ significantly between the left and right sides. Age ( B =3.77; P =0.03) and nonplanar ICAA ( B =4.70; P =0.01) were predictors of left but not right carotid plaque volume. ICAA and bifurcation angle did not predict plaque volume. CONCLUSIONS In this study, CA morphology in acute stroke patients is not associated with plaque volume or composition, but age and nonplanar ICAA can predict left carotid plaque volume.
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Affiliation(s)
- Jing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
| | - Lin Wang
- Department of Neurology, People’s Hospital of Daxing District, Beijing, China
| | - Yuan Shen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
| | - Xiping Gong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
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Mingming L, Peng P, Lichen Z, Shaohua L, Fei Y, Hongtao Z, Shitong L, Yao H, Xihai Z, Jianming C. Predictors of Progression in Intraplaque Hemorrhage Volume in Patients With Carotid Atherosclerosis: A Serial Magnetic Resonance Imaging Study. Front Neurol 2022; 13:815150. [PMID: 35911916 PMCID: PMC9334903 DOI: 10.3389/fneur.2022.815150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeThis study aimed to investigate the arterial disease risk factors for the progression of intraplaque hemorrhage (IPH) in patients with carotid atherosclerosis using serial high-resolution magnetic resonance (MR) imaging.MethodsConsecutive symptomatic patients who had MRI evidence of intraplaque hemorrhage present in the ipsilateral carotid artery with respect to the side of the brain affected by stroke or TIA were recruited in the study. All the patients underwent follow-up MR imaging at least 6 months after baseline. The annual change in IPH and other carotid plaque morphology was calculated, and a tertile method was used to classify the plaques as progressed or not with respect to IPH volume using the software CASCADE. Logistic regression and receiver operating characteristic (ROC) curve were conducted to evaluate the risk factors for the progression of IPH.ResultsA total of thirty-four symptomatic patients (mean age: 67.1 years, standard deviation [SD]: 9.8 years, 27 men) were eligible for the final analysis, and contralateral plaques containing IPH were seen in 11 of these patients (making 45 plaques with IPH in total). During mean 16.6-month (SD: 11.0 months) follow-up, the overall annual change in IPH volume in 45 plaques with IPH was mean −10.9 mm3 (SD: 49.1 mm3). Carotid plaques were significantly more likely to be classified in progressed IPH group if the patient was taking antiplatelet agent at baseline (OR: 9.76; 95%CI: 1.05 to 90.56; p = 0.045), had a baseline history of current or past smoking (OR: 9.28; 95%CI: 1.26 to 68.31; p = 0.029), or had a larger baseline carotid plaque-containing vessel wall volume (OR: 1.36 per 10 mm3; 95%CI: 1.02 to 1.81; p = 0.032) after adjustments for confounding factors. ROC analysis indicated that the combination of these three risk factors in the final model produced good discriminatory value for the progressed IPH group (area under the curve: 0.887).ConclusionsTaking an antiplatelet agent at baseline, a baseline history of current or past smoking and larger baseline carotid plaque-containing vessel wall volume were independently predictive of plaques being in the progressed IPH group. Our findings indicate that awareness and management of such risk factors may reduce the risk of intraplaque hemorrhage progression.
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Affiliation(s)
- Lu Mingming
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Zhang Lichen
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Liu Shaohua
- State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center of PLA General Hospital, Institute of Geriatrics, Beijing, China
| | - Yuan Fei
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Zhang Hongtao
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Liu Shitong
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - He Yao
- State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center of PLA General Hospital, Institute of Geriatrics, Beijing, China
- He Yao
| | - Zhao Xihai
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Zhao Xihai
| | - Cai Jianming
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Cai Jianming
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Che F, Mi D, Wang A, Ju Y, Sui B, Geng X, Zhao X, Zhao X. Extracranial carotid plaque hemorrhage predicts ipsilateral stroke recurrence in patients with carotid atherosclerosis – a study based on high-resolution vessel wall imaging MRI. BMC Neurol 2022; 22:237. [PMID: 35764942 PMCID: PMC9238155 DOI: 10.1186/s12883-022-02758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intraplaque hemorrhage (IPH) is a hallmark of carotid plaque vulnerability. We aim to investigate the association between IPH and recurrent ipsilateral ischemic stroke.
Methods
Patients with a recent stroke or transient ischemic attack (TIA) were prospectively recruited and underwent an ultrasonographic examination and carotid HR VWMRI on the side consistent with symptoms. Carotid plaque was defined as carotid intima-media-thickness (IMT) by ultrasound≥1.5 mm. IPH was determined that the ratio of the plaque signal intensity relative to that of adjacent muscle was > 1.5. All enrolled patients were clinically followed until an ipsilateral ischemic stroke, TIA, carotid endarterectomy (CEA)/carotid artery stenting (CAS), or death within 12 months. Univariate analysis was used to analyze the correlation between clinical characteristics and IPH. Kaplan-Meier survival analysis and a log-rank test were used to compare recurrence-free survival time between the IPH and non-IPH groups. Cox regression models evaluated IPH as the predictor of ipsilateral stroke recurrence.
Results
A total of 171 patients (mean age, 60.13 ± 10.04 years; 118 males) were included in the final analysis. Thirty-two patients (18.7%) showed carotid IPH. During the follow-up, patients with carotid IPH suffered 60.9% (14 of 23) of recurrent ipsilateral strokes and 60.0% (3 of 5) TIA. Multivariate Cox regression analysis proved IPH as a strong predictor of ipsilateral stroke; the adjusted hazard ratio (HR) was 6.64 (95% confidence interval [CI], 2.84–15.54, P < 0.001). Meanwhile, Cox regression analysis also proved that IPH could predict recurrent ischemic events; the adjusted HR was 8.08 (95% CI, 3.65–17.91, P < 0.001).
Conclusions
Carotid intraplaque hemorrhage is strongly associated with recurrent ischemic events and could predict recurrent ipsilateral stroke.
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Lu M, Zhang L, Yuan F, Peng P, Zhang H, Liu S, He Y, Cai J, Zhao X. Comparison of carotid atherosclerotic plaque characteristics between symptomatic patients with transient ischemic attack and stroke using high-resolution magnetic resonance imaging. BMC Cardiovasc Disord 2022; 22:190. [PMID: 35448952 PMCID: PMC9026690 DOI: 10.1186/s12872-022-02624-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/07/2022] [Indexed: 12/25/2022] Open
Abstract
Background This study aimed to compare the characteristics of carotid plaques between patients with transient ischemic attack (TIA) and ischemic stroke using magnetic resonance (MR) imaging. Methods Patients with a recent ischemic stroke or TIA who exhibited atherosclerotic plaques of carotid arteries in the symptomatic sides determined by MR vessel wall imaging were recruited. The plaque morphology and compositions including intraplaque hemorrhage (IPH), lipid-rich necrotic-core (LRNC) and calcification were compared between TIA and stroke patients. Logistic regression was performed to relate the plaque characteristics to the types of ischemic events. Results A total of 270 patients with TIA or ischemic stroke were recruited. Stroke patients had a significantly higher prevalence of diabetes (42.2% vs. 28.2%, p = 0.021), greater mean wall area (35.1 ± 10.1 mm2 vs. 32.0 ± 7.7 mm2, p = 0.004), mean wall thickness (1.3 ± 0.2 mm vs. 1.2 ± 0.2 mm, p = 0.001), maximum normalized wall index (NWI)(63.9% ± 6.0% vs. 62.2% ± 5.9%, p = 0.023) and %volume of LRNC (9.7% ± 8.2% vs. 7.4% ± 7.9%, p = 0.025) in the carotid arteries compared to those with TIA. After adjustment for clinical factors, above characteristics of carotid arteries were significantly associated with the type of ischemic events. After further adjustment for maximum NWI, this association remained statistically significant (OR, 1.41; CI, 1.01–1.96; p = 0.041). Conclusions Ischemic stroke patients had larger plaque burden and greater proportion of LRNC in carotid plaques compared to those with TIA. This study suggests that ischemic stroke patients had more vulnerable plaques compared to those with TIA.
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Affiliation(s)
- Mingming Lu
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Lichen Zhang
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Fei Yuan
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Hongtao Zhang
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shitong Liu
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yao He
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Jianming Cai
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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Effect of systemic immune inflammation index on symptom development in patients with moderate to severe carotid stenosis. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1055846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Baylam Geleri D, Watase H, Chu B, Chen L, Zhao H, Zhao X, Hatsukami TS, Yuan C. Detection of Advanced Lesions of Atherosclerosis in Carotid Arteries Using 3-Dimensional Motion-Sensitized Driven-Equilibrium Prepared Rapid Gradient Echo (3D-MERGE) Magnetic Resonance Imaging as a Screening Tool. Stroke 2021; 53:194-200. [PMID: 34587796 DOI: 10.1161/strokeaha.120.032505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Two-dimensional high-resolution multicontrast magnetic resonance imaging (2D-MC MRI) is currently the most reliable and reproducible noninvasive carotid vessel wall imaging technique. However, the long scan time required for 2D-MC MRI restricts its practical clinical application. Alternatively, 3-dimensional motion-sensitized driven-equilibrium prepared rapid gradient echo (3D-MERGE) vessel wall MRI can provide high isotropic resolution with extensive coverage in two minutes. In this study, we sought to prove that 3D-MERGE alone can serve as a screening tool to identify advanced carotid lesions. METHODS Two hundred twenty-seven subjects suspected of recent ischemic stroke or transient ischemic attack were imaged using 2D-MC MRI with an imaging time of 30 minutes, then with 3D-MERGE with an imaging time of 2 minutes, on 3T-MRI scanners. Two experienced reviewers interpreted plaque components using 2D-MC MRI as the reference standard and categorized plaques using a modified American Heart Association lesion classification for MRI. Plaques of American Heart Association type IV and above were classified as advanced. Arteries of American Heart Association types I to II and III were categorized as normal or with early lesions, respectively. One radiologist independently reviewed only 3D-MERGE and labeled the plaques as advanced if they had a wall thickness of >2 mm with high or low signal intensity compared with the adjacent sternocleidomastoid muscle. Sensitivity, specificity, and accuracy for 3D-MERGE were calculated. RESULTS Four hundred forty-nine arteries from 227 participants (mean age 61.2 years old, 64% male) were included in the analysis. Sensitivity, specificity, and accuracy for identification of advanced lesions on 3D-MERGE were 95.0% (95% CI, 91.8-97.2), 86.9% (95% CI, 81.4-92.0), 93.8% (95% CI, 91.1-95.8), respectively. CONCLUSIONS 3D-MERGE can accurately identify advanced carotid atherosclerotic plaques in patients suspected of stroke or transient ischemic attack. It has a more extensive coverage and higher sensitivity and specificity for advanced plaque detection with a much shorter acquisition time than 2D-MC MRI. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02017756.
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Affiliation(s)
- Duygu Baylam Geleri
- Department of Radiology, University of Washington, Seattle, WA. (D.B.G, B.C., C.Y.)
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, WA. (H.W., T.S.H.)
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA. (D.B.G, B.C., C.Y.).,BioMolecular Imaging Center, University of Washington, Seattle, WA. (B.C., C.Y.)
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA. (L.C.)
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University Shanghai, China (H.Z.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (X.Z.)
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, WA. (H.W., T.S.H.)
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA. (D.B.G, B.C., C.Y.).,BioMolecular Imaging Center, University of Washington, Seattle, WA. (B.C., C.Y.)
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A comparison of carotid atherosclerosis in symptomatic patients between 2002-2005 and 2012-2015 cohorts using multi-contrast magnetic resonance vessel wall imaging. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:623-630. [PMID: 34527028 PMCID: PMC8390937 DOI: 10.11909/j.issn.1671-5411.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the morphological and compositional characteristics of carotid plaques in two cohorts (2002−2005 and 2012−2015) of Chinese patients using magnetic resonance vessel wall imaging. METHODS Symptomatic patients with carotid atherosclerotic plaques who underwent carotid vessel wall magnetic resonance imaging between 2002−2005 and 2012−2015 were retrospectively recruited. Plaque morphology [including mean wall area, wall thickness, and maximum normalized wall index (NWI)] and composition [including calcification, intraplaque hemorrhage, and lipid-rich necrotic core (LRNC)] in symptomatic carotid arteries were evaluated and compared between patients in these two time periods. RESULTS A total of 258 patients, including 129 patients in the 2002−2005 cohort and 129 patients in the 2012−2015 cohort, were recruited. Statin use (49.6%vs. 32.6%, P = 0.004) and hypertension (76.0% vs. 62.8%, P = 0.015) were significantly more common in the 2012–2015 cohort than in the 2002−2005 cohort. Patients in the 2012−2015 cohort also exhibited significantly low plaque burden parameters (allP < 0.05), as well as a lower prevalence (68.2% vs. 89.9%, P < 0.001) and volume percentages of LRNC (11.2% ± 14.2% vs. 25.7% ± 17.7%, P < 0.001). These differences remained significant after adjustment for clinical factors. The differences in the volume percentages of LRNC also remained significant after an additional adjustment for maximum NWI ( P < 0.001).
CONCLUSIONS Patients in the 2012−2015 cohort had a lower plaque burden and volume percentages of LRNC in symptomatic carotid arteries than those in the 2002−2005 cohort. These findings indicate that carotid plaques in the recent cohort had a lower severity and vulnerability.
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Deng S, Zheng J, Wu Y, Yang D, Chen H, Sun B, Xue Y, Zhao X. Geometrical characteristics associated with atherosclerotic disease in the basilar artery: a magnetic resonance vessel wall imaging study. Quant Imaging Med Surg 2021; 11:2711-2720. [PMID: 34079735 DOI: 10.21037/qims-20-1291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Vascular geometry may play an important role in the development of atherosclerosis. This study aimed to investigate the relationships between the geometrical characteristics of basilar artery (BA) and the presence, burden, and distribution of BA plaques using magnetic resonance vessel wall imaging. Methods Patients with cerebrovascular symptoms in the posterior circulation were recruited and underwent magnetic resonance imaging. The BA's geometrical characteristics, including actual length, straightened length, tortuosity, lateral basilar artery-vertebral artery (VA) angle, lateral mid-BA angle, and BA convexity, were measured. The presence of plaques, stenosis, and plaque burden, including mean and maximal wall thickness, were evaluated. The BA's cross-sectional vessel wall was divided into 4 quadrants: dorsal, ventral, right, and left quadrant. The distribution of BA plaques was analyzed. Results Of 344 recruited patients (mean age: 68.1±11.1 years; 200 males), 100 (29.1%) had BA plaques. Patients with BA plaques had higher tortuosity of the BA (13.6±9.0 vs. 9.7±7.7, P<0.001) compared to those without BA plaques. Multivariate regression analysis showed that tortuosity of the BA was associated with the presence of BA plaques (OR, 1.641; 95% CI, 1.232 to 2.186; P=0.001) and mean wall thickness (β, 0.045; 95% CI, 0.008 to 0.081; P=0.017). The plaque distribution in the left wall and right wall of BA was more frequent in patients with right (P=0.006) and left (P<0.001) convex BA, respectively. Conclusions The BA's geometrical characteristics, particularly tortuosity and convexity, are independently associated with the presence, burden, and distribution of plaques in the BA.
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Affiliation(s)
- Shasha Deng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jinmei Zheng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuxin Wu
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dandan Yang
- Department of Biomedical Engineering, School of Medicine, Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Huajun Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xihai Zhao
- Department of Biomedical Engineering, School of Medicine, Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
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20
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Koska J, Migrino RQ, Chan KC, Cooper-Cox K, Reaven PD. The Effect of Exenatide Once Weekly on Carotid Atherosclerosis in Individuals With Type 2 Diabetes: An 18-Month Randomized Placebo-Controlled Study. Diabetes Care 2021; 44:1385-1392. [PMID: 33495294 PMCID: PMC8247511 DOI: 10.2337/dc20-2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Glucagon-like peptide 1 receptor agonists (GLP-1RAs) improved multiple proatherogenic risk factors and reduced cardiovascular events in recent clinical trials, suggesting that they may slow progression of atherosclerosis. We tested whether exenatide once weekly reduces carotid plaque progression in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS In a double-blind, pragmatic trial, 163 participants were randomized (2:1) to exenatide (n = 109) or placebo (n = 54). Changes in carotid plaque volume and composition were measured at 9 and 18 months by multicontrast 3 Tesla MRI. Fasting and post-high-fat meal plasma glucose and lipids, and endothelial function responses, were measured at 3, 9, and 18 months. RESULTS Exenatide reduced hemoglobin A1c (HbA1c) (estimated difference vs. placebo 0.55%, P = 0.0007) and fasting and postmeal plasma glucose (19 mg/dL, P = 0.0002, and 25 mg/dL, P < 0.0001, respectively). Mean (SD) change in plaque volume in the exenatide group (0.3% [2%]) was not different from that in the placebo group (-2.2% [8%]) (P = 0.4). The change in plaque volume in the exenatide group was associated with changes in HbA1c (r = 0.38, P = 0.0004), body weight, and overall plasma glucose (r = 0.29, P = 0.007 both). There were no differences in changes in plaque composition, body weight, blood pressure, fasting and postmeal plasma triglycerides, and endothelial function between the groups. CONCLUSIONS Exenatide once weekly for up to 18 months improved fasting and postprandial glycemic control but did not modify change in carotid plaque volume or composition. This study raises the possibility that short-term antiatherosclerotic effects may not play a central role in the cardiovascular benefits of GLP-1RAs.
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Affiliation(s)
- Juraj Koska
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | | | - Keith C Chan
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | | | - Peter D Reaven
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
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21
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Xin R, Yang D, Xu H, Han H, Li J, Miao Y, Du Z, Ding Q, Deng S, Ning Z, Shen R, Li R, Li C, Yuan C, Zhao X. Comparing Symptomatic and Asymptomatic Carotid Artery Atherosclerosis in Patients With Bilateral Carotid Vulnerable Plaques Using Magnetic Resonance Imaging. Angiology 2021; 73:104-111. [PMID: 34018407 DOI: 10.1177/00033197211012531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared plaque characteristics between symptomatic and asymptomatic sides in patients with bilateral carotid vulnerable plaques using magnetic resonance imaging (MRI). Participants (n = 67; mean age: 65.8 ± 7.7 years, 61 males) with bilateral carotid vulnerable plaques were included. Vulnerable plaques were characterized by intraplaque hemorrhage (IPH), large lipid-rich necrotic core (LRNC), or fibrous cap rupture (FCR) on MRI. Symptomatic vulnerable plaques showed greater plaque burden, LRNC volume (median: 221.4 vs 134.8 mm3, P = .003), IPH volume (median: 32.2 vs 22.5 mm3, P = .030), maximum percentage (Max%) LRNC (median: 51.3% vs 41.8%, P = .002), Max%IPH (median: 13.4% vs 9.5%, P = .022), cumulative slices of LRNC (median: 10 vs 8, P = .005), and more juxtaluminal IPH and/or thrombus (29.9% vs 6.0%, P = .001) and FCR (37.3% vs 16.4%, P = .007) than asymptomatic ones. After adjusting for plaque burden, differences in juxtaluminal IPH and/or thrombus (odds ratio [OR]: 5.49, 95% CI: 1.61-18.75, P = .007) and FCR (OR: 2.90, 95% CI: 1.16-7.24, P = .022) between bilateral sides remained statistically significant. For patients with bilateral carotid vulnerable plaques, symptomatic plaques had greater burden, more juxtaluminal IPH and/or thrombus, and FCR compared with asymptomatic ones. The differences in juxtaluminal IPH and/or thrombus and FCR between bilateral sides were independent of plaque burden.
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Affiliation(s)
- Ruijing Xin
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Dandan Yang
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute of Brain Disorders, Beijing, China
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Jin Li
- Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yingyu Miao
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Ziwei Du
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Qian Ding
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Shasha Deng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Chun Yuan
- Department of Radiology, 7284University of Washington, Seattle, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
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22
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Lepor NE, Sun J, Canton G, Contreras L, Hippe DS, Isquith DA, Balu N, Kedan I, Simonini AA, Yuan C, Hatsukami TS, Zhao XQ. Regression in carotid plaque lipid content and neovasculature with PCSK9 inhibition: A time course study. Atherosclerosis 2021; 327:31-38. [PMID: 34038761 DOI: 10.1016/j.atherosclerosis.2021.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce cardiovascular events, but their effects on atherosclerotic plaque remain elusive. Using serial magnetic resonance imaging (MRI), we studied changes in carotid plaque lipid content and neovasculature under PCSK9 inhibition with alirocumab. METHODS Among patients with low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dl but ineligible for high-dose statin therapy, those with lipid core on carotid MRI were identified to receive alirocumab 150 mg every 2 weeks. Follow-up MRI was performed at 3, 6, and 12 months after treatment. Pre- and post-contrast MRI were acquired to measure percent lipid core volume (% lipid core). Dynamic contrast-enhanced MRI was acquired to measure the extravasation rate of gadolinium contrast (Ktrans), a marker of plaque neovasculature. RESULTS Of 31 patients enrolled, 27 completed the study (mean age: 69 ± 9; male: 67%). From 9.8% at baseline, % lipid core was progressively reduced to 8.4% at 3 months, 7.5% at 6 months, and 7.2% at 12 months (p = 0.014 for trend), which was accompanied by a progressive increase in % fibrous tissue (p = 0.009) but not % calcification (p = 0.35). Ktrans was not reduced until 12 months (from 0.069 ± 0.019 min-1 to 0.058 ± 0.020 min-1; p = 0.029). Lumen and wall areas did not change significantly during the study period. CONCLUSIONS Regression in plaque composition and neovasculature were observed under PCSK9 inhibition on carotid MRI, which provides unique insight into the biological process of plaque stabilization with disease-modifying therapies.
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Affiliation(s)
- Norman E Lepor
- Westside Medical Associates of Los Angeles, Beverly Hills, CA, USA; Smidt Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Jie Sun
- University of Washington, Seattle, WA, USA.
| | | | - Laurn Contreras
- Westside Medical Associates of Los Angeles, Beverly Hills, CA, USA
| | | | | | | | - Ilan Kedan
- Smidt Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - Chun Yuan
- University of Washington, Seattle, WA, USA
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Zhang L, Zhu L, Lu M, Zhao X, Li F, Cai J, Yuan C. Comparison of Carotid Plaque Characteristics Between Men and Women Using Magnetic Resonance Vessel Wall Imaging: A Chinese Atherosclerosis Risk Evaluation Study. J Magn Reson Imaging 2021; 54:646-654. [PMID: 33638575 DOI: 10.1002/jmri.27576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Carotid vulnerable plaque is a major cause of stroke and differs between men and women. Few studies have investigated the differences in carotid plaque features between sexes in a Chinese population. PURPOSE To compare carotid atherosclerotic plaque features between men and women in a Chinese population using magnetic resonance imaging. STUDY TYPE Cross-sectional. SUBJECTS A total of 567 patients (mean age: 61.5 ± 10.1 years; 404 men) who had recent stroke or transient ischemia attack and atherosclerotic plaque in at least one carotid artery. FIELD STRENGTH A 3.0 T. SEQUENCE T1- and T2-weighted turbo spin echo, three-dimensional time-of-flight (TOF) fast field echo and magnetization-prepared rapid acquisition gradient echo sequences. ASSESSMENT Plaque characteristics including lumen area (LA), wall area (WA), total vessel area (TVA), mean wall thickness (MWT), and mean normalized wall index (NWI); presence of calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR); and percent composition area (%area) were evaluated and compared between men and women. STATISTICAL TESTS Independent-sample t test, Mann-Whitney U test, chi-square test, and multiple linear and logistic regressions. RESULTS In symptomatic arteries, men had significantly greater LA (46.2 ± 15.6 mm2 vs. 40.7 ± 12.9 mm2 , P < 0.05), WA (33.9 ± 11.5 mm2 vs. 26.3 ± 7.5 mm2 , P < 0.05), and TVA (80.1 ± 20.4 mm2 vs. 67.0 ± 18.0 mm2 , P < 0.05); higher MWT (1.2 ± 0.4 mm vs. 1.0 ± 0.2 mm, P < 0.05); and higher prevalence of LRNC (72.3% vs. 46.0%, P < 0.05) and IPH (18.6% vs. 4.9%, P < 0.05) compared with women. In asymptomatic arteries, men had significantly greater LA (48.3 ± 16.9 mm2 vs. 42.1 ± 12.6 mm2 , P < 0.05), WA (32.9 ± 11.0 mm2 vs. 25.8 ± 6.1 mm2 , P < 0.05), and TVA (81.2 ± 22.1 mm2 vs. 67.9 ± 16.5 mm2 , P < 0.05); higher MWT (1.2 ± 0.3 mm vs. 1.0 ± 0.2 mm, P < 0.05); higher prevalence of LRNC (67.8% vs. 42.9%, P < 0.05), IPH (14.9% vs. 1.2%, P < 0.05), and FCR (6.4% vs. 1.2%, P < 0.05); and higher %LRNC area (24.8 ± 17.2% vs. 17.8 ± 14.1%, P < 0.05) compared with women. DATA CONCLUSION Men have similar plaque burden but more vulnerable atherosclerotic plaques compared with women in both symptomatic and asymptomatic carotid arteries in a Chinese population. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lichen Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lina Zhu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Zhengzhou, Henan Province, China
| | - Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Xihai Zhao
- Center For Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Feiyu Li
- Operation Department, RIMAG Medical Imaging Corporation, Beijing, China
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, USA
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24
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Evolving determinants of carotid atherosclerosis vulnerability in asymptomatic patients from the MAGNETIC observational study. Sci Rep 2021; 11:2327. [PMID: 33504842 PMCID: PMC7840938 DOI: 10.1038/s41598-021-81247-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/28/2020] [Indexed: 11/08/2022] Open
Abstract
MRI can assess plaque composition and has demonstrated an association between some atherosclerotic risk factors (RF) and markers of plaque vulnerability in naive patients. We aimed at investigating this association in medically treated asymptomatic patients. This is a cross-sectional interim analysis (August 2013-September 2016) of a single center prospective study on carotid plaque vulnerability (MAGNETIC study). We recruited patients with asymptomatic carotid atherosclerosis (US stenosis > 30%, ECST criteria), receiving medical treatments at a tertiary cardiac rehabilitation. Atherosclerotic burden and plaque composition were quantified with 3.0 T MRI. The association between baseline characteristics and extent of lipid-rich necrotic core (LRNC), fibrous cap (CAP) and intraplaque hemorrhage (IPH) was studied with multiple regression analysis. We enrolled 260 patients (198 male, 76%) with median age of 71-y (interquartile range: 65-76). Patients were on antiplatelet therapy, ACE-inhibitors/angiotensin receptor blockers and statins (196-229, 75-88%). Median LDL-cholesterol was 78 mg/dl (59-106), blood pressure 130/70 mmHg (111-140/65-80), glycosylated hemoglobin 46 mmol/mol (39-51) and BMI 25 kg/m2 (23-28); moreover, 125 out of 187 (67%) patients were ex-smokers. Multivariate analysis of a data-set of 487 (94%) carotid arteries showed that a history of hypercholesterolemia, diabetes, hypertension or smoking did not correlate with LRNC, CAP or IPH. Conversely, maximum stenosis was the strongest independent predictor of LRNC, CAP and IPH (p < 0.001). MRI assessment of plaque composition in patients on treatment for asymptomatic carotid atherosclerosis shows no correlation between plaque vulnerability and the most well-controlled modifiable RF. Conversely, maximum stenosis exhibits a strong correlation with vulnerable features despite treatment.
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25
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Sun J, Lepor NE, Cantón G, Contreras L, Hippe DS, Isquith DA, Balu N, Kedan I, Simonini AA, Yuan C, Zhao XQ, Hatsukami TS. Serial magnetic resonance imaging detects a rapid reduction in plaque lipid content under PCSK9 inhibition with alirocumab. Int J Cardiovasc Imaging 2021; 37:1415-1422. [DOI: 10.1007/s10554-020-02115-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022]
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Carotid Artery Plaque Identification and Display System (MRI-CAPIDS) Using Opensource Tools. Diagnostics (Basel) 2020; 10:diagnostics10121111. [PMID: 33371362 PMCID: PMC7767364 DOI: 10.3390/diagnostics10121111] [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: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) represents one modality in atherosclerosis risk assessment, by permitting the classification of carotid plaques into either high- or low-risk lesions. Although MRI is generally used for observing the impact of atherosclerosis on vessel lumens, it can also show both the size and composition of itself, as well as plaque information, thereby providing information beyond that of simple stenosis. Software systems are a valuable aid in carotid artery stenosis assessment wherein commercial software is readily available but is not accessible to all practitioners because of its often high cost. This study focuses on the development of a software system designed entirely for registration, marking, and 3D visualization of the wall and lumen, using freely available open-source tools and libraries. It was designed to be free from “feature bloat” and avoid “feature-creep.” The image loading and display module of the modified QDCM library was improved by a minimum of 10,000%. A Bezier function was used in order to smoothen the curve of the polygon (referring to the shape formed by the marked points) by interpolating additional points between the marked points. This smoother curve led to a smoother 3D view of the lumen and wall.
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27
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Kassem M, Florea A, Mottaghy FM, van Oostenbrugge R, Kooi ME. Magnetic resonance imaging of carotid plaques: current status and clinical perspectives. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1266. [PMID: 33178798 PMCID: PMC7607136 DOI: 10.21037/atm-2020-cass-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition. Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T1-weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects. Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.
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Affiliation(s)
- Mohamed Kassem
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Alexandru Florea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Robert van Oostenbrugge
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, MUMC+, Maastricht, The Netherlands
| | - M Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Chen L, Canton G, Liu W, Hippe DS, Balu N, Watase H, Hatsukami TS, Waterton JC, Hwang JN, Yuan C. Fully automated and robust analysis technique for popliteal artery vessel wall evaluation (FRAPPE) using neural network models from standardized knee MRI. Magn Reson Med 2020; 84:2147-2160. [PMID: 32162395 PMCID: PMC8320767 DOI: 10.1002/mrm.28237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop a fully automated vessel wall (VW) analysis workflow (fully automated and robust analysis technique for popliteal artery evaluation, FRAPPE) on the popliteal artery in standardized knee MR images. METHODS Popliteal artery locations were detected from each MR slice by a deep neural network model and connected into a 3D artery centerline. Vessel wall regions around the centerline were then segmented using another neural network model for segmentation in polar coordinate system. Contours from vessel wall segmentations were used for vascular feature calculation, such as mean wall thickness and wall area. A transfer learning and active learning framework was applied in training the localization and segmentation neural network models to maintain accuracy while reducing manual annotations. This new popliteal artery analysis technique (FRAPPE) was validated against manual segmentation qualitatively and quantitatively in a series of 225 cases from the Osteoarthritis Initiative (OAI) dataset. RESULTS FRAPPE demonstrated high accuracy and robustness in locating popliteal arteries, segmenting artery walls, and quantifying arterial features. Qualitative evaluations showed 1.2% of slices had noticeable major errors, including segmenting the wrong target and irregular vessel wall contours. The mean Dice similarity coefficient with manual segmentation was 0.79, which is comparable to inter-rater variations. Repeatability evaluations show most of the vascular features have good to excellent repeatability from repeated scans of same subjects, with intra-class coefficient ranging from 0.80 to 0.98. CONCLUSION This technique can be used in large population-based studies, such as OAI, to efficiently assess the burden of atherosclerosis from routine MR knee scans.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Wenjin Liu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S. Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Hiroko Watase
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | - John C. Waterton
- Centre for Imaging Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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29
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Qiao H, Li D, Cao J, Qi H, Han Y, Han H, Xu H, Wang T, Chen S, Chen H, Wang Y, Zhao X. Quantitative evaluation of carotid atherosclerotic vulnerable plaques using in vivo T1 mapping cardiovascular magnetic resonaonce: validation by histology. J Cardiovasc Magn Reson 2020; 22:38. [PMID: 32434582 PMCID: PMC7240932 DOI: 10.1186/s12968-020-00624-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It has been proved that multi-contrast cardiovascular magnetic resonance (CMR) vessel wall imaging could be used to characterize carotid vulnerable plaque components according to the signal intensity on different contrast images. The signal intensity of plaque components is mainly dependent on the values of T1 and T2 relaxation. T1 mapping recently showed a potential in identifying plaque components but it is not well validated by histology. This study aimed to validate the usefulness of in vivo T1 mapping in assessing carotid vulnerable plaque components by histology. METHODS Thirty-four subjects (mean age, 64.0 ± 8.9 years; 26 males) with carotid plaques referred to carotid endarterectomy were prospectively enrolled and underwent 3 T CMR imaging from May 2017 to October 2017. The T1 values of intraplaque hemorrhage (IPH), necrotic core (NC) and loose matrix (LM) which were identified on multi-contrast vessel wall images or histology were measured on in-vivo T1 mapping. The IPHs were divided into two types based on the proportion of the area of fresh hemorrhage on histology. The T1 values of different plaque components were compared using Mann-Whitney U test and the agreement between T1 mapping and histology in identifying and quantifying IPH was analyzed with Cohen's Kappa and intraclass correlation coefficient (ICC). RESULTS Of 34 subjects, 19 had histological specimens matched with CMR imaging. The mean T1 values of IPH (651 ± 253 ms), NC (1161 ± 182 ms) and LM (1447 ± 310 ms) identified by histology were significantly different. The T1 values of Type 1 IPH were significantly shorter than that of Type 2 IPH (456 ± 193 ms vs. 775 ± 205 ms, p < 0.001). Moderate to excellent agreement was found in identification (kappa = 0.51, p < 0.001), classification (kappa = 0.40, p = 0.028) and segmentation (ICC = 0.816, 95% CI 0.679-0.894) of IPHs between T1 mapping and histology. CONCLUSIONS The T1 values of carotid plaque components, particularly for intraplaque hemorrhage, are differentiable, and the stage of intraplaque hemorrhage can be classified according to T1 values, suggesting the potential capability of assessment of vulnerable plaque components by T1 mapping.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Dongye Li
- Department of Radiology, Sun Yat-sen Memorial hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingli Cao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haikun Qi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Yongjun Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Yajie Wang
- Department of Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China.
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30
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Yang D, Ji Y, Wang D, Watase H, Hippe DS, Zhao X, Yuan C. Comparison of carotid atherosclerotic plaques between subjects in Northern and Southern China: a Chinese atherosclerosis risk evaluation study. Stroke Vasc Neurol 2020; 5:138-145. [PMID: 32404502 PMCID: PMC7337372 DOI: 10.1136/svn-2019-000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/05/2019] [Accepted: 12/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background and purpose To investigate differences in the characteristics of carotid atherosclerotic plaques of symptomatic subjects in northern and southern China using MRI. Methods Sixty-three subjects in northern China (mean age: 59.1±8.6 years, 45 men) and 56 subjects in southern China (mean age: 60.4±8.6 years, 38 men) were included. All subjects underwent carotid artery multicontrast vessel wall MRI. Plaque morphology, calcification, lipid-rich necrotic core, intraplaque haemorrhage, luminal surface disruption and high-risk plaque were measured and identified. All plaque characteristics were compared between subjects in northern and southern China using Mann-Whitney U test or χ2 test. Results Compared with subjects in southern China, those in northern China had significantly greater areas for lumen (57.7±14.9 mm2 vs 50.4±18.3 mm2, p=0.009), wall (38.4±13.1 mm2 vs 31.9±11.7 mm2, p<0.001) and total vessel (96.1±20.2 mm2 vs 82.4±22.7 mm2, p=0.001) and mean wall thickness (1.25±0.43 mm vs 1.13±0.40 mm, p=0.019). χ2 analysis showed that subjects in northern China tended to have a higher prevalence of intraplaque haemorrhage (14.3% vs 5.4%, p=0.106) and high-risk plaque (20.6% vs 10.7%, p=0.140) than those in southern China, although these differences were not statistically significant (all p>0.05). Conclusion Subjects in northern China have significantly larger vessel size and may have a higher prevalence of vulnerable plaques than those in southern China. Our findings provide additional perspective to optimise the management of cerebrovascular disease in individuals in different regions in China. Trial registration number NCT02017756
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Affiliation(s)
- Dandan Yang
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute of Brain Disorders, Beijing, China
| | - Yang Ji
- Department of Radiology, Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Dan Wang
- Department of Radiology, Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Tsinghua University, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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31
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Yang D, Liu Y, Han Y, Li D, Wang W, Li R, Yuan C, Zhao X. Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct. AJNR Am J Neuroradiol 2020; 41:836-843. [PMID: 32273265 DOI: 10.3174/ajnr.a6498] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/29/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Identifying the mere presence of carotid intraplaque hemorrhage would be insufficient to accurately discriminate the presence of acute cerebral infarct. We aimed to investigate the association between signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted MR imaging and acute cerebral infarct in patients with hemorrhagic carotid plaques using MR vessel wall imaging. MATERIALS AND METHODS Symptomatic patients with carotid intraplaque hemorrhage were included. The signal intensity ratios of carotid intraplaque hemorrhage against muscle on T1-weighted, TOF, and MPRAGE images were measured. The acute cerebral infarct was determined on the hemisphere ipsilateral to the carotid intraplaque hemorrhage. The association between signal intensity ratios of carotid intraplaque hemorrhage and acute cerebral infarct was analyzed. RESULTS Of 109 included patients (mean, 66.8 ± 9.9 years of age; 96 men), 40 (36.7%) had acute cerebral infarct. Patients with acute cerebral infarct had significantly higher signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted images than those without (Median, 1.44; 25-75 Percentiles, 1.14-1.82 versus Median, 1.27; 25-75 Percentiles, 1.06-1.55, P = .022). Logistic regression analysis revealed that the signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images was significantly associated with acute cerebral infarct before (OR, 4.08; 95% CI, 1.34-12.40; P = .013) and after (OR, 3.34; 95% CI, 1.08-10.31; P = .036) adjustment for clinical confounding factors. However, this association was not significant when further adjusted for occlusion of the carotid artery (P = .058) and volumes of intraplaque hemorrhage and lipid-rich necrotic core (P = .458). CONCLUSIONS The signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images is associated with acute cerebral infarct in symptomatic patients with carotid hemorrhagic plaques. This association is independent of traditional risk factors but not of the size of plaque composition. The possibility of applying T1 signals of carotid intraplaque hemorrhage to predict subsequent cerebrovascular ischemic events needs to be prospectively verified.
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Affiliation(s)
- D Yang
- From the Beijing Institute of Brain Disorders (D.Y., Y.H., D.L.), Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Department of Biomedical Engineering (D.Y., Y.H., D.L., R.L., X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Y Liu
- Department of Radiology (Y.L., W.W.), The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Y Han
- From the Beijing Institute of Brain Disorders (D.Y., Y.H., D.L.), Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Department of Biomedical Engineering (D.Y., Y.H., D.L., R.L., X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - D Li
- From the Beijing Institute of Brain Disorders (D.Y., Y.H., D.L.), Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Department of Biomedical Engineering (D.Y., Y.H., D.L., R.L., X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - W Wang
- Department of Radiology (Y.L., W.W.), The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - R Li
- Department of Biomedical Engineering (D.Y., Y.H., D.L., R.L., X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - C Yuan
- Department of Radiology (C.Y.), University of Washington, Seattle, Washington
| | - X Zhao
- Department of Biomedical Engineering (D.Y., Y.H., D.L., R.L., X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
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Xu HM, Huo R, Xin RJ, Yang DD, Liu Y, Lang N, Zhao XH, Wang T, Yuan HS. Association of atherosclerotic plaque features with collateral circulation status in elderly patients with chronic carotid stenosis. J Geriatr Cardiol 2020; 17:202-209. [PMID: 32362918 PMCID: PMC7189263 DOI: 10.11909/j.issn.1671-5411.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/20/2020] [Accepted: 04/04/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis. METHODS Elderly patients (> 60 years) with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups, and underwent magnetic resonance imaging and computed tomography imaging. The carotid plaque features including lipid-rich necrotic core, intraplaque hemorrhage, calcification, and fibrous cap rupture (FCR) were evaluated, and maximum wall thickness, normalized wall index (NWI), and luminal stenosis were measured. The association between these variables and collateral circulation status was analyzed. RESULTS Of the 97 patients (78 males, mean age: 69.0 ± 6.1 years), 19 (19.6%) had poor collaterals. The poor collateral group had a significantly higher NWI (93.7% ± 5.0% vs. 89.0% ± 7.9%, P = 0.011), a greater extent of stenosis (80.0% ± 11.4% vs. 75.3% ± 9.4%, P = 0.036) and FCR (84.2% vs. 55.1%, P = 0.020) compared with good collateral group. Carotid NWI (OR = 3.83, 95% CI: 1.36-10.82, P = 0.011) and more FCR (OR = 6.77, 95% CI: 1.35-33.85, P = 0.020) were associated with poor collateral circulation after adjustment for the confounding factors. The combination of NWI, FCR, systolic blood pressure, and triglycerides had the highest area-under-the-curve (AUC = 0.85) for detection of poor collaterals. CONCLUSIONS Carotid plaque features, specifically NWI and FCR, are independently associated with poor collateral circulation, and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.
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Affiliation(s)
- Hui-Min Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ran Huo
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Rui-Jing Xin
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Dan-Dan Yang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Ying Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xi-Hai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Hui-Shu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Jiang P, Chen Z, Hippe DS, Watase H, Sun B, Lin R, Yang Z, Xue Y, Zhao X, Yuan C. Association Between Carotid Bifurcation Geometry and Atherosclerotic Plaque Vulnerability: A Chinese Atherosclerosis Risk Evaluation Study. Arterioscler Thromb Vasc Biol 2020; 40:1383-1391. [PMID: 32160772 DOI: 10.1161/atvbaha.119.313830] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Carotid bifurcation geometry has been believed to be a risk factor for the initiation of atherosclerosis because of its influence on hemodynamics. However, the relationships between carotid bifurcation geometry and plaque vulnerability are not fully understood. This study aimed to determine the association between carotid bifurcation geometry and plaque vulnerability using magnetic resonance vessel wall imaging. Approach and Results: A total of 501 carotid arteries with nonstenotic atherosclerosis were included from the cross-sectional, multicenter CARE II study (Chinese Atherosclerosis Risk Evaluation). Four standardized carotid bifurcation geometric parameters (bifurcation angle, internal carotid artery planarity, luminal expansion FlareA, and tortuosity Tort2D) were derived from time-of-flight magnetic resonance angiography. Presence of vulnerable plaque, which was characterized by intraplaque hemorrhage, large lipid-rich necrotic core, or disrupted luminal surface, was determined based on multicontrast carotid magnetic resonance vessel wall images. Vulnerable plaques (N=43) were found to occur at more distal locations (ie, near the level of flow divider) than stable plaques (N=458). Multivariable logistic regression showed that the luminal expansion FlareA (odds ratio, 0.45 [95% CI, 0.25-0.81]; P=0.008) was associated with plaque vulnerability after adjustment for age, sex, maximum wall thickness, plaque location, and other geometric parameters. CONCLUSIONS Smaller luminal expansion at carotid bifurcation is associated with vulnerable plaque. The finding needs to be verified with longitudinal studies and the underlying mechanism should be further explored with hemodynamics measurement in the future.
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Affiliation(s)
- Peirong Jiang
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Zhensen Chen
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Daniel S Hippe
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Department of Surgery (H.W.), University of Washington, Seattle
| | - Bin Sun
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Ruolan Lin
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Zheting Yang
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Yunjing Xue
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (X.Z.)
| | - Chun Yuan
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
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Gao X, Song J, Watase H, Hippe DS, Zhao X, Canton G, Tian F, Du R, Ji S, Yuan C. Differences in Carotid Plaques Between Symptomatic Patients With and Without Diabetes Mellitus. Arterioscler Thromb Vasc Biol 2020; 39:1234-1239. [PMID: 31070472 DOI: 10.1161/atvbaha.118.312092] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective- Diabetes mellitus is associated with high-risk atherosclerotic plaques. This study aimed to compare characteristics of carotid atherosclerotic plaques in symptomatic Chinese diabetic and nondiabetic patients using vessel wall magnetic resonance imaging. Approach and Results- Patients with cerebral ischemic symptoms in the anterior circulation and carotid atherosclerotic plaque determined by ultrasound were recruited from a cross-sectional, observational, multicenter study of CARE-II (Chinese Atherosclerosis Risk Evaluation). All patients underwent magnetic resonance imaging for carotid arteries. The morphological and compositional characteristics of carotid plaques were compared between diabetic and nondiabetic patients using linear (continuous variables) and logistic regression (binary variables). In a total of 584 recruited patients, 182 (31.2%) had diabetes mellitus. From the univariate analysis, diabetic patients had significantly greater mean wall area (33.7 versus 31.1 mm2; P=0.002), maximum wall thickness (3.2 versus 2.8 mm; P<0.001), and mean normalized wall index (43.8% versus 41.0%; P<0.001) and had significantly higher prevalence of calcification (51.6% versus 36.6%; P=0.001), lipid-rich necrotic core (77.5% versus 58.5%; P<0.001), and high-risk plaque (29.7% versus 19.9%; P=0.011) than nondiabetic patients. After adjusting for clinical characteristics, the differences in presence of calcification ( P=0.018) and lipid-rich necrotic core ( P=0.001) remained statistically significant. Conclusions- Symptomatic Chinese diabetic patients are more likely to have carotid plaques with calcification and lipid-rich necrotic core than nondiabetic patients, suggesting that diabetic patients may develop more severe atherosclerotic disease that should be accounted for in their clinical management.
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Affiliation(s)
- Xiao Gao
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Jinyu Song
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Hiroko Watase
- Department of Surgery (H.W.), University of Washington, Seattle
| | - Daniel S Hippe
- Department of Radiology (D.S.H., G.C., C.Y.), University of Washington, Seattle
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z., C.Y.)
| | - Gador Canton
- Department of Radiology (D.S.H., G.C., C.Y.), University of Washington, Seattle
| | - Fengshi Tian
- Department of Cardiology (F.T.), Tianjin Fourth Central Hospital, China
| | - Ran Du
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Shengzhang Ji
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Chun Yuan
- Department of Radiology (D.S.H., G.C., C.Y.), University of Washington, Seattle.,Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z., C.Y.)
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35
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Cao Y, Zhao X, Watase H, Hippe DS, Wu Y, Zhang H, Yue L, Canto GM, Song Y, Shi H, Wang G, Li R, Bao H, Yuan C. Comparison of Carotid Atherosclerosis between Patients at High Altitude and Sea Level: A Chinese Atherosclerosis Risk Evaluation Study. J Stroke Cerebrovasc Dis 2020; 29:104448. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 01/29/2023] Open
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Liu W, Balu N, Canton G, Hippe DS, Watase H, Waterton JC, Hatsukami T, Yuan C. Understanding Atherosclerosis Through an Osteoarthritis Data Set. Arterioscler Thromb Vasc Biol 2020; 39:1018-1025. [PMID: 31070477 DOI: 10.1161/atvbaha.119.312513] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Atherosclerotic cardiovascular disease remains a worldwide epidemic and one of the leading causes of death nowadays. Vessel wall imaging can be used to understand the development and progression of atherosclerosis, but it is rarely done because of the high cost. We recently identified the Osteoarthritis Initiative, a large prospective cohort study of knee osteoarthritis, which might serve as a valuable source for atherosclerosis research with its serial knee magnetic resonance imaging data. We have found that these images are suitable for vessel wall image analysis of the lower extremity arteries. Here, we will introduce the Osteoarthritis Initiative data set and explain why it could be used for cardiovascular research purposes. Also, we will briefly comment on peripheral artery atherosclerosis as it is covered in the Osteoarthritis Initiative image data set and review the use of vessel wall imaging for studying atherosclerosis. We think data mining of imaging studies, not originally designed on cardiovascular research, can not only maximize the value of the imaging data set but also boost our understanding of atherosclerosis.
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Affiliation(s)
- Wenjin Liu
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Niranjan Balu
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Gador Canton
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Division of Vascular Surgery, Department of Surgery (H.W., T.H.), University of Washington, Seattle
| | - John C Waterton
- Centre for Imaging Sciences, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom (J.C.W.)
| | - Thomas Hatsukami
- Division of Vascular Surgery, Department of Surgery (H.W., T.H.), University of Washington, Seattle
| | - Chun Yuan
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
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Marlevi D, Mulvagh SL, Huang R, DeMarco JK, Ota H, Huston J, Winter R, Macedo TA, Abdelmoneim SS, Larsson M, Pellikka PA, Urban MW. Combined spatiotemporal and frequency-dependent shear wave elastography enables detection of vulnerable carotid plaques as validated by MRI. Sci Rep 2020; 10:403. [PMID: 31942025 PMCID: PMC6962347 DOI: 10.1038/s41598-019-57317-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/25/2019] [Indexed: 12/29/2022] Open
Abstract
Fatal cerebrovascular events are often caused by rupture of atherosclerotic plaques. However, rupture-prone plaques are often distinguished by their internal composition rather than degree of luminal narrowing, and conventional imaging techniques might thus fail to detect such culprit lesions. In this feasibility study, we investigate the potential of ultrasound shear wave elastography (SWE) to detect vulnerable carotid plaques, evaluating group velocity and frequency-dependent phase velocities as novel biomarkers for plaque vulnerability. In total, 27 carotid plaques from 20 patients were scanned by ultrasound SWE and magnetic resonance imaging (MRI). SWE output was quantified as group velocity and frequency-dependent phase velocities, respectively, with results correlated to intraplaque constituents identified by MRI. Overall, vulnerable lesions graded as American Heart Association (AHA) type VI showed significantly higher group and phase velocity compared to any other AHA type. A selection of correlations with intraplaque components could also be identified with group and phase velocity (lipid-rich necrotic core content, fibrous cap structure, intraplaque hemorrhage), complementing the clinical lesion classification. In conclusion, we demonstrate the ability to detect vulnerable carotid plaques using combined SWE, with group velocity and frequency-dependent phase velocity providing potentially complementary information on plaque characteristics. With such, the method represents a promising non-invasive approach for refined atherosclerotic risk prediction.
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Affiliation(s)
- David Marlevi
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden. .,Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Sharon L Mulvagh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America.,Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Runqing Huang
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - J Kevin DeMarco
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, United States of America.,Department of Radiology, Uniformed Services University of Health Sciences, Bethesda, MD, United States of America
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - John Huston
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Reidar Winter
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Thanila A Macedo
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Sahar S Abdelmoneim
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matthew W Urban
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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Chen SY, Wu WF, Di C, Zhao XX. Association between magnetic resonance imaging of carotid artery and coronary stenosis detected by computed tomography angiography. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:299-309. [PMID: 32065808 DOI: 10.3233/xst-190619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the correlation between carotid artery stenosis (CAS) measured by magnetic resonance imaging (MRI) and the coronary stenosis (CS) determined by computed tomography angiography (CTA). METHODS In this prospective study, 42 subjects diagnosed with coronary artery disease (CAD) underwent MRI and CTA examinations. The severity degree and number of CAS, the score, detection rate and type of carotid plaque, and also the severity degree and number of CS were assessed. Spearman's rank correlation test was used to evaluate the correlation between CAS and CS. RESULTS CS was detected in 42 (100%) subjects, while CAS was detected in 36 (85.7%) subjects. Distribution of CAS severity grades in multiple-vessel group was significantly different from other groups, which with more moderate and severe stenosis (p < 0.05). A positive and significant correlation between the CAS severity and CS severity (r = 0.612, p < 0.05), and the number of involved coronary vessels (r = 0.572, p < 0.05) were observed, respectively. Both detection rate (r = 0.587, p < 0.05) and score (r = 0.735, p < 0.05) of carotid plaque showed a good correlation with the number of involved coronary vessels. After carotid MRI, 71 carotid plaques were detected in 42 subjects, with an incidence rate of 9.9% in subjects with mild CS, 18.3% in moderate CS and 71.8% in severe CS. CONCLUSION Correlation between CAS measured by MRI and CS determined by CTA was identified in present study. These results indicated that the non-invasive CAS evaluation employing the MRI may be clinically useful for the assessment of CS.
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Affiliation(s)
- Si-Ying Chen
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Wen-Fang Wu
- Department of Radiology, Jining No.1 People's Hospital, Shandong Province, China
| | - Cong Di
- Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Shandong Province, China
| | - Xin-Xiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
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Wei H, Zhang M, Li Y, Zhao X, Canton G, Sun J, Xu D, Zhou Z, Chen S, Ferguson MS, Hatsukami TS, Li R, Yuan C. Evaluation of 3D multi-contrast carotid vessel wall MRI: a comparative study. Quant Imaging Med Surg 2020; 10:269-282. [PMID: 31956548 DOI: 10.21037/qims.2019.09.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Conventional reference multi-contrast black-blood (BB) MRI can be used for measuring luminal stenosis severity and plaque components, and its performance has been validated by intra- and inter-reader reproducibility test and histology. Recently, a set of 3D multi-contrast BB sequences have been developed, but its accuracy and reliability have not been well investigated. In this study, we evaluated the performance of 3D multi-contrast MRI (3D-MERGE, T2-VISTA, and SNAP) by comparing it with reference multi-contrast vessel wall MRI and assessing the inter-reader reproducibility. Methods In total, 27 patients were recruited in this study. Twenty-six participants underwent reference and 3D multi-contrast imaging in a 3.0T MR scanner. One participant underwent carotid endarterectomy (CEA) after 3D MR imaging. Two trained reviewers interpreted reference and 3D datasets. Lumen area (LA), wall area (WA), normalized wall index (NWI), maximum wall thickness (MaxWT), and mean wall thickness (MWT) were measured, and the presence of lipid-rich necrotic core (LRNC), intra-plaque hemorrhage (IPH) and calcification (CA) were identified. Inter-reader reproducibility of 3D interpretation was assessed. Results 3D imaging provided comparable measurements with reference imaging in LA (43.81±25.74 vs. 43.35±24.66 mm2) and MaxWT (1.65±1.33 vs. 1.62±1.10 mm), with a lower NWI (0.40±0.15 vs. 0.43±0.11), WA (29.40±21.92 vs. 30.64±16.17 mm2) and MWT (1.09±0.69 vs. 1.14±0.47), and showed good agreement for identification of LRNC (κ=0.66, 95% CI: 0.30-1.00) and CA (κ=0.69, 95% CI: 0.42-0.97), and excellent agreement for IPH (κ=1.00, 95% CI: 1.00-1.00). Inter-reader agreement of 3D analysis was good (LRNC, κ=0.87, 95% CI: 0.61-1.00; CA, κ=0.66, 95% CI: 0.36-0.96; IPH, κ=1.00, 95% CI: 1.00-1.00). Conclusions 3D multi-contrast vessel wall imaging provides comparable performance in morphological measurements and identification of carotid plaque components as reference multi-contrast MRI, with good inter-reader reproducibility.
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Affiliation(s)
- Hanyu Wei
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Miaoqi Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Yunduo Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Zechen Zhou
- Philips Research North America, Cambridge, MA, USA
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | | | | | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China.,Department of Radiology, University of Washington, Seattle, WA, USA
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Segment-specific progression of carotid artery atherosclerosis: a magnetic resonance vessel wall imaging study. Neuroradiology 2019; 62:211-220. [PMID: 31720758 DOI: 10.1007/s00234-019-02316-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aimed to investigate the segment-specific progression of atherosclerotic carotid plaques using serial multi-contrast magnetic resonance (MR) imaging. METHODS Symptomatic patients with carotid 30-70% stenosis were recruited and underwent carotid MR vessel wall imaging at baseline and follow-up time point (≥ 6 months after baseline). The location of plaques was determined according to the maximum wall thickness located above or below carotid bifurcation. The baseline and changing characteristics of carotid plaques were compared between plaques above and below carotid bifurcation, and the risk factors for segment-specific plaque progression were analyzed with logistic regression. RESULTS Ninety-six carotid plaques from 73 patients (mean age 66.5 ± 11.4 years old) were eligible for statistical analysis. Compared with plaques located below carotid bifurcation, those above bifurcation had significantly greater stenosis at baseline (57.2 ± 13.0% vs. 50.4 ± 13.5%, p = 0.016, adjusted p = 0.005) and greater progression rate of carotid wall volume (35.2 ± 68.8 mm3/year vs. 4.2 ± 65.0 mm3/year, p = 0.026, adjusted p = 0.005) before and after adjusting for all clinical risk factors and baseline stenosis and wall volume of carotid arteries. Logistic regression showed that the related risk factors were age, hypertension, and smoke for the progression of plaques located above the bifurcation and age for plaques below the bifurcation, respectively. CONCLUSION Plaques located above the bifurcation of carotid arteries had greater annual progression and correlated with more cardiovascular risk factors compared with those located below the bifurcation.
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Song YJ, Kwak HS, Chung GH, Jo S. Quantification of Carotid Intraplaque Hemorrhage: Comparison between Manual Segmentation and Semi-Automatic Segmentation on Magnetization-Prepared Rapid Acquisition with Gradient-Echo Sequences. Diagnostics (Basel) 2019; 9:diagnostics9040184. [PMID: 31718016 PMCID: PMC6963393 DOI: 10.3390/diagnostics9040184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose: Carotid intraplaque hemorrhage (IPH) increases risk of territorial cerebral ischemic events, but different sequences or criteria have been used to diagnose or quantify carotid IPH. The purpose of this study was to compare manual segmentation and semi-automatic segmentation for quantification of carotid IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequences. Methods: Forty patients with 16–79% carotid stenosis and IPH on MPRAGE sequences were reviewed by two trained radiologists with more than five years of specialized experience in carotid plaque characterization with carotid plaque MRI. Initially, the radiologists manually viewed the IPH based on the MPRAGE sequence. IPH volume was then measured by three different semi-automatic methods, with high signal intensity 150%, 175%, and 200%, respectively, above that of adjacent muscle on the MPRAGE sequence. Agreement on measurements between manual segmentation and semi-automatic segmentation was assessed using the intraclass correlation coefficient (ICC). Results: There was near-perfect agreement between manual segmentation and the 150% and 175% criteria for semi-automatic segmentation in quantification of IPH volume. The ICC of each semi-automatic segmentation were as follows: 150% criteria: 0.861, 175% criteria: 0.809, 200% criteria: 0.491. The ICC value of manual vs. 150% criteria and manual vs. 175% criteria were significantly better than the manual vs. 200% criteria (p < 0.001). Conclusions: The ICC of 150% and 175% criteria for semi-automatic segmentation are more reliable for quantification of IPH volume. Semi-automatic classification tools may be beneficial in large-scale multicenter studies by reducing image analysis time and avoiding bias between human reviewers.
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Affiliation(s)
- Young Ju Song
- Department of Radiology of Chonbuk National University Hospital, Jeon-ju 54907, Korea;
| | - Hyo Sung Kwak
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeon-ju 54907, Korea;
- Correspondence: ; Tel.: +82-63-250-2582; Fax: +82-63-272-0481
| | - Gyung Ho Chung
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeon-ju 54907, Korea;
| | - Seongil Jo
- Department of Statistics (Institute of Applied Statistics), Chonbuk National University, Jeon-ju 54907, Korea;
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Wu J, Xin J, Yang X, Sun J, Xu D, Zheng N, Yuan C. Deep morphology aided diagnosis network for segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black-blood vessel wall MRI. Med Phys 2019; 46:5544-5561. [PMID: 31356693 DOI: 10.1002/mp.13739] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/14/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Early detection of carotid atherosclerosis on the vessel wall (VW) magnetic resonance imaging (MRI) (VW-MRI) images can prevent the progression of cardiovascular disease. However, the manual inspection process of the VW-MRI images is cumbersome and has low reproducibility. Therefore in this paper, by using the convolutional neural networks (CNNs), we develop a deep morphology aided diagnosis (DeepMAD) network for automated segmentation of the VW of carotid artery and for automated diagnosis of the carotid atherosclerosis with the black-blood (BB) VW-MRI (i.e., the T1-weighted MRI) in a slice-by-slice manner. METHODS The proposed DeepMAD network consists of a segmentation subnetwork and a diagnosis subnetwork for performing the segmentation and diagnosis tasks on the BB-VW-MRI images, where the manual labeled lumen area, the manual labeled outer wall area and the manual labeled lesion Types based on the modified American Heart Association (AHA) criteria are used as the ground-truth. Specifically, a deep U-shape CNN with a weighted fusion layer is designed as the segmentation subnetwork, where the lumen area and the outer wall area can be simultaneously segmented under the supervision of the triple Dice loss to provide the vessel wall map as morphological information. Then, the image stream from the BB-VWMRI image and the morphology stream from the obtained vessel wall map are extracted from two deep CNNs and combined to obtain the diagnosis results of atherosclerosis in the diagnosis subnetwork. In addition, the triple input set is formed by three carotid regions of interest (ROIs) from three consecutive slices of the MRI sequence and input to the DeepMAD network, where the first and last slices used as additional adjacent slices to provide 2.5D spatial information along the carotid artery centerline for the intermediate slice, which is the target slice for segmentation and diagnosis in the study. RESULTS Compared to other existing methods, the DeepMAD network can achieve promising segmentation performances (0.9594 Dice for the lumen and 0.9657 Dice for the outer wall) and better diagnosis Accuracy of the carotid atherosclerosis (0.9503 AUC and 0.8916 Accuracy) in the test dataset (including invisible subjects) from same source as the training dataset. In addition, the trained DeepMAD model can be successfully transferred to another test dataset for segmentation and diagnosis tasks with remarkable performance (0.9475 Dice for the lumen and 0.9542 Dice for the outer wall, 0. 9227 AUC and 0.8679 Accuracy for diagnosis). CONCLUSIONS Even without the intervention of reviewers required for previous works, the proposed DeepMAD network automatically segments the lumen and the outer wall together and diagnoses the carotid atherosclerosis with high performances. The DeepMAD network can be used in clinical trials to help radiologists get rid of tedious reading tasks, such as screening review to separate the normal carotid from the atherosclerotic arteries and outlining the vessel wall contours.
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Affiliation(s)
- Jiayi Wu
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jingmin Xin
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Nanning Zheng
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Watase H, Canton G, Sun J, Zhao X, Hatsukami TS, Yuan C. Four Different Carotid Atherosclerotic Behaviors Based on Luminal Stenosis and Plaque Characteristics in Symptomatic Patients: An in Vivo Study. Diagnostics (Basel) 2019; 9:diagnostics9040137. [PMID: 31581663 PMCID: PMC6963409 DOI: 10.3390/diagnostics9040137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 01/19/2023] Open
Abstract
Correct stratification of ischemic stroke risk allows for the proper treatment of carotid atherosclerotic disease. We seek to differentiate plaque types based on stenosis level and plaque morphology. The Chinese Atherosclerosis Risk Evaluation (CARE-II) study is a cross-sectional, observational, multicenter study to assess carotid atherosclerotic plaques in symptomatic subjects using vessel wall magnetic resonance imaging. Plaque morphology and presence of plaque components were reviewed using multi-contrast magnetic resonance imaging. The carotid arteries were divided into four groups based on stenosis level and plaque components. Out of 1072 ischemic stroke subjects, 452 ipsilateral side carotid arteries were included. Significant stenosis (SS) (≥50% stenosis) with high-risk plaque (HRP) features was present in 37 arteries (8.2%), SS(+)/HRP(-) in 29 arteries (6.4%), SS(-)/HRP(+) in 57 arteries (12.6%), and SS(-)/HRP(-) in 329 arteries (72.8%). The prevalence of SS(-)/HRP(+) arteries in this cohort was substantial and had greater wall thickness than the SS(+)/HRP(-) group. These arteries may be misclassified for carotid revascularization by current guidelines based on the degree of luminal stenosis only. These findings have implications for further studies to assess stroke risk using vessel wall imaging.
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Affiliation(s)
- Hiroko Watase
- Department of Surgery, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Gador Canton
- Department of Radiology, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Jie Sun
- Department of Radiology, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, China Haidian District, Beijing 100084, China.
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Chun Yuan
- Department of Radiology, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
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Berry JD, Mehta A, Lin K, Ayers CR, Carroll T, Pandey A, Garside DB, Daviglus ML, Yuan C, Lloyd-Jones DM. Association of Long-Term Risk Factor Levels With Carotid Atherosclerosis: The Chicago Healthy Aging Magnetic Resonance Imaging Plaque Study (CHAMPS). Circ Cardiovasc Imaging 2019; 12:e009226. [PMID: 31522549 DOI: 10.1161/circimaging.119.009226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Absence of cardiovascular risk factors (RF) in young adulthood is associated with a lower risk for cardiovascular disease. However, it is unclear if low RF burden in young adulthood decreases the quantitative burden and qualitative features of atherosclerosis. METHODS Multi-contrast carotid magnetic resonance imaging was performed on 440 Chicago Healthy Aging Study participants in 2009 to 2011, whose RF (total cholesterol, blood pressure, diabetes mellitus, and smoking) were measured in 1967 to 1973. Participants were divided into 4 groups: low-risk (with total cholesterol <200 mg/dL and no treatment, blood pressure <120/80 mm Hg and no treatment, no smoking, and no diabetes mellitus), 0 high RF but some RF unfavorable (≥1 RF above low-risk threshold but below high-risk threshold), 1 high RF (total cholesterol ≥240 mg/dL or treated, blood pressure ≥140/90 or treated, diabetes mellitus, or smoking), and 2 or more high RF. Association of baseline RF status with carotid atherosclerosis (overall mean carotid wall thickness and lipid-rich necrotic core) at follow-up was assessed. RESULTS Among 424 participants with evaluable carotid magnetic resonance images, the mean age was 32 years at baseline and 73 years at follow-up; 67% were male, 86% white, and 36% were low-risk at baseline. Two or more high RF status was associated with higher carotid wall thickness (0.99±0.11 mm) and lipid-rich necrotic core prevalence (30%), as compared with low-risk group (0.94±0.09 mm and 17%, respectively). Each increment in baseline RF status was associated with higher carotid wall thickness (β-coefficient, 0.015; 95% CI, 0.004-0.026) and with higher lipid-rich necrotic core prevalence at older age (odds ratio, 1.26; 95% CI, 1.00-1.58) in models adjusted for baseline RF and demographics. CONCLUSIONS RF status in young adulthood is associated with the burden and quality of carotid atherosclerosis in older age suggesting that the decades-long protective effect of low-risk status might be mediated through a lower burden of quantitative and qualitative features of atherosclerotic plaque.
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Affiliation(s)
- Jarett D Berry
- Division of Cardiology, Department of Internal Medicine (J.D.B., A.P.), UT Southwestern Medical Center, Dallas, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.M.)
| | - Kai Lin
- Department of Radiology (K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Colby R Ayers
- Department of Clinical Sciences (C.R.A.), UT Southwestern Medical Center, Dallas, TX
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine (J.D.B., A.P.), UT Southwestern Medical Center, Dallas, TX
| | - Daniel B Garside
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago (D.B.G., M.L.D.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago (D.B.G., M.L.D.)
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Seattle (C.Y.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine (D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Wang T, Qiao H, Xu H, Xu D, Liu G, Yuan C, Zhao X. Identification of carotid non-hemorrhagic lipid-rich necrotic core by magnetization-prepared rapid acquisition gradient-echo imaging: Validation by contrast-enhanced T1 weighted imaging. Magn Reson Imaging 2019; 63:155-158. [PMID: 31425806 DOI: 10.1016/j.mri.2019.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/08/2019] [Accepted: 08/15/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
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Liu H, Sun J, Hippe DS, Wu W, Chu B, Balu N, Hatsukami T, Yuan C. Improved carotid lumen delineation on non-contrast MR angiography using SNAP (Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage) imaging. Magn Reson Imaging 2019; 62:87-93. [PMID: 31247251 DOI: 10.1016/j.mri.2019.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage (SNAP) was developed for improved imaging of intraplaque hemorrhage (IPH). Its signal polarity also allows for non-contrast time-of-flight MR angiography (TOF). This study sought to compare SNAP and TOF in delineating carotid lumen using contrast-enhanced MRA (CE-MRA) as the reference standard. MATERIALS AND METHODS Two hundred and eighty-nine matched slices from 15 arteries among 11 subjects (9 males and 2 females, mean age of 72.1 ± 8.6 years) with luminal stenosis on CE-MRA were studied. Cross-sectional slices centered around the carotid bifurcation were matched between the three MRA techniques (SNAP, TOF, and CE-MRA) and classified as slices with or without plaque (focal wall thickness ≥ 1.5 mm) by additional black-blood vessel wall MRI. Lumen area was measured using a Sobel gradient map for TOF and CE-MRA (magnitude images) and a polarity map for SNAP. Agreement between techniques for measuring lumen area and percent stenosis was evaluated using intraclass correlation coefficient (ICC) and paired t-test. RESULTS Among the 289 matched slices, SNAP showed a higher agreement with CE-MRA than TOF for measuring lumen area (ICC: 0.93 vs. 0.83; p = 0.03). Agreement with CE-MRA was high for both SNAP and TOF in slices without plaque (ICC: 0.91 vs. 0.89; p > 0.05) but favored SNAP over TOF in slices with plaque (ICC: 0.93 vs. 0.80; p = 0.02). CONCLUSION SNAP, assisted by signal polarity information, demonstrated a higher agreement with CE-MRA in delineating carotid lumen compared to TOF, particularly in slices with plaque where flow conditions may be more complex.
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Affiliation(s)
- Haining Liu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States.
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Wei Wu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States; Tongji Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology, Department of Radiology, 1095 Jiefang Avenue, Wuhan 430000, China
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Thomas Hatsukami
- Department of Surgery, University of Washington, Seattle, WA 98109, United States
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA 98109, United States; Department of Bioengineering, University of Washington, Seattle, WA 98109, United States; Department of Bioengineering, Tsinghua University, Beijing 100084, China
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Plaque components segmentation in carotid artery on simultaneous non-contrast angiography and intraplaque hemorrhage imaging using machine learning. Magn Reson Imaging 2019; 60:93-100. [PMID: 30959178 DOI: 10.1016/j.mri.2019.04.001] [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: 12/28/2018] [Revised: 02/27/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE This study sought to determine the feasibility of using Simultaneous Non-contrast Angiography and intraPlaque Hemorrhage (SNAP) to detect the lipid-rich/necrotic core (LRNC), and develop a machine learning based algorithm to segment plaque components on SNAP images. METHODS Sixty-eight patients (age: 58±9 years, 24 males) with carotid artery atherosclerotic plaque were imaged on a 3 T MR scanner with both traditional multi-contrast vessel wall MR sequences (TOF, T1W, and T2W) and 3D SNAP sequence. The manual segmentations of carotid plaque components including LRNC, intraplaque hemorrhage (IPH), calcification (CA) and fibrous tissue (FT) on traditional multi-contrast images were used as reference. By utilizing the intensity and morphological information from SNAP, a machine learning based two steps algorithm was developed to firstly identify LRNC (with or without IPH), CA and FT, and then segmented IPH from LRNC. Ten-fold cross-validation was used to evaluate the performance of proposed method. The overall pixel-wise accuracy, the slice-wise sensitivity & specificity & Youden's index, and the Pearson's correlation coefficient of the component area between the proposed method and the manual segmentation were reported. RESULTS In the first step, all tested classifiers (Naive Bayes (NB), Support Vector Machine (SVM), Random Forest (RF), Gradient Boosting Decision Tree (GBDT) and Artificial Neural Network (ANN)) had overall pixel-wise accuracy higher than 0.88. For RF, GBDT and ANN classifiers, the correlation coefficients of areas were all higher than 0.82 (p < 0.001) for LRNC and 0.79 for CA (p < 0.001), and the Youden's indexes were all higher than 0.79 for LRNC and 0.76 for CA, which were better than that of NB and SVM. In the second step, the overall pixel-wise accuracy was higher than 0.78 for the five classifiers, and RF achieved the highest Youden's index (0.69) with the correlation coefficients as 0.63 (p < 0.001). CONCLUSIONS The RF is the overall best classifier for our proposed method, and the feasibility of using SNAP to identify plaque components, including LRNC, IPH, CA, and FT has been validated. The proposed segmentation method using a single SNAP sequence might be a promising tool for atherosclerotic plaque components assessment.
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Lu M, Peng P, Qiao H, Cui Y, Ma L, Cui B, Cai J, Zhao X. Association between age and progression of carotid artery atherosclerosis: a serial high resolution magnetic resonance imaging study. Int J Cardiovasc Imaging 2019; 35:1287-1295. [PMID: 30739271 DOI: 10.1007/s10554-019-01538-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
This study aimed to investigate the association between age and progression of carotid atherosclerotic plaques using serial high resolution magnetic resonance imaging (MRI). Symptomatic patients who had carotid atherosclerosis with 30-70% stenosis were enrolled in this study. Carotid MRI was performed at baseline and follow-up time point (≥ 6 months after baseline), respectively. The characteristics of carotid plaque progression among different age groups (> 75 years old, 60-75 years old and < 60 years old) were compared. Logistic regression was performed to relate age with carotid plaque progression. Of recruited 84 patients, 73 (mean age, 66.5 ± 11.4 years old; males, 82.2%) with 96 plaques were included in the final analysis. Compared with younger patients, older ones had significantly higher incidence of calcification in carotid plaques (> 75 years old: 91.3%, 60-75 years old: 65.7% and < 60 years old: 55.3%, p = 0.013), greater annual change of carotid wall volume (> 75 years old: 39.0 (4.3-104.6) mm3, 60-75 years old: 28.7 (- 28.0 to 73.7) mm3 and < 60 years old: 4.8 (- 27.1-31.9) mm3, p = 0.032) and maximum carotid wall area (> 75 years old: 6.1 (- 3.5 to 17.2) mm2, 60-75 years old: 2.4 (- 4.7 to 15.1) mm2 and < 60 years old: 1.4 (- 5.8 to 6.9) mm2, p = 0.046). Age (OR 1.44; 95% CI 1.10-1.89; p = 0.009) and hypertension (OR 4.61; 95% CI 1.41-15. 02; p = 0.011) were independent predictors in discriminating upper quartile of annual change of carotid wall volume after adjusting for all clinical factors. Older patients have faster progression rate in carotid plaques than younger ones and age is independently associated with carotid plaque progression. Our findings suggest that the carotid plaques of older patients need to be monitored more frequently.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Huiyu Qiao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Yuanyuan Cui
- Department of Radiology, PLA General Hospital, Beijing, 100853, China
| | - Lu Ma
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Bao Cui
- Department of Radiology, Chinese PLA Bethune International Peace Hospital, Shijiazhuang, China
| | - Jianming Cai
- Department of Radiology, PLA General Hospital, Beijing, 100853, China.
| | - Xihai Zhao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, 100084, China.
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Lu M, Cui Y, Peng P, Qiao H, Cai J, Zhao X. Shape and Location of Carotid Atherosclerotic Plaque and Intraplaque Hemorrhage: A High-resolution Magnetic Resonance Imaging Study. J Atheroscler Thromb 2019; 26:720-727. [PMID: 30626781 PMCID: PMC6711842 DOI: 10.5551/jat.47449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: The present study aimed to investigate the association between shape and location of atherosclerotic plaques and intraplaque hemorrhage (IPH) in carotid arteries using magnetic resonance (MR) imaging. Methods: Overall, 114 symptomatic patients (mean age: 64.9±10.9 years; 81 males) who underwent MR imaging and had advanced carotid plaques were included in analysis. IPH presence and carotid plaque shape and location (below and above bifurcation) were evaluated. The plaque shape was defined as follows: type-I: the arc-length of plaque is greater in the upstream; type-II: the arc-length of plaque in downstream and upstream is equal; and type-III: the arc-length of plaque is greater in downstream. The plaque shape and location were compared between plaques with and without IPH and their associations with IPH were determined. Results: Of 181detectedplaques, 57 (31.5%) had IPH. Compared with plaques without IPH, those with IPH had higher incidence of the plaque shape of type-I (66.7% vs. 32.2%, P<0.001), lower incidence of plaque shape of type-III (24.6% vs. 50.0%, P=0.001), and were more likely located above carotid bifurcation (71.9% vs. 48.4%, P=0.003). The plaque shape of type-I (OR, 4.01; 95%CI, 1.36–11.83; P=0.012) and location above bifurcation (OR, 3.21; 95%CI, 1.07–9.61; P=0.037) of carotid plaques were significantly associated with IPH after adjusting for confounder factors. Conclusions: Carotid plaque shape and location are significantly associated with the occurrence of IPH. Our findings could provide new insights for the pathogenesis of IPH and vulnerably plaques.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, PLA General Hospital.,Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | | | - Peng Peng
- Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | | | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
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Identification of carotid lipid-rich necrotic core and calcification by 3D magnetization-prepared rapid acquisition gradient-echo imaging. Magn Reson Imaging 2018; 53:71-76. [PMID: 30021124 DOI: 10.1016/j.mri.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE This study sought to investigate the feasibility of three-dimensional MPRAGE in identifying the lipid-rich necrotic core (LRNC) and calcification (CA) of carotid atherosclerotic plaques. MATERIALS AND METHODS Twelve patients (mean age 68.4 ± 11.8 years; 7 males) with carotid atherosclerotic plaques on ultrasound were included and underwent multicontrast magnetic resonance (MR) vessel wall imaging. The contrast enhanced T1W (CE-T1W) images were considered as reference for identifying LRNC. The signal intensity of LRNC, CA, sterno-cleidomastoid muscle and fibrous tissue (FT) was measured on CE-T1W, T1W, T2W, and MPRAGE images, respectively. The relative signal intensity (rSI) of LRNC and CA against muscle or FT was compared among four sequences. Area under the curve (AUC) of rSIs of LRNC, CA and FT against muscle on MPRAGE, T1W and T2W images in discriminating the LRNC or CA from FT and the other plaque component was calculated. RESULTS Of 352 slices, 88 (25.0%) had LRNC, 31 (8.8%) had CA, 14 (4.0%) had both LRNC and CA, and 247 (70.2%) had no components. Among four imaging sequences, MPRAGE images showed the lowest rSI of LRNC (0.34 ± 0.18) and CA (0.20 ± 0.16) against muscle, followed by T1W (0.48 ± 0.18 and 0.33 ± 0.21), CE-T1W (0.58 ± 0.23 and 0.40 ± 0.21) and T2W (0.71 ± 0.47 and 0.43 ± 0.40) images. In addition, the MPRAGE images showed the lowest rSI of LRNC (0.57 ± 0.26) and CA (0.33 ± 0.23) against FT. MPRAGE showed greater AUC than T2W and T1W in discriminating the LRNC (0.827 vs. 0.703 vs. 0.635) and CA (0.917 vs. 0.838 vs. 0.825). CONCLUSION MPRAGE sequence might be a potential non-contrast enhanced imaging tool for identification of carotid LRNC and CA.
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