1
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Eisenmenger LB, Spahic A, McNally JS, Johnson KM, Song JW, Junn JC. MR Imaging for Intracranial Vessel Wall Imaging: Pearls and Pitfalls. Magn Reson Imaging Clin N Am 2023; 31:461-474. [PMID: 37414472 DOI: 10.1016/j.mric.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Conventional vascular imaging methods have primarily focused on evaluating the vascular lumen. However, these techniques are not intended to evaluate vessel wall abnormalities where many cerebrovascular pathologies reside. With increased interest for the visualization and study of the vessel wall, high-resolution vessel wall imaging (VWI) has gained traction.Over the past two decades, there has been a rapid increase in number of VWI publications with improvements in imaging techniques and expansion on clinical applications. With increasing utility and interest in VWI, application of proper protocols and understanding imaging characteristics of vasculopathies are important for the interpreting radiologists to understand.
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Affiliation(s)
- Laura B Eisenmenger
- University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA.
| | - Alma Spahic
- University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | | | - Kevin M Johnson
- University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Jae W Song
- University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jacqueline C Junn
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1234, New York City, NY 10029, USA
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2
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Gutierrez J, Katan M, Elkind MS. Inflammatory and Infectious Vasculopathies. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Meng Y, Mo Z, Hao J, Peng Y, Yan H, Mu J, Ma D, Zhang X, Li Y. High-resolution intravascular magnetic resonance imaging of the coronary artery wall at 3.0 Tesla: toward evaluation of atherosclerotic plaque vulnerability. Quant Imaging Med Surg 2021; 11:4522-4529. [PMID: 34737920 DOI: 10.21037/qims-21-286] [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: 03/16/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
Background To validate the feasibility of generating high-resolution intravascular 3.0 Tesla (T) magnetic resonance imaging of the coronary artery wall to further plaque imaging. Methods A receive-only 0.014-inch diameter magnetic resonance imaging guidewire (MRIG) was manufactured for intravascular imaging within a phantom experiment and the coronary artery wall of the swine. For coronary artery wall imaging, both high-resolution images and conventional resolution images were acquired. A 16-channel commercial surface coil for magnetic resonance imaging was employed for the control group. Results For the phantom experiment, the MRIG showed a higher signal-to-noise ratio than the surface coil. The peak signal-to-noise ratio of the MRIG and the surface coil-generated imaging were 213.6 and 19.8, respectively. The signal-to-noise ratio decreased rapidly as the distance from the MRIG increased. For the coronary artery wall experiment, the vessel wall imaging by the MRIG could be identified clearly, whereas the vessel wall imaging by the surface coil was blurred. The average signal-to-noise ratio of the artery wall was 21.1±5.40 by the MRIG compared to 8.4±2.19 by the surface coil, where the resolution was set at 0.2 mm × 0.2 mm × 2 mm. As expected, the high-resolution sequence clearly showed more details than the conventional resolution sequence set at 0.7 mm × 0.7 mm × 2.0 mm. Histological examination showed no evidence of mechanical injuries in the target vessel walls. Conclusions The study validated the feasibility of generating magnetic resonance imaging (MRI) at 0.2 mm × 0.2 mm × 2 mm for the coronary artery wall using a 0.014 inch MRIG.
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Affiliation(s)
- Yanfeng Meng
- Department of MRI, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhiguang Mo
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,The Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Shenzhen, China
| | - Jinying Hao
- Department of MRI, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Yueyou Peng
- Department of MRI, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Yan
- Department of MRI, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Jingbo Mu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Dengfeng Ma
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoliang Zhang
- Department of Biomedical Engineering, State University of New York at Buffalo, NY, USA
| | - Ye Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,The Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Shenzhen, China
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4
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Kang N, Qiao Y, Wasserman BA. Essentials for Interpreting Intracranial Vessel Wall MRI Results: State of the Art. Radiology 2021; 300:492-505. [PMID: 34313475 DOI: 10.1148/radiol.2021204096] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intracranial vessel wall (VW) MRI has become widely available in clinical practice, providing multiple uses for evaluation of neurovascular diseases. The Vessel Wall Imaging Study Group of the American Society of Neuroradiology has recently reported expert consensus recommendations for the clinical implementation of this technique. However, the complexity of the neurovascular system and caveats to the technique may challenge its application in clinical practice. The purpose of this article is to review concepts essential for accurate interpretation of intracranial VW MRI results. This knowledge is intended to improve diagnostic confidence and performance in the interpretation of VW MRI scans. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Ningdong Kang
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
| | - Ye Qiao
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
| | - Bruce A Wasserman
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
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5
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Spagnolo-Allende A, Gutierrez J. Role of Brain Arterial Remodeling in HIV-Associated Cerebrovascular Outcomes. Front Neurol 2021; 12:593605. [PMID: 34239489 PMCID: PMC8258100 DOI: 10.3389/fneur.2021.593605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
As the life expectancy of people living with HIV (PLWH) on combination antiretroviral therapy (cART) increases, so does morbidity from cerebrovascular disease and neurocognitive disorders. Brain arterial remodeling stands out as a novel investigational target to understand the role of HIV in cerebrovascular and neurocognitive outcomes. We therefore conducted a review of publications in PubMed, EMBASE, Web of Science and Wiley Online Library, from inception to April 2021. We included search terms such as HIV, cART, brain, neuroimmunity, arterial remodeling, cerebrovascular disease, and neurocognitive disorders. The literature shows that, in the post-cART era, PLWH continue to experience an increased risk of stroke and neurocognitive disorders (albeit milder forms) compared to uninfected populations. PLWH who are immunosuppressed have a higher proportion of hemorrhagic strokes and strokes caused by opportunistic infection and HIV vasculopathy, while PLWH on long-term cART have higher rates of ischemic strokes, compared to HIV-seronegative controls. Brain large artery atherosclerosis in PLWH is associated with lower CD4 nadir and higher CD4 count during the stroke event. HIV vasculopathy, a form of non-atherosclerotic outward remodeling, on the other hand, is associated with protracted immunosuppression. HIV vasculopathy was also linked to a thinner media layer and increased adventitial macrophages, suggestive of non-atherosclerotic degeneration of the brain arterial wall in the setting of chronic central nervous system inflammation. Cerebrovascular architecture seems to be differentially affected by HIV infection in successfully treated versus immunosuppressed PLWH. Brain large artery atherosclerosis is prevalent even with long-term immune reconstitution post-cART. HIV-associated changes in brain arterial walls may also relate to higher rates of HIV-associated neurocognitive disorders, although milder forms are more prevalent in the post-cART era. The underlying mechanisms of HIV-associated pathological arterial remodeling remain poorly understood, but a role has been proposed for chronic HIV-associated inflammation with increased burden on the vasculature. Neuroimaging may come to play a role in assessing brain arterial remodeling and stratifying cerebrovascular risk, but the data remains inconclusive. An improved understanding of the different phenotypes of brain arterial remodeling associated with HIV may reveal opportunities to reduce rates of cerebrovascular disease in the aging population of PLWH on cART.
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Affiliation(s)
| | - Jose Gutierrez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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6
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Pacheco FT, Cruz Junior LCHD, Padilha IG, Nunes RH, Maia Junior ACM, Campos CMS, Amaral LLFD, Massaro AR, Rocha AJD. Current uses of intracranial vessel wall imaging for clinical practice: a high-resolution MR technique recently available. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:642-650. [PMID: 33084739 DOI: 10.1590/0004-282x20200044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022]
Abstract
Intracranial vessel wall imaging plays an increasing role in diagnosing intracranial vascular diseases. With the growing demand and subsequent increased use of this technique in clinical practice, radiologists and neurologists should be aware of the choices in imaging parameters and how they affect image quality, clinical indications, methods of assessment, and limitations in the interpretation of these images. Due to the improvement of the MRI techniques, the possibility of accurate and direct evaluation of the abnormalities in the arterial vascular wall (vessel wall imaging) has evolved, adding substantial data to diagnosis when compared to the indirect evaluation based on conventional flow analyses. Herein, the authors proposed a comprehensive approach of this technique reinforcing appropriated clinical settings to better use intracranial vessel wall imaging.
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Affiliation(s)
- Felipe Torres Pacheco
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
| | | | - Igor Gomes Padilha
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
| | - Renato Hoffmann Nunes
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
| | - Antônio Carlos Martins Maia Junior
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Fleury Medicina e Saúde, Departamento de Neurorradiologia, São Paulo, Brazil
| | | | - Lázaro Luís Faria do Amaral
- Hospital Beneficência Portuguesa de São Paulo, BP Medicina Diagnóstica, Departamento de Neurorradiologia, São Paulo SP, Brazil
| | | | - Antônio José da Rocha
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
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7
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Gutierrez J, Byrd D, Yin MT, Morgello S. Relationship Between Brain Arterial Pathology and Neurocognitive Performance Among Individuals With Human Immunodeficiency Virus. Clin Infect Dis 2020; 68:490-497. [PMID: 30107467 DOI: 10.1093/cid/ciy501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background Human immunodeficiency virus-positive (HIV+) individuals have higher rates of cognitive impairment and cerebrovascular disease compared with uninfected populations. We hypothesize that cerebrovascular disease, specifically brain large artery disease, may play a role in HIV-associated neurocognitive disorders (HAND). Methods Participants (N = 94) in the Manhattan HIV Brain Bank study were followed on average 32 ± 33 months with repeated neuropsychological examinations until death. We used five cognitive domains (motor, processing speed, working memory, verbal fluency, and executive functioning) to assess ante mortem performance. We quantified the diameter of the lumen and arterial wall thickness obtained during autopsy. The diagnoses of HAND were attributed using the American Academy of Neurology nosology. We used generalized linear mixed model to account for repeated measures, follow-up time, and codependence between arteries. Models were adjusted for demographics, viral loads, CD4 counts, history of opportunistic infections, and vascular risks. Results We included 94 HIV+ individuals (mean age 56 ± 8.3, 68% men, 54% African American). In adjusted models, there was an association between arterial wall thickness and global cognitive score (B = -0.176, P value = .03), processing speed (B = -0.175, P = .05), and verbal fluency (B = -0.253, P = .02). Participants with incident or worsening HAND had thicker brain arterial walls (B = 0.523 ± 0.234, P = .03) and smaller arterial lumen (B = -0.633 ± 0.252, P = .01). Conclusions We report here a novel association between brain arterial wall thickening and poorer ante mortem cognitive performance and diagnosis of incident or worsening HAND at death. Strategies to preserve the arterial lumen or to prevent wall thickening may impact HAND.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Stroke Division, New York Presbyterian/Columbia University Medical Center, New York
| | - Desiree Byrd
- Departments of Neurology and Pathology, Mount Sinai School of Medicine, New York Presbyterian/Columbia University Medical Center, New York
| | - Michael T Yin
- Department of Medicine, Infectious Disease Division, New York Presbyterian/Columbia University Medical Center, New York
| | - Susan Morgello
- Departments of Neurology and Pathology, Mount Sinai School of Medicine, New York Presbyterian/Columbia University Medical Center, New York
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8
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Santarosa C, Cord B, Koo A, Bhogal P, Malhotra A, Payabvash S, Minja FJ, Matouk CC. Vessel wall magnetic resonance imaging in intracranial aneurysms: Principles and emerging clinical applications. Interv Neuroradiol 2019; 26:135-146. [PMID: 31818175 DOI: 10.1177/1591019919891297] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intracranial high-resolution vessel wall magnetic resonance imaging is an imaging paradigm that complements conventional imaging modalities used in the evaluation of neurovascular pathology. This review focuses on the emerging utility of vessel wall magnetic resonance imaging in the characterization of intracranial aneurysms. We first discuss the technical principles of vessel wall magnetic resonance imaging highlighting methods to determine aneurysm wall enhancement and how to avoid common interpretive pitfalls. We then review its clinical application in the characterization of ruptured and unruptured intracranial aneurysms, in particular, the emergence of aneurysm wall enhancement as a biomarker of aneurysm instability. We offer our perspective from a high-volume neurovascular center where vessel wall magnetic resonance imaging is in routine clinical use.
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Affiliation(s)
| | - Branden Cord
- Department of Neurosurgery, Yale University, New Haven, USA
| | - Andrew Koo
- Department of Neurosurgery, Yale University, New Haven, USA
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | - Ajay Malhotra
- Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
| | - Sam Payabvash
- Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
| | - Frank J Minja
- Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
| | - Charles C Matouk
- Department of Neurosurgery, Yale University, New Haven, USA.,Department of Biomedical Imaging and Radiology, Yale University, New Haven, USA
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9
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De Alwis PM, Smith BR, Wu T, Artrip C, Steinbach S, Morse C, Lau CY, Rapoport SI, Snow J, Tramont E, Reich DS, Nair G, Nath A. In-vivo MRI Reveals Changes to Intracerebral Vasculature Caliber in HIV Infection. Front Neurol 2019; 10:687. [PMID: 31297086 PMCID: PMC6607694 DOI: 10.3389/fneur.2019.00687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To characterize cerebral arterial remodeling in HIV-infected (HIV+) individuals in-vivo, and to study its clinical and immunological associations. Methods: T2*-weighted magnetic resonance imagining sequences was used to determine cross-sectional area (vascular caliber) of the anterior (A1 segment) and middle (M1 segment) cerebral arteries in HIV- (control) and HIV+ subjects on antiretroviral therapy. Correlations of A1 caliber with clinical, demographic parameters, and immunological markers in cerebrospinal fluid (CSF) were determined using multivariable analyses. Results: A1 and M1 calibers from 22 HIV- control subjects (age: median 48.5 years, range 22-60 years, 55% male) and 61 HIV+ subjects (age: median 53 years, range 25–60 years, 67% male) were studied. ANCOVA, adjusting for ethnicity and sex (age was not correlated with M1 or A1 caliber in either group), revealed that HIV+ subjects had larger caliber in the A1 segment than HIV- subjects (4.95 ± 0.14 mm2, and 4.47 ± 0.21 mm2 respectively, p = 0.048), but caliber of the M1 segment did not differ among the groups (7.21 ± 0.14 mm2 and 7.09 ± 0.23 mm2 respectively, p = 0.65). In the HIV+ cohort, longer disease duration and higher current CD4 T-cell count were associated with reduced A1 caliber (r =−0.42 and −0.33 respectively, p < 0.05). In addition, increase in cardiovascular disease risk (CVD risk) was associated with a decrease in A1 caliber in the HIV group (r = −0.35, p < 0.05). Conclusions: This cross-sectional study reveals an increase in A1 caliber in the HIV+ cohort, compared to control subjects, which is especially prominent in early phase of the disease. This increase in caliber may be associated with acute pathological processes in HIV during the initial stages of infection resulting in loss of compliance or thinning of the arterial wall. At later stages, such changes may be confounded by arteriosclerotic changes that are common in later stages of HIV infection. This study suggests there is extensive vessel remodeling in various stages of infection. Long-term longitudinal follow-up of this cohort is planned to further verify this hypothesis and to better understand this MRI marker of intracranial vascular caliber.
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Affiliation(s)
- Paba M De Alwis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Bryan R Smith
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Cristah Artrip
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Sally Steinbach
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Caryn Morse
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Stanley I Rapoport
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Joseph Snow
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Edmund Tramont
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
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10
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Shapiro SD, Goldman J, Morgello S, Honig L, Elkind MSV, Marshall RS, Mohr JP, Gutierrez J. Pathological correlates of brain arterial calcifications. Cardiovasc Pathol 2018; 38:7-13. [PMID: 30399527 DOI: 10.1016/j.carpath.2018.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/12/2018] [Accepted: 09/29/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In clinical practice, calcifications seen on computed tomographic studies within the large brain arteries are often referred to as a surrogate marker for cholesterol-mediated atherosclerosis. However, limited data exist to support the association between calcification and atherosclerosis. In this study, we examined if intracranial arterial calcifications were associated with cholesterol-mediated intracranial large artery atherosclerosis (ILAA) within the arteries of the circle of Willis in an autopsy-based sample. METHODS We carried out a cross-sectional analysis of histopathological characteristics of brain large arteries obtained from autopsy cases. Brain large arteries were examined for evidences of calcifications, which were rated as macroscopic (coalescent) and microscopic (scattered). In addition to calcification, we also obtained measurement of the arterial wall and the presence of ILAA and nonatherosclerotic arterial fibrosis. We built hierarchical models adjusted for demographic and vascular risk factors to assess the relationship between calcification and ILAA. RESULTS In univariate analysis, the presence of any arterial calcifications was associated with cerebral infarcts (29% vs. 14%, P<.01). Multivariate analysis revealed that among all calcifications, coalescent calcifications were not associated with ILAA. In contrast, scattered calcifications were associated with ILAA (P<.001), decreased lumen diameter (-1.87 +/- 0.41 mm, P≤.001), and increased luminal stenosis (0.03% +/- 0.01%, P≤.006). These findings were independent of age, sex, or other vascular risk factors. CONCLUSIONS This study demonstrates that coalescent calcifications in brain large arteries, although associated with morbidity, are not synonymous with cholesterol-driven ILAA. Understanding the precise pathological components of cerebrovascular disease, including nonatherosclerotic arterial calcifications, will help develop individualized therapies beyond amelioration of traditional risk factors such as hyperlipidemia.
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Affiliation(s)
- Steven D Shapiro
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - James Goldman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University
| | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai
| | - Lawrence Honig
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Randolph S Marshall
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jay P Mohr
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY.
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11
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Abstract
OBJECTIVE To test whether HIV is associated with brain large artery vulnerable intima. DESIGN Cross-sectional study of autopsied HIV-positive (HIV+) cases sex and age-matched to HIV-negative (HIV-) controls. METHODS Brain large arteries from 302 autopsied cases (50% HIV+) were evaluated morphometrically for the presence of atherosclerosis, size of necrotic core, and fibrous cap thickness. Intima vulnerability was measured as intima elastolytic score [0-5, based on intimal metalloproteinases (MMP)-2, MMP-3, and MMP-9, and tissue inhibitor for MMP-1 and MMP-2 staining], intima inflammatory score (0-3, based on intimal presence of CD3 and CD68 cells and TNF-α staining), neoangiogenesis (factor VIII staining), and apoptosis (caspase 3 staining). Hierarchical generalized linear models were used to obtain the beta estimates and their 95% confidence intervals, adjusting for demographics and vascular risk factors. RESULTS The prevalence of atherosclerosis did not differ by HIV status. Necrotic cores filled larger proportions of the intima in HIV+ individuals with CD4 cell count above 200 cells/μl at death compared to HIV- controls (adjusted B = 11.6%, P = 0.04). HIV+ individuals had greater elastolytic scores (adjusted B = 0.34, P = 0.02), especially those with less than 200 CD4 cells/μl at death (adjusted B = 0.41, P = 0.01). Intima inflammation, neoangiogenesis, and apoptosis were not different among HIV+ cases versus HIV- controls. CONCLUSION Individuals with HIV and CD4 cell count at least 200 cells/μl at death had relatively larger necrotic cores, whereas those with HIV and CD4 cell count below 200 cells/μl at death had evidence of increased connective tissue remodeling in the intima. These findings suggest an increased potential for endothelial erosion, thrombosis, and plaque rupture that may relate to higher risk for vascular events.
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12
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Brain Large Artery Lymphocytic Inflammation and Human Immunodeficiency Virus-Related Brain Arterial Remodeling. J Virol 2018; 92:JVI.00081-18. [PMID: 29618649 DOI: 10.1128/jvi.00081-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022] Open
Abstract
The pathogenesis of increased stroke risk in human immunodeficiency virus (HIV) remains unclear. Our study investigated the relationship between adventitial and intimal CD3+ T cells and brain arterial remodeling that potentially contributes to HIV-related vasculopathy and stroke. Large brain arteries from 84 HIV+ cases and 78 HIV- cases were analyzed to determine interadventitial and luminal diameters, intimal and wall thickness, percent stenosis, and the presence of atherosclerosis. Immunohistochemical analysis was performed to detect and visually score CD3, a pan-T-cell marker, in the intima and adventitia. Our study showed that numbers of adventitial CD3+ T cells are lower among persons with HIV than among those without HIV, especially if CD4 counts are <200, though intimal CD3+ T cell numbers did not differ by HIV status. Among those with HIV but CD4 counts of <200 at the time of death, intimal CD3+ T cells were associated with hypertrophic outward remodeling, while among those with HIV and CD4 of >200 or HIV- controls, intimal CD3+ T cells were associated with hypertrophic inward remodeling. We conclude that intimal lymphocytic inflammation is involved in brain arterial remodeling that may contribute to HIV-related cerebrovascular pathology.IMPORTANCE Although mortality from human immunodeficiency virus (HIV) has decreased with the use of combination antiretroviral therapies, there is now an increased risk of cardiovascular and cerebrovascular disease associated with HIV. Thus, there is a need to understand the pathogenesis of stroke in HIV infection. Our study examines how lymphocytic inflammation in brain arteries may contribute to increased cerebral vasculopathy. With this understanding, our study can potentially help direct future therapies to target and prevent brain arterial remodeling processes associated with HIV.
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13
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Tan HW, Chen X, Maingard J, Barras CD, Logan C, Thijs V, Kok HK, Lee MJ, Chandra RV, Brooks M, Asadi H. Intracranial Vessel Wall Imaging with Magnetic Resonance Imaging: Current Techniques and Applications. World Neurosurg 2018; 112:186-198. [PMID: 29360586 DOI: 10.1016/j.wneu.2018.01.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
Abstract
Vessel wall magnetic resonance imaging (VW-MRI) is a modern imaging technique with expanding applications in the characterization of intracranial vessel wall pathology. VW-MRI provides added diagnostic capacity compared with conventional luminal imaging methods. This review explores the principles of VW-MRI and typical imaging features of various vessel wall pathologies, such as atherosclerosis, dissection, and vasculitis. Radiologists should be familiar with this important imaging technique, given its increasing use and future relevance to everyday practice.
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Affiliation(s)
- Haur Wey Tan
- Department of Radiology, Austin Hospital, Melbourne, Australia.
| | - Xiao Chen
- Department of Radiology, Austin Hospital, Melbourne, Australia
| | - Julian Maingard
- Department of Radiology, Austin Hospital, Melbourne, Australia; Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Christen D Barras
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Interventional Radiology Service, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia; Department of Imaging, Monash University, Melbourne, Victoria, Australia
| | - Mark Brooks
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Radiology, Interventional Neuroradiology Service, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
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14
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Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J. The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It. Radiology 2018; 286:12-28. [DOI: 10.1148/radiol.2017162096] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arjen Lindenholz
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jaco J. M. Zwanenburg
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
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15
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Roth W, Morgello S, Goldman J, Mohr JP, Elkind MSV, Marshall RS, Gutierrez J. Histopathological Differences Between the Anterior and Posterior Brain Arteries as a Function of Aging. Stroke 2017; 48:638-644. [PMID: 28196941 DOI: 10.1161/strokeaha.116.015630] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We tested the hypothesis that posterior brain arteries differ pathologically from anterior brain arteries and that this difference varies with age. METHODS Brain large arteries from 194 autopsied individuals (mean age 56±17 years, 63% men, 25% nonwhite, 17% with brain infarcts) were analyzed to obtain the areas of arterial layers and lumen as well as the relative content of elastin, collagen, and amyloid. Visual rating was used to determine the prevalence of atheroma, calcification, vasa vasorum, pattern of intima thickening, and internal elastic lamina gaps. We used multilevel models adjusting for age, sex, ethnicity, vascular risk factors, artery type and location, and multiple comparisons. RESULTS Of 1362 large artery segments, 5% had vasa vasorum, 5% had calcifications, 15% had concentric intimal thickening, and 11% had atheromas. Posterior brain arteries had thinner walls, less elastin, and more concentric intima thickening than anterior brain arteries. Compared to anterior brain arteries, the basilar artery had higher arterial area encircled by the internal elastic lamina, whereas the vertebral arteries had higher prevalence of elastin loss, concentric intima thickening, and nonatherosclerotic stenosis. In younger individuals, vertebral artery calcifications were more likely than calcification in anterior brain arteries, but this difference attenuated with age. CONCLUSIONS Posterior brain arteries differ pathologically from anterior brain arteries in the degree of wall thickening, elastin loss, and concentric intimal thickening.
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Affiliation(s)
- William Roth
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Susan Morgello
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - James Goldman
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Jay P Mohr
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Mitchell S V Elkind
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Randolph S Marshall
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Jose Gutierrez
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.).
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16
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Qiao Y, Guallar E, Suri FK, Liu L, Zhang Y, Anwar Z, Mirbagheri S, Xie YJ, Nezami N, Intrapiromkul J, Zhang S, Alonso A, Chu H, Couper D, Wasserman BA. MR Imaging Measures of Intracranial Atherosclerosis in a Population-based Study. Radiology 2016; 280:860-8. [PMID: 27022858 PMCID: PMC5006718 DOI: 10.1148/radiol.2016151124] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To implement a magnetic resonance (MR) imaging protocol to measure intracranial atherosclerotic disease (ICAD) in a population-based multicenter study and report examination and reader reliability of these MR imaging measurements and descriptive statistics representative of the general population. Materials and Methods This prospective study was approved by the institutional review boards and compliant with HIPAA. Atherosclerosis Risk in Communities (ARIC) study participants (n = 1980) underwent brain MR imaging from 2011 to 2013 at four ARIC sites. Imaging included three-dimensional black-blood MR imaging and time-of-flight MR angiography. One hundred two participants returned for repeat MR imaging to estimate examination and reader variability. Plaque presence according to vessel segment was recorded. Quantitative measurements included lumen size and degree of stenosis, wall and/or plaque thickness, area and volume, and normalized wall index for each vessel segment. Reliability was assessed with percentage agreement, κ statistics, and intraclass correlation coefficients. Results Of the 1980 participants, 1755 (mean age, 77.6 years; 1026 women [59%]; 1234 white [70%]) completed examinations with adequate to excellent image quality. The weighted ICAD prevalence was 34.4% (637 of 1755 participants) and was higher in men than women (38.5% [302 of 729 participants] vs 31.7% [335 of 1026 participants], respectively; P = .012) and in African Americans compared with whites (41.1% [215 of 518 participants] vs 32.4% [422 of 1234 participants], respectively; P = .002). Percentage agreement of plaque identification per participant was 87.0% (interreader estimate), 89.2% (intrareader estimate), and 89.9% (examination estimate). Examination and reader reliability ranged from fair to good (κ, 0.50-0.78) for plaque presence and from good to excellent (intraclass correlation coefficient, 0.69-0.99) for quantitative vessel wall measurements. Conclusion Vessel wall MR imaging is a reliable tool for identifying and measuring ICAD and provided insight into ICAD distribution across a U.S. community-based population. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Ye Qiao
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Eliseo Guallar
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Fareed K. Suri
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Li Liu
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Yiyi Zhang
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Zeeshan Anwar
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Saeedeh Mirbagheri
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - YuanYuan Joyce Xie
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Nariman Nezami
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Jarunee Intrapiromkul
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Shuqian Zhang
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Alvaro Alonso
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Haitao Chu
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - David Couper
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Bruce A. Wasserman
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
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17
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Gutierrez J, Menshawy K, Goldman J, Dwork AJ, Elkind MSV, Marshall RS, Morgello S. Metalloproteinases and Brain Arterial Remodeling Among Individuals With and Those Without HIV Infection. J Infect Dis 2016; 214:1329-1335. [PMID: 27549585 DOI: 10.1093/infdis/jiw385] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/12/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study tests the hypothesis that increased elastolytic activity is associated differentially with dolichoectasia in individuals with and those without human immunodeficiency virus (HIV) infection. METHODS Large arteries from 84 autopsied brains from HIV-positive individuals and 78 autopsied brains from HIV-negative individuals were stained for metalloproteinase 2 (MMP-2), MMP-3, MMP-9, tissue inhibitor of metalloproteinases 1 (TIMP-1), TIMP-2, CD68, and caspase 3. Average pixel intensity was automatically obtained and categorized as high, moderate, or low. Dolichoectasia was defined as a lumen to wall ratio ≥95th percentile. RESULTS High MMP-9 staining alone (P = .001) or coexistent with low TIMP-2 staining was associated with dolichoectasia only in HIV-negative individuals (P = <.001). In HIV-positive individuals, MMP-9 was associated with dolichoectasia only when coexpressed with caspase 3 (P = .01). Thinning of the media was associated with CD68 staining (P = <.001) in HIV-negative individuals, while caspase 3 was associated with a thinner media only in HIV-positive individuals (P = .01). Media thickness modified the association between lumen to wall ratio and MMP expression. CONCLUSIONS A role for MMP/TIMP balance in dolichoectasia appears more prominent in HIV-negative individuals, while apoptosis, mediated by caspase 3, is the most important determinant of media thinning in HIV-infected individuals. Furthermore, apoptosis and media thickness appear to mediate the effects of MMP in the HIV-infected population.
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Affiliation(s)
| | - Khaled Menshawy
- Alexandria Faculty of Medicine, Alexandria University, Egypt
| | - James Goldman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons
| | - Andrew J Dwork
- Department of Pathology and Cell Biology, College of Physicians and Surgeons
- Department of Psychiatry, Columbia University Medical Center
| | - Mitchell S V Elkind
- Department of Neurology
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | | | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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18
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Mandell DM, Mossa-Basha M, Qiao Y, Hess CP, Hui F, Matouk C, Johnson MH, Daemen MJAP, Vossough A, Edjlali M, Saloner D, Ansari SA, Wasserman BA, Mikulis DJ. Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2016; 38:218-229. [PMID: 27469212 DOI: 10.3174/ajnr.a4893] [Citation(s) in RCA: 418] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial vessel wall MR imaging is an adjunct to conventional angiographic imaging with CTA, MRA, or DSA. The technique has multiple potential uses in the context of ischemic stroke and intracranial hemorrhage. There remain gaps in our understanding of intracranial vessel wall MR imaging findings and research is ongoing, but the technique is already used on a clinical basis at many centers. This article, on behalf of the Vessel Wall Imaging Study Group of the American Society of Neuroradiology, provides expert consensus recommendations for current clinical practice.
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Affiliation(s)
- D M Mandell
- From the Division of Neuroradiology (D.M.M., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - M Mossa-Basha
- Department of Radiology (M.M.-B.), University of Washington, Seattle, Washington
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - C P Hess
- Department of Radiology and Biomedical Imaging (C.P.H., D.S.), University of California, San Francisco, San Francisco, California
| | - F Hui
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - C Matouk
- Departments of Neurosurgery (C.M., M.H.J.).,Radiology and Biomedical Imaging (C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery (C.M., M.H.J.).,Radiology and Biomedical Imaging (C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - M J A P Daemen
- Department of Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, the Netherlands
| | - A Vossough
- Departments of Surgery (A.V.).,Radiology (A.V.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Edjlali
- Department of Radiology (M.E.), Université Paris Descartes Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - D Saloner
- Department of Radiology and Biomedical Imaging (C.P.H., D.S.), University of California, San Francisco, San Francisco, California
| | - S A Ansari
- Departments of Radiology (S.A.A.).,Neurology (S.A.A.).,Neurological Surgery (S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - D J Mikulis
- From the Division of Neuroradiology (D.M.M., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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Abstract
OBJECTIVE To test the hypothesis that brain arteries from HIV+ cases have a greater degree of inflammation than brain arteries from HIV- cases, and that inflammation is associated with brain arterial remodeling. DESIGN Case-control study, cross-sectional. METHODS Brain arteries from 162 autopsy cases (84 with HIV) were systematically analyzed for thickness of the intima, media, and adventitia, and atherosclerosis and dolichoectasia. Inflammation was assessed with CD68 immunohistochemistry, and measured with a semiquantitative score reflecting the number and location (i.e., arterial layer) of activated macrophages infiltrating the arterial wall. Latent varicella zoster virus (VZV) was assessed with anti-VZV gene 63 product immunohistochemistry. Demographic and clinical variables were available in all cases, and longitudinal data about CD4 cell counts were available among cases with HIV. Multilevel generalized linear models were used to test the association between inflammation and HIV. RESULTS Arteries from HIV+ cases had a higher inflammation score (B = 0.36, P = 0.05) compared with arteries from HIV- cases, although the association was attenuated after controlling for demographic variables, vascular risk factors, and latent VZV (B = 0.20, P = 0.18). Although intimal inflammation was similar in cases with and without HIV, adventitial inflammation was associated with HIV. Intimal inflammation was associated with intracranial atherosclerosis independent of HIV status, but adventitial inflammation was associated with HIV-associated dolichoectasia in arteries with a thin media. CONCLUSIONS Adventitial inflammation is associated with HIV and dolichoectasia independent of intracranial atherosclerosis. This suggests that differential inflammatory responses may play a role in intracranial atherosclerosis and dolichoectasia.
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20
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Abstract
The role of infection in cerebrovascular disease is complex and remains incompletely understood. Over the last 5 years, investigators have made notable inroads in untangling this thorny topic. In this review, we examine these recent developments, concentrating on four aspects of the relationship between infection and stroke. We first discuss specific infectious agents as direct causes of stroke, focusing on recent work implicating herpesviruses and HIV in cerebral vasculopathy. We then discuss systemic infection of any type as a stroke trigger, focusing on the relationship of infection to timing of acute stroke, both in children and adults, as well as the role of vaccination in stroke prevention. We examine the evidence for chronic infection or "infectious burden" as a stroke risk factor. Finally, we discuss recent work on infection as a risk factor for increased morbidity after stroke, possible mechanisms mediating this effect, and the evidence for prophylactic antibiotics.
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Affiliation(s)
- Eliza C Miller
- The Neurological Institute of New York, 710 W. 168th St., 14th floor, New York, NY, 10032, USA.
| | - Mitchell S V Elkind
- The Neurological Institute of New York, 710W. 168th St., Room 642, New York, NY, 10032, USA.
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21
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Gutierrez J, Goldman J, Dwork AJ, Elkind MSV, Marshall RS, Morgello S. Brain arterial remodeling contribution to nonembolic brain infarcts in patients with HIV. Neurology 2015; 85:1139-45. [PMID: 26320196 DOI: 10.1212/wnl.0000000000001976] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/05/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cerebrovascular disease is a cause of morbidity in HIV-infected populations. The relationship among HIV infection, brain arterial remodeling, and stroke is unclear. METHODS Large brain arteries (n = 1,878 segments) from 284 brain donors with and without HIV were analyzed to obtain media and wall thickness and lumen-to-wall ratio, and to determine the presence of atherosclerosis and dolichoectasia (arterial remodeling extremes). Neuropathologic assessment was used to characterize brain infarcts. Multilevel models were used to assess for associations between arterial characteristics and HIV. Associations between arterial characteristics and brain infarcts were examined in HIV+ individuals only. RESULTS Adjusting for vascular risk factors, HIV infection was associated with thicker arterial walls and smaller lumen-to-wall ratios. Cerebral atherosclerosis accounted for one-quarter of the brain infarcts in HIV+ cases, and was more common with aging, diabetes, a lower CD4 nadir, and a higher antemortem CD4 count. In contrast, a higher lumen-to-wall ratio was the only arterial predictor of unexplained infarcts in HIV+ cases. Dolichoectasia was more common in HIV+ cases with smoking and media thinning, and with protracted HIV infection and a detectable antemortem viral load. CONCLUSIONS HIV infection may predispose to inward remodeling compared to uninfected controls. However, among HIV+ cases with protracted immunosuppression, outward remodeling is the defining arterial phenotype. Half of all brain infarcts in this sample were attributed to the extremes of brain arterial remodeling: atherosclerosis and dolichoectasia. Understanding the mechanisms influencing arterial remodeling will be important in controlling cerebrovascular disease in the HIV-infected population.
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Affiliation(s)
- Jose Gutierrez
- From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY.
| | - James Goldman
- From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
| | - Andrew J Dwork
- From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
| | - Mitchell S V Elkind
- From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
| | - Randolph S Marshall
- From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
| | - Susan Morgello
- From the Departments of Neurology (J.G., M.S.V.E., R.S.M.), Pathology and Cell Biology (J.G., A.J.D.), Psychiatry (A.J.D.), and Epidemiology (M.S.V.E.), Columbia University Medical Center; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
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Gutierrez J, Elkind MSV, Virmani R, Goldman J, Honig L, Morgello S, Marshall RS. A pathological perspective on the natural history of cerebral atherosclerosis. Int J Stroke 2015; 10:1074-80. [PMID: 25854637 DOI: 10.1111/ijs.12496] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/06/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND The natural history of intracranial large artery atherosclerosis has been mainly described from lumen-based imaging studies, and much of what is reported to be known about atherosclerosis is derived from non-cerebral arteries. AIMS To test the hypothesis that atherosclerosis is only partially represented by stenosis and that advanced atherosclerosis is more common that severe stenosis in noncardioembolic infarcts. METHODS Cerebral large arteries from 196 autopsy cases were studied. The revised American Heart Association classification for atherosclerosis was used to determine the phenotype in each available artery. Cross-sectional lumen stenosis was obtained as defined by the Glagov's method. RESULTS As age of cases increased, there was a progressive increment in the frequency of atherosclerotic lesions, rising from 5% of all arteries at age 20-40, to more than 40% at age 60 or older. Stenosis also increased with age: less than 3% of the arteries in those ≤50 years had >40% stenosis, while one out of five arteries in those >80 years had >40% stenosis. In most cases (80%), atherosclerosis and stenosis were directly related. However, one out of five cases with advanced atherosclerosis had <30% stenosis. In arteries supplying brain areas with noncardioembolic infarcts, the majority of segments exhibiting advanced atherosclerosis had lumen stenosis of <40%. CONCLUSION Although intracranial atherosclerosis is typically associated with stenosis, a substantial minority of cases shows advanced atherosclerosis in the absence of stenosis >40%. Definitions based solely on stenosis may underestimate the extent and role of intracranial large artery atherosclerosis.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | | | - James Goldman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Lawrence Honig
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Randolph S Marshall
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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Nemeth CL, Bekhbat M, Neigh GN. Neural effects of inflammation, cardiovascular disease, and HIV: Parallel, perpendicular, or progressive? Neuroscience 2014; 302:165-73. [PMID: 25239371 DOI: 10.1016/j.neuroscience.2014.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 12/19/2022]
Abstract
The pervasive reach of the inflammatory system is evidenced by its involvement in numerous disease states. Cardiovascular disease, marked by high levels of circulating inflammatory mediators, affects an estimated 83.6 million Americans. Similarly, human immunodeficiency virus (HIV) produces a paradoxical state of generalized immune activity despite widespread immunosuppression, and affects 35 million people worldwide. Patients living with HIV (PLWH) suffer from inflammatory conditions, including cardiovascular disease (CVD), at a rate exceeding the general population. In this combined disease state, immune mechanisms that are common to both CVD and HIV may interact to generate a progressive condition that contributes to the exacerbated pathogenesis of the other to the net effect of damage to the brain. In this review, we will outline inflammatory cell mediators that promote cardiovascular risk factors and disease initiation and detail how HIV-related proteins may accelerate this process. Finally, we examine the extent to which these comorbid conditions act as parallel, perpendicular, or progressive sequela of events to generate a neurodegenerative environment, and consider potential strategies that can be implemented to reduce the burden of CVD and inflammation in PLWH.
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Affiliation(s)
- C L Nemeth
- Department of Physiology, Emory University, 615 Michael Street, Atlanta, GA 30322, United States
| | - M Bekhbat
- Department of Physiology, Emory University, 615 Michael Street, Atlanta, GA 30322, United States
| | - G N Neigh
- Department of Physiology, Emory University, 615 Michael Street, Atlanta, GA 30322, United States; Department of Psychiatry, Emory University, 615 Michael Street, Atlanta, GA 30322, United States.
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Gutierrez J, Goldman J, Honig LS, Elkind MSV, Morgello S, Marshall RS. Determinants of cerebrovascular remodeling: do large brain arteries accommodate stenosis? Atherosclerosis 2014; 235:371-9. [PMID: 24929285 PMCID: PMC4121968 DOI: 10.1016/j.atherosclerosis.2014.05.925] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/03/2014] [Accepted: 05/05/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE It is hypothesized that outward remodeling in systemic arteries is a compensatory mechanism for lumen area preservation in the face of increasing arterial stenosis. Large brain arteries have also been studied, but it remains unproven if all assumptions about arterial remodeling can be replicated in the cerebral circulation. METHODS The sample included 196 autopsied subjects with a mean age of 55 years; 63 % were men, and 74 % non-Hispanic whites. From each of 1396 dissected cadaveric large arteries of the circle of Willis, the areas of the lumen, intima, media, and adventitia were measured. Internal elastic lamina (IEL) area was defined as the area encircled by this layer. Stenosis was calculated by dividing the plaque area by the IEL area and multiplying by 100. RESULTS Plotting stenosis against lumen area or stratified by arterial size showed no preservation of the lumen in the setting of growing stenosis. We could not find an association between greater IEL proportion and stenosis (B = 0.44, P = 0.86). Stratifying arteries by their size, we found that smaller arteries have greater lumen reduction at any degree of stenosis (B = -23.65, P ≤ 0.0001), and although larger arteries show a positive association between IEL proportion and stenosis, this was no longer significant after adjusting for covariates (B = 6.0, P = 0.13). CONCLUSIONS We cannot confirm the hypothesis that large brain arteries undergo outward remodeling as an adaptive response to increasing degrees of stenosis. We found that the lumen decreases proportionally to the degree of stenosis.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA.
| | - James Goldman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
| | - Lawrence S Honig
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Randolph S Marshall
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
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Bladowska J, Knysz B, Zimny A, Małyszczak K, Kołtowska A, Szewczyk P, Gąsiorowski J, Furdal M, Sąsiadek MJ. Value of perfusion-weighted MR imaging in the assessment of early cerebral alterations in neurologically asymptomatic HIV-1-positive and HCV-positive patients. PLoS One 2014; 9:e102214. [PMID: 25013963 PMCID: PMC4094508 DOI: 10.1371/journal.pone.0102214] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/16/2014] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Asymptomatic central nervous system (CNS) involvement occurs in the early stage of the human immunodeficiency virus (HIV) infection. It has been documented that the hepatitis C virus (HCV) can replicate in the CNS. The aim of the study was to evaluate early disturbances in cerebral microcirculation using magnetic resonance (MR) perfusion-weighted imaging (PWI) in asymptomatic HIV-1-positive and HCV-positive patients, as well as to assess the correlation between PWI measurements and the clinical data. Materials and Methods Fifty-six patients: 17 HIV-1-positive non-treated, 18 HIV-1-positive treated with combination antiretroviral therapy (cART), 7 HIV-1/HCV-positive non-treated, 14 HCV-positive before antiviral therapy and 18 control subjects were enrolled in the study. PWI was performed with a 1.5T MR unit using dynamic susceptibility contrast (DSC) method. Cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) were evaluated in the posterior cingulated region (PCG), basal ganglia (BG), temporoparietal (TPC) and frontal cortices (FC), as well as in white matter of frontoparietal areas. Correlations of rCBV values with immunologic data and liver histology activity index (HAI) were analyzed. Results Significantly lower rCBV values were found in the right TPC and left FC as well as in PCG in HIV-1-positive naïve (p = 0.009; p = 0.020; p = 0.012), HIV-1 cART treated (p = 0.007; p = 0.009; p = 0.033), HIV-1/HCV-positive (p = 0.007; p = 0.027; p = 0.045) and HCV-positive patients (p = 0.010; p = 0.005; p = 0.045) compared to controls. HIV-1-positive cART treated and HIV-1/HCV-positive patients demonstrated lower rCBV values in the right FC (p = 0.009; p = 0.032, respectively) and the left TPC (p = 0.036; p = 0.005, respectively), while HCV-positive subjects revealed lower rCBV values in the left TPC region (p = 0.003). We found significantly elevated rCBV values in BG in HCV-positive patients (p = 0.0002; p<0.0001) compared to controls as well as to all HIV-1-positive subjects. There were no significant correlations of rCBV values and CD4 T cell count or HAI score. Conclusions PWI examination enables the assessment of HIV-related as well as HCV-related early cerebral dysfunction in asymptomatic subjects. HCV-infected patients seem to reveal the most pronounced perfusion changes.
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Affiliation(s)
- Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | - Brygida Knysz
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Zimny
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Małyszczak
- Division of Psychotherapy and Psychosomatic Medicine, Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | - Anna Kołtowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Szewczyk
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Gąsiorowski
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Furdal
- Regional Specialistic Hospital, Department of Cardiology, Wroclaw, Poland
| | - Marek J. Sąsiadek
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland
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Gutierrez J, Rosoklija G, Murray J, Chon C, Elkind MSV, Goldman J, Honig LS, Dwork AJ, Morgello S, Marshall RS. A quantitative perspective to the study of brain arterial remodeling of donors with and without HIV in the Brain Arterial Remodeling Study (BARS). Front Physiol 2014; 5:56. [PMID: 24600402 PMCID: PMC3928551 DOI: 10.3389/fphys.2014.00056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/28/2014] [Indexed: 11/13/2022] Open
Abstract
Mechanisms underlying brain arterial remodeling are uncertain. We tested the hypothesis that arterial size and location are important determinants of arterial characteristics. We collected large and penetrating brain arteries from cadavers with and without HIV. Morphometric characterization was obtained from digital images using color-based thresholding. The association of arterial size and location with lumen diameter, media and adventitia area, media proportion, a wall thickness, wall-to-lumen ratio and stenosis was obtained with multilevel mixed models and a P value ≤ 0.05 was considered significant. We included 336 brains, in which 2279 large arteries and 1488 penetrating arteries were identified. We found that arterial size was significantly associated with all arterial characteristics studied of large and penetrating arteries with exception of arterial stenosis in large arteries. After adjusting for size, an independent association was found between lumen diameters, media and adventitia thickness with artery locations. Arterial stenosis was also associated with artery location in both large and penetrating arteries. In summary, significant effects of size and/or location were found in arterial characteristics typically used to define arterial remodeling. Brain arterial remodeling characteristics differ across arterial sizes and location, and these differences should be controlled for in future studies of brain arterial remodeling.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Gorazd Rosoklija
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA ; Macedonia Academy of Science and Arts Skopje, Macedonia
| | - Jacinta Murray
- Department of Neurology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Christina Chon
- Department of Neurology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA ; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center New York, NY, USA
| | - James Goldman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Lawrence S Honig
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Andrew J Dwork
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA ; Macedonia Academy of Science and Arts Skopje, Macedonia ; Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Randolph S Marshall
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
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