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Lei W, Qian S, Zhu X, Hu J. Haemodynamic Effects on the Development and Stability of Atherosclerotic Plaques in Arterial Blood Vessel. Interdiscip Sci 2023; 15:616-632. [PMID: 37418092 DOI: 10.1007/s12539-023-00576-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: 03/04/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
Studying the formation and stability of atherosclerotic plaques in the hemodynamic field is essential for understanding the growth mechanism and preventive treatment of atherosclerotic plaques. In this paper, based on a multiplayer porous wall model, we established a two-way fluid-solid interaction with time-varying inlet flow. The lipid-rich necrotic core (LRNC) and stress in atherosclerotic plaque were described for analyzing the stability of atherosclerotic plaques during the plaque growth by solving advection-diffusion-reaction equations with finite-element method. It was found that LRNC appeared when the lipid levels of apoptotic materials (such as macrophages, foam cells) in the plaque reached a specified lower concentration, and increased with the plaque growth. LRNC was positively correlated with the blood pressure and was negatively correlated with the blood flow velocity. The maximum stress was mainly located at the necrotic core and gradually moved toward the left shoulder of the plaque with the plaque growth, which increases the plaque instability and the risk of the plaque shedding. The computational model may contribute to understanding the mechanisms of early atherosclerotic plaque growth and the risk of instability in the plaque growth.
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Affiliation(s)
- Weirui Lei
- School of Physics and Electronics, Hunan Normal University, Changsha, 410006, China
| | - Shengyou Qian
- School of Physics and Electronics, Hunan Normal University, Changsha, 410006, China.
| | - Xin Zhu
- Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Jiwen Hu
- School of Mathematics and Physics, University of South China, Hengyang, 421001, 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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Zhao XQ, Sun J, Hippe DS, Isquith DA, Canton G, Yamada K, Balu N, Crouse JR, Anderson TJ, Huston J, O’Brien KD, Hatsukami TS, Yuan C. Magnetic Resonance Imaging of Intraplaque Hemorrhage and Plaque Lipid Content With Continued Lipid-Lowering Therapy: Results of a Magnetic Resonance Imaging Substudy in AIM-HIGH. Circ Cardiovasc Imaging 2022; 15:e014229. [PMID: 36378778 PMCID: PMC9773914 DOI: 10.1161/circimaging.122.014229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intraplaque hemorrhage (IPH) is associated with plaque progression and ischemic events, and plaque lipid content (% lipid core) predicts the residual atherosclerotic cardiovascular disease risk. This study examined the impact of IPH on lipid content change in the setting of intensive lipid-lowering therapy. METHODS In total, 214 AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low High-Density Lipoprotein/High Triglycerides: Impact on Global Health Outcomes) participants with clinically established ASCVD and low high-density lipoprotein cholesterol received cartoid MRI at baseline and 2 years to assess changes in carotid morphology and composition. Patients were randomized to extended-release niacin or placebo, and all received simvastatin with optional ezetimibe as necessary to lower low-density lipoprotein cholesterol to 40 to 80 mg/dL. Changes in lipid content and carotid morphology were tested using the Wilcoxon signed-rank test. Differences between subjects with and without IPH and between subjects assigned extended-release niacin or placebo were tested using the Wilcoxon rank-sum test. Linear regression was used to test the association of IPH and lipid content changes after adjusting for clinical risk factors. RESULTS Among 156 patients (61±9 years; 81% men) with complete MRI, prior statin use: <1 year, 26%; 1 to 5 years, 37%; >5 years, 37%. Triglycerides and ApoB decreased significantly, whereas high-density lipoprotein cholesterol and ApoA1 increased significantly over time. Plaque lipid content was significantly reduced (-0.5±2.4 %/year, P = 0.017) without a significant difference between the 2 treatment groups. However, the lipid content increased in plaques with IPH but regressed in plaques without IPH (1.2±2.5 %/year versus -1.0±2.2, P = 0.006). Additionally, IPH was associated with a decrease in lumen area (-0.4±0.9 mm2/year versus 0.3±1.4, P = 0.033). IPH remained significantly associated with increase in lipid content in multivariable analysis (54.4%, 95% CI: 26.8, 88.0, P < 0.001). CONCLUSIONS Carotid plaques under continued intensive lipid-lowering therapy moved toward stabilization. However, plaques with IPH showed greater increases in lipid content and greater decreases in lumen area than plaques without IPH. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01178320.
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Affiliation(s)
- Xue-Qiao Zhao
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel A. Isquith
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | - John R. Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J. Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin D. O’Brien
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Thomas S. Hatsukami
- Department of Surgery (Division of Vascular Surgery), University of Washington, Seattle, Washington
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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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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Chen S, Liu C, Chen X, Liu WV, Ma L, Zha Y. A Radiomics Approach to Assess High Risk Carotid Plaques: A Non-invasive Imaging Biomarker, Retrospective Study. Front Neurol 2022; 13:788652. [PMID: 35350403 PMCID: PMC8957977 DOI: 10.3389/fneur.2022.788652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to construct a radiomics-based MRI sequence from high-resolution magnetic resonance imaging (HRMRI), combined with clinical high-risk factors for non-invasive differentiation of the plaque of symptomatic patients from asyptomatic patients. Methods A total of 115 patients were retrospectively recruited. HRMRI was performed, and patients were diagnosed with symptomatic plaques (SPs) and asymptomatic plaques (ASPs). Patients were randomly divided into training and test groups in the ratio of 7:3. T2WI was used for segmentation and extraction of the texture features. Max-Relevance and Min-Redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were employed for the optimized model. Radscore was applied to construct a diagnostic model considering the T2WI texture features and patient demography to assess the power in differentiating SPs and ASPs. Results SPs and ASPs were seen in 75 and 40 patients, respectively. Thirty texture features were selected by mRMR, and LASSO identified a radscore of 16 radiomics features as being related to plaque vulnerability. The radscore, consisting of eight texture features, showed a better diagnostic performance than clinical information, both in the training (area under the curve [AUC], 0.923 vs. 0.713) and test groups (AUC, 0.989 vs. 0.735). The combination model of texture and clinical information had the best performance in assessing lesion vulnerability in both the training (AUC, 0.926) and test groups (AUC, 0.898). Conclusion This study demonstrated that HRMRI texture features provide incremental value for carotid atherosclerotic risk assessment.
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Affiliation(s)
- Sihan Chen
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Changsheng Liu
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Xixiang Chen
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Weiyin Vivian Liu
- Advanced Application Team, MR Research, GE Healthcare, Beijing, China
| | - Ling Ma
- He Kang Corporate Management (SH) Co. Ltd, Shanghai, China
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
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Che F, Liu Y, Gong X, Wang A, Bai X, Ju Y, Sui B, Jing J, Geng X, Zhao X. Extracranial Carotid Plaque Hemorrhage Is Independently Associated With Poor 3-month Functional Outcome After Acute Ischemic Stroke-A Prospective Cohort Study. Front Neurol 2022; 12:780436. [PMID: 34970212 PMCID: PMC8712340 DOI: 10.3389/fneur.2021.780436] [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: 09/21/2021] [Accepted: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
Background and Purpose: Carotid plaque hemorrhage (IPH) is a critical plaque vulnerable feature. We aim to elucidate the association between symptomatic extracranial carotid atherosclerotic IPH and poor 3-month functional outcome after acute ischemic stroke by high-resolution vessel wall MRI (HRVMRI). Methods: We prospectively studied consecutive patients with a recent stroke or transient ischemic attack (TIA) of carotid atherosclerotic origin. All patients underwent a High-Resolution (HR) VWMRI scan of ipsilateral extracranial carotid within 1 week after admission. The patients recruited were interviewed by telephone after 3 months after stroke onset. The primary outcome was a 3-month functional prognosis of stroke, expressed as a modified Rankin Scale (mRS) score. A poor prognosis was defined as a 3-month modified Rankin Scale (mRS) score ≥ of 3. Univariate analysis was used to analyze the correlation between risk factors and IPH. The relation between IPH and 3-month functional outcome was analyzed by Logistic regression analysis. Results: A total of 156 patients (mean age, 61.18 ± 10.12 years; 108 males) were included in the final analysis. There were significant differences in the age, gender, smoking history, national institutes of health stroke scale (NIHSS) on admission, and diastolic blood pressure (DBP) on admission between the IPH group and the non-IPH group (all p < 0.05). During the follow-up, 32 patients (20.5%) had a poor functional outcome. According to the prognosis analysis of poor functional recovery, there was a significant difference between the two groups [36.7 vs. 16.7%; unadjusted odds ratio (OR), 2.32, 95% confidence interval (CI), 1.12–4.81, p = 0.024). Even after adjusting for confounding factors [such as age, gender, smoking history, National Institutes of Health Stroke Scale (NIHSS) on admission, DBP on admission, stenosis rate of carotid artery (CA), calcification, loose matrix, lipo-rich necrotic core (LRNC), and statins accepted at 3 months], IPH was still a strong predictor of poor 3-month outcome, and the adjusted OR was 3.66 (95% CI 1.68–7.94, p = 0.001). Conclusions: Extracranial carotid IPH is significantly associated with poor 3-month outcome after acute ischemic stroke and can predict the poor 3-month functional prognosis.
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Affiliation(s)
- Fengli Che
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yanfang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiping Gong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Bai
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurology, China-America Institute of Neuroscience, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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Trandafir C, Laurent-Chabalier S, Cosma C, Frandon J, Thouvenot E, Renard D. Association of symptomatic atherosclerotic carotid arteries with plaque areas showing low densities on CTA. Eur J Neurol 2021; 29:1056-1061. [PMID: 34941017 DOI: 10.1111/ene.15229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage (IPH) is a key feature of vulnerable carotid atherosclerotic plaque (CAP), associated with low densities (<25 Hounsfield unit, HU) on CTA. This study aimed to analyze CAP on routine CTA performed in patients with symptomatic and asymptomatic carotid stenosis undergoing carotid endarterectomy (CEA) by assessing HU of the CAP area showing the lowest density (CAPALD) using radiological tools available in daily clinical practice, and to compare CAPALD values between symptomatic and asymptomatic carotids. MATERIAL AND METHODS We retrospectively screened pre-operative CTA scans of 206 consecutive adult patients undergoing CEA for symptomatic or asymptomatic stenosis. CAPALD values were compared between symptomatic and asymptomatic carotids. Asymptomatic carotids included arteries contralateral to the symptomatic CEA artery, and asymptomatic stenotic arteries undergoing CEA and their contralateral arteries. Carotids were excluded when <30% stenosis, or when CAP could not be identified or CAPALD not measured. RESULTS In total, 95 symptomatic and 112 asymptomatic carotids (derived from 174 patients) were analysed. In multivariate analysis, symptomatic arteries showed more severe stenosis (median 70% vs. 67%, p=0.0228) and lower CAPALD values (median 17 vs. 25 HU, p=0.049), whereas degree of stenosis and CAPALD values were not correlated (rho=-0.02, p=0.77). HU values <25 were more frequent in symptomatic than asymptomatic carotids (68% vs. 47%, p=0.0022). CONCLUSION On CTA, symptomatic carotids are associated with CAP areas with low densities. CTA analysis of CAP may be interesting to help identifying vulnerable plaques at risk for future stroke, especially in patients lacking strict indications for CEA based on the current guidelines.
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Affiliation(s)
| | - Sabine Laurent-Chabalier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, Univ. Montpellier, Nîmes, France
| | - Catalin Cosma
- Department of Vascular and Thoracic Surgery, CHU Nîmes, Univ. Montpellier, Nîmes, France
| | - Julien Frandon
- Department of Medical Imaging, CHU Nîmes, Univ. Montpellier, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, Univ. Montpellier, Nîmes, France.,Institut de Génomique Fonctionnelle, CNRS, UMR5203, INSERM 1191, Univ. Montpellier, Montpellier, France
| | - Dimitri Renard
- Department of Neurology, CHU Nîmes, Univ. Montpellier, Nîmes, France
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Sato S, Matsumoto H, Li D, Ohya H, Mori H, Sakai K, Ogura K, Oishi Y, Masaki R, Tanaka H, Kondo S, Tsujita H, Tsukamoto S, Isodono K, Kitamura R, Komori Y, Yoshii N, Sato I, Christodoulou AG, Xie Y, Shinke T. Coronary High-Intensity Plaques at T1-weighted MRI in Stable Coronary Artery Disease: Comparison with Near-Infrared Spectroscopy Intravascular US. Radiology 2021; 302:557-565. [PMID: 34904874 DOI: 10.1148/radiol.211463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background The histologic nature of coronary high-intensity plaques (HIPs) at T1-weighted MRI in patients with stable coronary artery disease remains to be fully understood. Coronary atherosclerosis T1-weighted characterization (CATCH) enables HIP detection by simultaneously acquiring dark-blood plaque and bright-blood anatomic reference images. Purpose To determine if intraplaque hemorrhage (IPH) or lipid is the predominant substrate of HIPs on T1-weighted images by comparing CATCH MRI scans with findings on near-infrared spectroscopy (NIRS) intravascular US (IVUS) images. Materials and Methods This study retrospectively included consecutive patients who underwent CATCH MRI before NIRS IVUS between December 2019 and February 2021 at two facilities. At MRI, HIP was defined as plaque-to-myocardium signal intensity ratio of at least 1.4. The presence of an echolucent zone at IVUS (reported to represent IPH) was recorded. NIRS was used to determine the lipid component of atherosclerotic plaque. Lipid core burden index (LCBI) was calculated as the fraction of pixels with a probability of lipid-core plaque greater than 0.6 within a region of interest. Plaque with maximum LCBI within any 4-mm-long segment (maxLCBI4 mm) greater than 400 was regarded as lipid rich. Multivariable analysis was performed to evaluate NIRS IVUS-derived parameters associated with HIPs. Results There were 205 plaques analyzed in 95 patients (median age, 74 years; interquartile range [IQR], 67-78 years; 75 men). HIPs (n = 42) at MRI were predominantly associated with an echolucent zone at IVUS (79% [33 of 42] vs 8.0% [13 of 163], respectively; P < .001) and a higher maxLCBI4 mm at NIRS (477 [IQR, 258-738] vs 232 [IQR, 59-422], respectively; P < .001) than non-HIPs. In the multivariable model, HIPs were independently associated with an echolucent zone (odds ratio, 24.5; 95% CI: 9.3, 64.7; P < .001), but not with lipid-rich plaque (odds ratio, 2.0; 95% CI: 0.7, 5.4; P = .20). Conclusion The predominant substrate of T1-weighed MRI-defined high-intensity plaques in stable coronary artery disease was intraplaque hemorrhage, not lipid. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Stuber in this issue.
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Affiliation(s)
- Shunya Sato
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hidenari Matsumoto
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Debiao Li
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hidefumi Ohya
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hiroyoshi Mori
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Koshiro Sakai
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Kunihiro Ogura
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Yosuke Oishi
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Ryota Masaki
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hideaki Tanaka
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Seita Kondo
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Hiroaki Tsujita
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Shigeto Tsukamoto
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Koji Isodono
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Ryoji Kitamura
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Yoshiaki Komori
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Nobuyuki Yoshii
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Ikumi Sato
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Anthony G Christodoulou
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Yibin Xie
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
| | - Toshiro Shinke
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (S.S., H. Matsumoto, K.S., K.O., Y.O., R.M., H. Tanaka, S.K., H. Tsujita, S.T., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (D.L., A.G.C., Y.X.); Departments of Cardiology (H.O., K.I., R.K.) and Radiological Technology (I.S.), Ijinkai Takeda General Hospital, Kyoto, Japan; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan (H. Mori); MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan (Y.K.); and Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (N.Y.)
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9
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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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10
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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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11
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Cervical Carotid Plaque MRI : Review of Atherosclerosis Imaging Features and their Histologic Underpinnings. Clin Neuroradiol 2021; 31:295-306. [PMID: 33398451 DOI: 10.1007/s00062-020-00987-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Magnetic resonance (MR) imaging is considered the gold standard for non-invasive evaluation of carotid artery plaque morphology and composition. A number of studies have demonstrated the clinical utility of MR plaque imaging in the risk stratification of carotid atherosclerotic disease, determination of stroke etiology, and identification of surgical and endovascular candidates for carotid revascularization procedures. The MR plaque imaging also provides researchers and clinicians with valuable insights into the pathogenesis, natural history and composition of carotid atherosclerotic disease. Nevertheless, the field of MR plaque imaging is complex, and requires a thorough knowledge of the histologic basis for how various plaque features appear on imaging. This article details the pathogenesis and histology of atherosclerosis, reviews the expected appearance of different plaque components, and describes how MR imaging features may be related to symptomatology or predict future ischemic events.
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12
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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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13
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Chen L, Sun J, Canton G, Balu N, Hippe DS, Zhao X, Li R, Hatsukami TS, Hwang JN, Yuan C. Automated Artery Localization and Vessel Wall Segmentation using Tracklet Refinement and Polar Conversion. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2020; 8:217603-217614. [PMID: 33777593 PMCID: PMC7996631 DOI: 10.1109/access.2020.3040616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Quantitative analysis of blood vessel wall structures is important to study atherosclerotic diseases and assess cardiovascular event risks. To achieve this, accurate identification of vessel luminal and outer wall contours is needed. Computer-assisted tools exist, but manual preprocessing steps, such as region of interest identification and/or boundary initialization, are still needed. In addition, prior knowledge of the ring shape of vessel walls has not been fully explored in designing segmentation methods. In this work, a fully automated artery localization and vessel wall segmentation system is proposed. A tracklet refinement algorithm was adapted to robustly identify the artery of interest from a neural network-based artery centerline identification architecture. Image patches were extracted from the centerlines and converted in a polar coordinate system for vessel wall segmentation. The segmentation method used 3D polar information and overcame problems such as contour discontinuity, complex vessel geometry, and interference from neighboring vessels. Verified by a large (>32000 images) carotid artery dataset collected from multiple sites, the proposed system was shown to better automatically segment the vessel wall than traditional vessel wall segmentation methods or standard convolutional neural network approaches. In addition, a segmentation uncertainty score was estimated to effectively identify slices likely to have errors and prompt manual confirmation of the segmentation. This robust vessel wall segmentation system has applications in different vascular beds and will facilitate vessel wall feature extraction and cardiovascular risk assessment.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Daniel S. Hippe
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | | | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
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14
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Fernandes e Fernandes J, Mendes Pedro L, Gonçalves I. The conundrum of asymptomatic carotid stenosis-determinants of decision and evidence. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1279. [PMID: 33178811 PMCID: PMC7607137 DOI: 10.21037/atm-2020-cass-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/24/2020] [Indexed: 01/27/2023]
Abstract
Management of asymptomatic carotid disease continues to challenge medical practice and present evidence is often conflicting. Stroke is a significant burden in Public Health and 11% to 15% appear as first neurologic event associated with asymptomatic carotid stenosis. Randomized trials provided support for Guidelines and Recommendations to intervene on asymptomatic stenosis, but at a known cost of a high number of unnecessary operations. Conflicting evidence from natural history studies and the widespread use of proper medical management including risk factors control, lowering-lipid drugs and strict control of arterial hypertension have reduced the incidence of strokes associated to asymptomatic carotid disease challenging established practice. Need to identify vulnerable lesions prone to develop thromboembolic brain events and also vulnerable patients at a higher risk of stroke is necessary and essential to further improve effectiveness of our interventions. After review of published literature on natural history of asymptomatic carotid stenosis, diagnostic methods to identify plaque vulnerability and present-day results of both endarterectomy and stenting, a strategy for management of asymptomatic carotid stenosis is suggested aiming to reduce unnecessary interventions and effectively contribute to stroke prevention.
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Affiliation(s)
- José Fernandes e Fernandes
- Department of Surgery and Vascular Surgery, Faculty of Medicine University of Lisbon, Lisbon, Portugal
- Santa Maria University Hospital, Lisbon Academic Medical Center, Lisbon, Portugal
- Senior Consultant Vascular Surgeon, Cardiovascular Institute/Hospital da Luz Torres de Lisboa, Lisbon, Portugal
| | - Luis Mendes Pedro
- Senior Consultant Vascular Surgeon, Cardiovascular Institute/Hospital da Luz Torres de Lisboa, Lisbon, Portugal
- Department of Vascular Surgery, Faculty of Medicine University of Lisbon, Lisbon, Portugal
- Vascular Surgery Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Isabel Gonçalves
- Cardiology Department, Skåne University Hospital and Clinical Sciences Malmö, Lund University, Sweden
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15
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Zhu G, Hom J, Li Y, Jiang B, Rodriguez F, Fleischmann D, Saloner D, Porcu M, Zhang Y, Saba L, Wintermark M. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020; 10:1048-1067. [PMID: 32968660 DOI: 10.21037/cdt.2020.03.10] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Carotid artery plaque is a measure of atherosclerosis and is associated with future risk of atherosclerotic cardiovascular disease (ASCVD), which encompasses coronary, cerebrovascular, and peripheral arterial diseases. With advanced imaging techniques, computerized tomography (CT) and magnetic resonance imaging (MRI) have shown their potential superiority to routine ultrasound to detect features of carotid plaque vulnerability, such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC), and calcification. The correlation between imaging features and histological changes of carotid plaques has been investigated. Imaging of carotid features has been used to predict the risk of cardiovascular events. Other techniques such as nuclear imaging and intra-vascular ultrasound (IVUS) have also been proposed to better understand the vulnerable carotid plaque features. In this article, we review the studies of imaging specific carotid plaque components and their correlation with risk scores.
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Affiliation(s)
- Guangming Zhu
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ying Li
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA.,Clinical Medical Research Center, Luye Pharma Group Ltd., Beijing 100000, China
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Dominik Fleischmann
- Department of Radiology, Cardiovascular Imaging Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Saloner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Michele Porcu
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Yanrong Zhang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
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16
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Abstract
Current risk stratification for stroke is still based upon percentage of carotid stenosis, despite this measure providing minimal patient-specific information on the actual risk of stroke for both symptomatic individuals without significant carotid artery stenosis as well as asymptomatic carotid stenosis patients. A continuously growing body of literature suggests that the identification and quantification of certain carotid plaque characteristics, including lipid-rich necrotic core (LRNC), thin/ruptured fibrous cap (FC), and intraplaque hemorrhage (IPH), provide a superior means of predicting future stroke. These characteristics are identifiable via magnetic resonance imaging (MRI), with most features detectable using commercially available coils and sequences utilized in routine clinical practice in as little as 4 minutes. The presence of LRNC, a thin/ruptured FC, and IPH is associated with increased risk of future stroke or TIA. Plaques with greater than 40% LRNC with a thin overlying FC are prone to rupture. LRNC is T2 hypointense and lacks enhancement on contrast enhanced T1 weighted images. Increasing LRNC size is associated with the development of new ulceration, FC rupture, increasing plaque burden, as well as fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome (ACS), and symptom-driven revascularization, allowing for MR biomarkers of carotid plaque vulnerability to be utilized for systemic athero-thrombotic risk and not just stroke/TIA. LRNC typically shrinks with appropriate statin therapy, with PCSK9 inhibitors possibly playing a role in patients with inadequate response. Carotid plaques with IPH represent a more advanced stage of atherosclerotic disease. IPH is detectable with field strengths of both 3.0 T and 1.5 T and will demonstrate high signal on all T1 weighted imaging sequences. The presence of IPH increases the risk of future stroke in both symptomatic and asymptomatic patients, with multivariate analysis identifying IPH as a predictor of stroke, independent of percent stenosis, with no statistical difference in men vs. women, demonstrating that simple carotid stenosis measurements and traditional risk factor analysis may be inadequate in identifying patients at the highest risk for adverse cerebrovascular events. In the evaluation for recurrent stroke in recently symptomatic patients with >50% carotid stenosis, the estimated annual stroke risk is 23.2% in IPH+ patients and only 0.6% in IPH- patients, calling into question the current risk-benefit assessment for CEA. Additionally, a recent meta-analysis suggests that IPH+ plaque in patients with symptomatic <50% stenosis may be the etiology of embolic strokes previously labeled as "embolic stroke of undetermined source" (ESUS). There are no prospective drug trials testing the ability of any lipid-lowering therapies to decrease IPH and/or total plaque volume (TPV). Given the continuously increasing evidence of IPH as a significant predictor of carotid plaque progression and future adverse vascular events, trials aimed at targeted therapy for IPH represents a significant need.
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Affiliation(s)
- Michael E Porambo
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - J Kevin DeMarco
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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17
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Mota RI, Morgan SE, Bahnson EM. Diabetic vasculopathy: macro and microvascular injury. CURRENT PATHOBIOLOGY REPORTS 2020; 8:1-14. [PMID: 32655983 PMCID: PMC7351096 DOI: 10.1007/s40139-020-00205-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Diabetes is a common and prevalent medical condition as it affects many lives around the globe. Specifically, type-2 Diabetes (T2D) is characterized by chronic systemic inflammation alongside hyperglycemia and insulin resistance in the body, which can result in atherosclerotic legion formation in the arteries and thus progression of related conditions called diabetic vasculopathies. T2D patients are especially at risk for vascular injury; adjunct in many of these patients heir cholesterol and triglyceride levels reach dangerously high levels and accumulate in the lumen of their vascular system. RECENT FINDINGS Microvascular and macrovascular vasculopathies as complications of diabetes can accentuate the onset of organ illnesses, thus it is imperative that research efforts help identify more effective methods for prevention and diagnosis of early vascular injuries. Current research into vasculopathy identification/treatment will aid in the amelioration of diabetes-related symptoms and thus reduce the large number of deaths that this disease accounts annually. SUMMARY This review aims to showcase the evolution and effects of diabetic vasculopathy from development to clinical disease as macrovascular and microvascular complications with a concerted reference to sex-specific disease progression as well.
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Affiliation(s)
- Roberto I. Mota
- Department of Surgery, Division of Vascular Surgery; University of North Carolina at Chapel Hill, NC 27599
- Center for Nanotechnology in Drug Delivery; University of North Carolina at Chapel Hill, NC 27599
- McAllister Heart Institute, University of North Carolina at Chapel Hill, NC 27599
| | - Samuel E. Morgan
- Department of Surgery, Division of Vascular Surgery; University of North Carolina at Chapel Hill, NC 27599
- Center for Nanotechnology in Drug Delivery; University of North Carolina at Chapel Hill, NC 27599
| | - Edward M. Bahnson
- Department of Surgery, Division of Vascular Surgery; University of North Carolina at Chapel Hill, NC 27599
- Center for Nanotechnology in Drug Delivery; University of North Carolina at Chapel Hill, NC 27599
- McAllister Heart Institute, University of North Carolina at Chapel Hill, NC 27599
- Department of Cell Biology and Physiology. University of North Carolina at Chapel Hill, NC 27599
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18
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Saba L, Lanzino G, Lucatelli P, Lavra F, Sanfilippo R, Montisci R, Suri JS, Yuan C. Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraparenchymal Hemorrhage: A Preliminary Analysis. AJNR Am J Neuroradiol 2019; 40:1538-1545. [PMID: 31395662 DOI: 10.3174/ajnr.a6160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/28/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The presence of IPH is considered the most dangerous feature because it is significantly associated with clinical ipsilateral cerebrovascular events. Our aim was to explore the characterization of plaque with CT in symptomatic subjects with bilateral intraplaque hemorrhage. MATERIALS AND METHODS Three-hundred-forty-three consecutive patients with recent anterior circulation ischemic events (<2 weeks) and CT of the carotid arteries (performed within 14 days of the cerebrovascular event) evaluated between June 2012 and September 2017 were analyzed for plaque volume composition to identify all subjects with bilateral intraplaque hemorrhage. Plaque volume was semiautomatically measured, and tissue components were classified according to the attenuation values such as the following: calcified (for values of ≥130 HU), mixed (for values of ≥60 and <130 HU), lipid (for values of ≥25 and <60 HU), and intraplaque hemorrhage (for values of <25 HU). Twenty-one subjects (15 men; mean age, 70 ± 11 years; range, 44-87 years) had bilateral intraplaque hemorrhage and were included in the analysis. RESULTS Volume measurement revealed significantly larger plaques on the symptomatic side compared with the asymptomatic one (mean, 28 ± 9 versus 22 ± 8 mm, P = .007). Intraplaque hemorrhage volume and percentage were also significantly higher in the plaque ipsilateral to the cerebrovascular event (P < .001 and < .001, respectively). The volume of other plaque components did not show a statically significant association except for lipid and lipid + intraplaque hemorrhage percentages (23% versus 18% and 11% versus 15%), which were significantly different between the symptomatic and the asymptomatic sides (.016 and .011, respectively). The intraplaque hemorrhage/lipid ratio was higher on the symptomatic side (0.596 versus 0.171, P = .001). CONCLUSIONS In patients with bilateral intraplaque hemorrhage and recent ischemic symptoms, the plaque ipsilateral to the symptomatic side has significantly larger volume and a higher percentage of intraplaque hemorrhage compared with the contralateral, asymptomatic side.
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Affiliation(s)
- L Saba
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - G Lanzino
- Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - P Lucatelli
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology (P.L.), Sapienza University of Rome, Rome, Italy
| | - F Lavra
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - R Sanfilippo
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - R Montisci
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - J S Suri
- Diagnostic and Monitoring Division (J.S.S.), Atheropoint, Roseville, California.,Department of Electrical Engineering (J.S.S.), University of Idaho, Moscow, Idaho
| | - C Yuan
- Center for Biomedical Imaging Research (C.Y.), Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Department of Radiology (C.Y.), University of Washington, Seattle, Washington
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19
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Saba L, Saam T, Jäger HR, Yuan C, Hatsukami TS, Saloner D, Wasserman BA, Bonati LH, Wintermark M. Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol 2019; 18:559-572. [PMID: 30954372 DOI: 10.1016/s1474-4422(19)30035-3] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/15/2023]
Abstract
Stroke represents a massive public health problem. Carotid atherosclerosis plays a fundamental part in the occurence of ischaemic stroke. European and US guidelines for prevention of stroke in patients with carotid plaques are based on quantification of the percentage reduction in luminal diameter due to the atherosclerotic process to select the best therapeutic approach. However, better strategies for prevention of stroke are needed because some subtypes of carotid plaques (eg, vulnerable plaques) can predict the occurrence of stroke independent of the degree of stenosis. Advances in imaging techniques have enabled routine characterisation and detection of the features of carotid plaque vulnerability. Intraplaque haemorrhage is accepted by neurologists and radiologists as one of the features of vulnerable plaques, but other characteristics-eg, plaque volume, neovascularisation, and inflammation-are promising as biomarkers of carotid plaque vulnerability. These biomarkers could change current management strategies based merely on the degree of stenosis.
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Affiliation(s)
- Luca Saba
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy.
| | - Tobias Saam
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany; Radiologisches Zentrum Rosenheim, Rosenheim, Germany
| | - H Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Bruce A Wasserman
- The Russell H Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
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20
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Mossa-Basha M, Watase H, Sun J, Shibata DK, Hippe DS, Balu N, Hatsukami T, Yuan C. Inter-rater and scan-rescan reproducibility of the detection of intracranial atherosclerosis on contrast-enhanced 3D vessel wall MRI. Br J Radiol 2019; 92:20180973. [PMID: 30789784 DOI: 10.1259/bjr.20180973] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The objective is to establish interscan, inter- and intra-rater reproducibility of a multicontrast three-dimensional contrast-enhanced intracranial vessel wall (IVW) MRI protocol with 0.6 mm acquired (0.3 mm interpolated) isotropic resolution in the detection of intracranial atherosclerosis. METHODS Subjects with established intracranial atherosclerosis were prospectively recruited and underwent two contrast-enhanced three-dimensional IVW scans within a 2-week period. Four raters with varying degrees of vessel wall imaging interpretation experience, through an iterative training process developed guidelines for plaque identification with no, possible and definite plaque categories. Using these guidelines, the raters reviewed the cases in pairs (consensus rating), while blinded to the interpretations of the other pair, clinical reports and patient history. The rater pairs reviewed 19 segments per patient for the presence and location of atherosclerotic plaques. Inter-scan, inter rater and intra rater reproducibility were assessed. RESULTS 19 subjects were scanned twice, with 361 total segments reviewed and 304-324 evaluable segments analyzed in the different reproducibility assessments. Overall inter-rater agreement for possible and definite plaque was 88.9 % [κ = 0.73; 95% confidence interval (CI) (0.62-0.81)], inter-scan/intra-rater agreement was 82.1 % [κ = 0.58; 95% CI (0.48-0.70)] and inter-scan/inter-rater agreement of 84.5% [κ = 0.64; 95% CI (0.51 - 0.76)]. CONCLUSION Contrast-enhanced IVW imaging, with the utilization of detailed plaque definition guidelines for image review, can be a reproducible technique for the evaluation of intracranial atherosclerosis. ADVANCES IN KNOWLEDGE This work is the first to establish reproducibility of IVW for plaque identification with and without contrast. Reproducibility using contrast is important as most IVW applications rely on lesion enhancement.
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Affiliation(s)
- Mahmud Mossa-Basha
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Hiroko Watase
- 2 Department of Surgery, University of Washington School of Medicine , Seattle , United States
| | - Jie Sun
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Dean K Shibata
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Daniel S Hippe
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Niranjan Balu
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Thomas Hatsukami
- 2 Department of Surgery, University of Washington School of Medicine , Seattle , United States
| | - Chun Yuan
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
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21
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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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22
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111In-DANBIRT In Vivo Molecular Imaging of Inflammatory Cells in Atherosclerosis. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:6508724. [PMID: 30538613 PMCID: PMC6257909 DOI: 10.1155/2018/6508724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/24/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022]
Abstract
Atherosclerosis-related morbidity and mortality remain a global concern. Atherosclerotic disease follows a slow and silent progression, and the transition from early-stage lesions to vulnerable plaques remains difficult to diagnose. Inflammation is a key component of the development of atherosclerotic plaque and consequent life-threatening complications. This study assessed 111In-DANBIRT as an in vivo, noninvasive SPECT/CT imaging probe targeting an inflammatory marker, Lymphocyte Function Associated Antigen-1 (LFA-1), in atherosclerotic plaques. Methods. Selective binding of 111In-DANBIRT was assessed using Sprague-Dawley rats exposed to filtered air and ozone (1 ppm) by inhalation for 4 hours to induce a circulating leukocytosis and neutrophilia in peripheral blood. After 24 hours, whole blood was collected and incubated with radiolabeled DANBIRT (68Ga-DANBIRT and 111In-DANBIRT). Isolated cell component smeared slides using cytospin technique were stained with Wright-Giemsa stain. Apolipoprotein E-deficient (apoE−/−) mice were fed either a normal diet or a high-fat diet (HFD) for 8 weeks. Longitudinal SPECT/CT imaging was performed 3 hours after administration at baseline, 4, and 8 weeks of HFD diet, followed by tissue harvesting for biodistribution, serum lipid analysis, and histology. 3D autoradiography was performed in both groups 24 hours after administration of 111In-DANBIRT. Results. Increased specific uptake of radiolabeled DANBIRT by neutrophils in the ozone-exposed group was evidenced by the acute immune response due to 4-hour ozone exposure. Molecular imaging performed at 3 hours using SPECT/CT imaging evidenced an exponential longitudinal increase in 111In-DANBIRT uptake in atherosclerosis lesions in HFD-fed mice compared to normal-diet-fed mice. Such results were consistent with increased immune response to vascular injury in cardiovascular and also immune tissues, correlated by 24 hours after administration of 3D autoradiography. Histologic analysis confirmed atherosclerotic disease progression with an increased vascular lesion area in HFD-fed mice compared to normal-diet-fed mice. Conclusion. 111In-DANBIRT is a promising molecular imaging probe to assess inflammation in evolving atheroma and atherosclerotic plaque.
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23
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Kim S, Kwak HS, Hwang SB, Chung GH. Dynamic change of carotid intraplaque hemorrhage volume in subjects with mild carotid stenosis. Eur J Radiol 2018; 105:15-19. [PMID: 30017272 DOI: 10.1016/j.ejrad.2018.05.018] [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: 12/18/2017] [Revised: 03/16/2018] [Accepted: 05/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of intraplaque hemorrhage (IPH) in the carotid artery is important as it is correlated with an increased risk of cerebral ischemic events. We examined changes in IPH with magnetic resonance imaging (MRI) over an extended follow-up period in patients with mild carotid stenosis. MATERIALS AND METHODS From November 2013 to November 2015, we retrospectively reviewed cerebral MRI of 2036 patients, including magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequences obtained with a 3.0 T (T) MRI unit. An experienced neuroradiologist reviewed all studies and found 38 patients with carotid IPH and carotid stenosis that were categorized as mild (<30%), according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Twenty-five patients agreed to join this study and signed informed consent for (MPRAGE) sequence imaging. We used semi-automated software to measure IPH volume on both the initial and follow up scans. RESULTS The median follow-up time of patients with mild carotid stenosis and IPH was 33.3 months. IPH volume increased in 10 of 27 carotid arteries (37.0%), with a mean volume increase of 42.6 ± 44.0 mm3. IPH volume decreased in 17 of 27 carotid arteries (63%), with a mean volume decrease of 17.2 ± 22.8 mm3. Two patients without IPH at baseline showed IPH development on follow-up imaging. There were no significant differences in patient demographics between the two groups. CONCLUSIONS Carotid IPH volume in subjects with mild carotid stenosis can change over time and may not be correlated with any typical patient demographics.
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Affiliation(s)
- Sangheon Kim
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea
| | - Hyo Sung Kwak
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea.
| | - Seung Bae Hwang
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea
| | - Gyung-Ho Chung
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea
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24
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LeBlanc S, Coulombe F, Bertrand OF, Bibeau K, Pibarot P, Marette A, Alméras N, Lemieux I, Després JP, Larose E. Hypertriglyceridemic Waist: A Simple Marker of High-Risk Atherosclerosis Features Associated With Excess Visceral Adiposity/Ectopic Fat. J Am Heart Assoc 2018; 7:JAHA.117.008139. [PMID: 29654193 PMCID: PMC6015425 DOI: 10.1161/jaha.117.008139] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Subclinical atherosclerosis identification remains challenging; abdominal visceral adiposity may improve risk stratification beyond traditional cardiovascular risk factors. Hypertriglyceridemic waist, a visceral adiposity marker combining elevated triglycerides (≥2 mmol/L) and waist circumference (≥90 cm), has been related to carotid atherosclerosis, although associations with high‐risk features, including lipid‐rich necrotic core (LRNC), remain unknown. We tested the hypothesis that hypertriglyceridemic waist is an independent marker of high‐risk atherosclerosis features. Methods and Results In this cross‐sectional study including 467 white men (mean age, 45.9±14.8 years; range 19.4–77.6 years), carotid atherosclerosis characteristics were examined by magnetic resonance imaging and associations with hypertriglyceridemic waist and benefits beyond Framingham Risk Score (FRS) and Pathobiological Determinants of Atherosclerosis in Youth (PDAY) were determined. Subclinical carotid atherosclerosis was present in 61.9% of participants, whereas 50.1% had LRNC. Hypertriglyceridemic waist was associated with carotid maximum wall thickness (P=0.014), wall volume (P=0.025), normalized wall index (P=0.004), and Carotid Atherosclerosis Score (derived from wall thickness and LRNC; P=0.049). Hypertriglyceridemic waist was associated with carotid LRNC volume beyond FRS (P=0.037) or PDAY (P=0.015), contrary to waist circumference alone (both P>0.05). Although 69.7% and 62.0% of participants with carotid atherosclerosis and/or LRNC were not high‐risk by FRS or PDAY, respectively, hypertriglyceridemic waist correctly reclassified 9.7% and 4.5% of them, respectively. Combining hypertriglyceridemic waist with FRS (net reclassification improvement=0.17; P<0.001) or PDAY (net reclassification improvement=0.05; P=0.003) was superior to each score alone in identifying individuals with carotid atherosclerosis and/or LRNC. Conclusions Hypertriglyceridemic waist is an independent marker of carotid high‐risk atherosclerosis features in men, improving on FRS and PDAY risk score.
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Affiliation(s)
- Stéphanie LeBlanc
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.,Département de Médecine, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - François Coulombe
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.,Département de Médecine, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Olivier F Bertrand
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.,Département de Médecine, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Karine Bibeau
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.,Département de Médecine, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - André Marette
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.,Département de Médecine, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Natalie Alméras
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.,Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Isabelle Lemieux
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Jean-Pierre Després
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.,Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Eric Larose
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada .,Département de Médecine, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
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Zhao XQ, Hatsukami TS. Risk Factors for Development of Carotid Plaque Components. JACC Cardiovasc Imaging 2018; 11:193-195. [PMID: 28412422 DOI: 10.1016/j.jcmg.2016.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Xue-Qiao Zhao
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
| | - Thomas S Hatsukami
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Washington
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Lu M, Peng P, Cui Y, Qiao H, Li D, Cai J, Zhao X. Association of Progression of Carotid Artery Wall Volume and Recurrent Transient Ischemic Attack or Stroke: A Magnetic Resonance Imaging Study. Stroke 2018; 49:614-620. [PMID: 29382804 DOI: 10.1161/strokeaha.117.019422] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/18/2017] [Accepted: 12/15/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the association between carotid plaque progression and subsequent recurrent events using magnetic resonance imaging. METHODS Sixty-three symptomatic patients with ipsilateral carotid atherosclerotic stenosis (30%-69% stenosis) determined by ultrasound underwent first and second carotid artery magnetic resonance imaging for carotid artery at baseline and ≥6 months after the first scan, respectively. All the patients had clinical follow-up after the second magnetic resonance scan for ≤5 years until the onset of recurrent transient ischemic attack or stroke. Presence/absence of carotid plaque compositional features, particularly intraplaque hemorrhage and fibrous cap rupture was identified. The annual progression of carotid wall volume between 2 magnetic resonance scans was measured. Univariate and multivariate Cox regression was used to calculate the hazard ratio and corresponding 95% confidence interval of carotid plaque features in discriminating recurrent events. Receiver-operating-characteristic-curve analysis was conducted to determine the area-under-the-curve of carotid plaque features in predicting recurrent events. RESULTS Sixty-three patients (mean age: 66.5±10.0 years old; 54 males) were eligible for final statistics analysis. During a mean follow-up duration of 55.1±13.6 months, 14.3% of patients (n=9) experienced ipsilateral recurrent transient ischemic attack/stroke. The annual progression of carotid wall volume was significantly associated with recurrent events before (hazard ratio, 1.14 per 10 mm3; 95% confidence interval, 1.02-1.27; P=0.019) and after (hazard ratio, 1.19 per 10 mm3; 95% confidence interval, 1.03-1.37; P=0.022) adjusted for confounding factors. In discriminating the recurrence of transient ischemia attack/stroke, receiver-operator curve analysis indicated that combined with annual progression of wall volume, there was a significant incremental improvement in the area-under-the-curve of intraplaque hemorrhage (area-under-the-curve: 0.69-0.81) and fibrous cap rupture (area-under-the-curve: 0.73-0.84). CONCLUSIONS The annual progression of carotid wall volume is independently associated with recurrent ischemic cerebrovascular events, and this measurement has added value for intraplaque hemorrhage and fibrous cap rupture in predicting future events.
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Affiliation(s)
- Mingming Lu
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Peng Peng
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Yuanyuan Cui
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Huiyu Qiao
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Dongye Li
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Jianming Cai
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.).
| | - Xihai Zhao
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.).
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Qi H, Sun J, Qiao H, Chen S, Zhou Z, Pan X, Wang Y, Zhao X, Li R, Yuan C, Chen H. Carotid Intraplaque Hemorrhage Imaging with Quantitative Vessel Wall T1 Mapping: Technical Development and Initial Experience. Radiology 2017; 287:276-284. [PMID: 29117484 DOI: 10.1148/radiol.2017170526] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To develop a three-dimensional (3D) high-spatial-resolution time-efficient sequence for use in quantitative vessel wall T1 mapping. Materials and Methods A previously described sequence, simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging, was extended by introducing 3D golden angle radial k-space sampling (GOAL-SNAP). Sliding window reconstruction was adopted to reconstruct images at different inversion delay times (different T1 contrasts) for voxelwise T1 fitting. Phantom studies were performed to test the accuracy of T1 mapping with GOAL-SNAP against a two-dimensional inversion recovery (IR) spin-echo (SE) sequence. In vivo studies were performed in six healthy volunteers (mean age, 27.8 years ± 3.0 [standard deviation]; age range, 24-32 years; five male) and five patients with atherosclerosis (mean age, 66.4 years ± 5.5; range, 60-73 years; five male) to compare T1 measurements between vessel wall sections (five per artery) with and without intraplaque hemorrhage (IPH). Statistical analyses included Pearson correlation coefficient, Bland-Altman analysis, and Wilcoxon rank-sum test with data permutation by subject. Results Phantom T1 measurements with GOAL-SNAP and IR SE sequences showed excellent correlation (R2 = 0.99), with a mean bias of -25.8 msec ± 43.6 and a mean percentage error of 4.3% ± 2.5. Minimum T1 was significantly different between sections with IPH and those without it (mean, 371 msec ± 93 vs 944 msec ± 120; P = .01). Estimated T1 of normal vessel wall and muscle were 1195 msec ± 136 and 1117 msec ± 153, respectively. Conclusion High-spatial-resolution (0.8 mm isotropic) time-efficient (5 minutes) vessel wall T1 mapping is achieved by using the GOAL-SNAP sequence. This sequence may yield more quantitative reproducible biomarkers with which to characterize IPH and monitor its progression. © RSNA, 2017.
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Affiliation(s)
- Haikun Qi
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Jie Sun
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Huiyu Qiao
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Shuo Chen
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Zechen Zhou
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Xinlei Pan
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Yishi Wang
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Xihai Zhao
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Rui Li
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Chun Yuan
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
| | - Huijun Chen
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, Room 109, School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China (H. Qi, H. Qiao, S.C., X.P., Y.W., X.Z., R.L., C.Y., H.C.); Philips Research China, Shanghai, China (Z.Z.); and Department of Radiology, University of Washington, Seattle, Wash (J.S., C.Y.)
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Sun J, Zhao XQ, Balu N, Neradilek MB, Isquith DA, Yamada K, Cantón G, Crouse JR, Anderson TJ, Huston J, O'Brien K, Hippe DS, Polissar NL, Yuan C, Hatsukami TS. Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes: The MRI Substudy in AIM-HIGH. JACC Cardiovasc Imaging 2017; 10:241-249. [PMID: 28279371 DOI: 10.1016/j.jcmg.2016.06.017] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. BACKGROUND Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. METHODS As part of the event-driven clinical trial AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes), subjects with clinically established atherosclerotic disease underwent multicontrast carotid magnetic resonance imaging (MRI) to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazards survival models. RESULTS Of the 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (82% male, mean age 61 ± 9 years, 94% statin use). During median follow-up of 35.1 months, 18 subjects (8.4%) reached the AIM-HIGH endpoint. High lipid content (hazard ratio [HR] per 1 SD increase in percent lipid core volume: 1.57; p = 0.002) and thin/ruptured fibrous cap (HR: 4.31; p = 0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (HR: 3.00; p = 0.053). High calcification content (HR per 1 SD increase in percent calcification volume: 0.66; p = 0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment. CONCLUSIONS Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Xue-Qiao Zhao
- Department of Medicine, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Daniel A Isquith
- Department of Medicine, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Gádor Cantón
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - John R Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J Anderson
- Libin Cardiovascular Institute of Alberta and Cumming School of Medicine, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin O'Brien
- Department of Medicine, University of Washington, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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Chung GH, Kwak HS, Hwang SB, Noh SJ. Magnetic resonance imaging of intracranial atherosclerosis: Comparison of ex vivo 3T MRI and histologic findings. Eur J Radiol 2017; 97:110-114. [PMID: 29153360 DOI: 10.1016/j.ejrad.2017.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/02/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Imaging the lipid-rich necrotic core (LRNC) is very important when evaluating the response of lipid-lowering therapy. The purpose of this study was to assess ex vivo LRNC of intracranial atherosclerosis using 3T MRI. MATERIALS AND METHODS Thirty-one atherosclerotic lesions from 17 specimens were analyzed (basilar artery=15, middle cerebral artery=16) using 3T MRI. Specimens were not chemically processed for imaging studies. Reconstructed MRI was matched with histologic sections at corresponding locations. RESULTS The median plaque thickness of intracranial atherosclerosis was 0.6mm (0.4-2.0mm). All specimens had a LRNC on histologic findings. Three specimens had plaque calcification on histologic findings. LRNC of 30 specimens (96.8%) appeared as homogeneous isointensity/hypointensity on T1-weighted imaging and hypointensity on T2-weighted imaging compared with T1-weighted imaging. CONCLUSIONS All specimens with ex vivo intracranial atherosclerosis had LRNC. Intracranial atherosclerosis could be an indication for lipid-lowering therapy, similar to previous carotid MR studies.
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Affiliation(s)
- Gyung Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Medical School and Hospital, Republic of Korea
| | - Hyo Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Medical School and Hospital, Republic of Korea.
| | - Seung Bae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, Republic of Korea
| | - Sang Jae Noh
- Department of Forensic Medicine, Chonbuk National University Medical School and Hospital, Republic of Korea
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30
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Wang J, Chen H, Sun J, Hippe DS, Zhang H, Yu S, Cai J, Xie L, Cui B, Yuan C, Zhao X, Yuan W, Liu H. Dynamic contrast-enhanced MR imaging of carotid vasa vasorum in relation to coronary and cerebrovascular events. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Yuan C, Sun J. MR Quantification of Plaque Lipid Content. JACC Cardiovasc Imaging 2017; 10:757-759. [DOI: 10.1016/j.jcmg.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 10/19/2022]
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32
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Brinjikji W, Lehman VT, Kallmes DF, Rabinstein AA, Lanzino G, Murad MH, Mulvagh S, Klaas J, Graff-Radford J, DeMarco KJ, Huston III J. The effects of statin therapy on carotid plaque composition and volume: A systematic review and meta-analysis. J Neuroradiol 2017; 44:234-240. [DOI: 10.1016/j.neurad.2016.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/26/2016] [Accepted: 12/21/2016] [Indexed: 01/30/2023]
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Kerwin WS, Miller Z, Yuan C. Imaging of the high-risk carotid plaque: magnetic resonance imaging. Semin Vasc Surg 2017; 30:54-61. [PMID: 28818259 DOI: 10.1053/j.semvascsurg.2017.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The emergence of the concept of high-risk atherosclerotic plaque has led to considerable interest in noninvasive imaging techniques to identify high-risk features before clinical sequelae. For plaques in the carotid arteries, magnetic resonance imaging has undergone considerable histologic validation to link imaging features to indicators of plaque instability, including plaque burden, intraplaque hemorrhage, fibrous cap disruption, lipid rich necrotic core, and calcification. Recently introduced imaging technologies, especially those focused on three-dimensional imaging sequences, are now poised for integration into the clinical workup of patients with suspected carotid atherosclerosis. The purpose of this article is to review the carotid plaque magnetic resonance imaging techniques that are most ready for integration into the clinic.
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Affiliation(s)
- William S Kerwin
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Zach Miller
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Chun Yuan
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109.
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Khan AA, Hecker JC, Lal BK, Sikdar S. Clinical viability of carotid plaque strain estimation using B-mode ultrasound image sequences. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2877-2880. [PMID: 28268915 DOI: 10.1109/embc.2016.7591330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is estimated that approximately 30% of ischemic strokes are caused by rupture of plaque in the carotid artery. Development of techniques focusing on identifying plaques that are vulnerable to rupture is thus indispensable for stroke prevention. Recent studies have demonstrated that motion analysis of plaques from B-mode and RF ultrasound (US) image sequences can be used to estimate plaque strain. However, viability of these methods in a clinical setting, with variable acquisition protocols, has not been demonstrated yet. In this paper, we explore the viability of estimating plaque strain from B-mode US images of asymptomatic patients, acquired in a real clinical setting with different acquisition settings, frame rates, and operators. Our proposed strain measures, shear strain rate entropy and variance, combined with the recently reported maximum absolute shear strain rate, show that the plaques fall into two distinct clusters. Moreover, these clusters show good correlations with plaque echolucency and echogenicity. We conclude that B-mode US imaging is a viable tool for characterizing plaque dynamics in clinical environments. In future studies, we plan to implement this method on multi-center studies for longitudinal monitoring of plaque.
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Kwak HS, Yang HJ, Hwang SB, Chung GH. Carotid Wall Imaging with Routine Brain MRI to Facilitate Early Detection of Carotid Plaque and Intraplaque Hemorrhage. J Stroke 2017; 19:107-108. [PMID: 28178412 PMCID: PMC5307945 DOI: 10.5853/jos.2016.01571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hyo Sung Kwak
- Department of Radiology of Chonbuk National University, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Hye Jin Yang
- Department of Radiology of Chonbuk National University, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Bae Hwang
- Department of Radiology of Chonbuk National University, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Gyung Ho Chung
- Department of Radiology of Chonbuk National University, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Wang X, Sun J, Zhao X, Hippe DS, Hatsukami TS, Liu J, Li R, Canton G, Song Y, Yuan C. Ipsilateral plaques display higher T1 signals than contralateral plaques in recently symptomatic patients with bilateral carotid intraplaque hemorrhage. Atherosclerosis 2017; 257:78-85. [PMID: 28110259 PMCID: PMC5325786 DOI: 10.1016/j.atherosclerosis.2017.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Prospective studies have shown a strong association between carotid intraplaque hemorrhage (IPH), detected by magnetic resonance imaging (MRI), and cerebrovascular ischemic events. However, IPH is also observed in a substantial number of asymptomatic patients. We hypothesized that there are differences in the characteristics of IPH+ plaques associated with recent symptoms, compared to IPH+ plaques not associated with recent symptoms. METHODS Patients with recent (≤2 weeks) anterior circulation ischemic events were scanned using a standardized multisequence protocol. Those showing IPH bilaterally were included and analyzed for differences in T1/T2 signals, plaque morphology, and coexisting plaque characteristics between the ipsilateral symptomatic and contralateral asymptomatic sides. RESULTS Thirty-one subjects (67 ± 9 years, 97% males) with bilateral IPH were studied. Despite comparable luminal stenosis (53 ± 42% vs. 53 ± 39%, p = 0.99), T1 signal of IPH measured as signal-intensity-ratio compared to muscle was stronger (SIRIPH-to-muscle: 5.8 ± 2.4 vs. 4.7 ± 1.8, p = 0.004) and tended to be more extensively distributed (IPH volume: 150 ± 199 vs. 88 ± 106 mm3, p = 0.071) on the symptomatic side. IPH+ plaques on the symptomatic side were longer (24 ± 6 vs. 21 ± 7 mm, p = 0.026) and associated with larger necrotic core volume (406 ± 354 vs. 291 ± 293 mm3, p = 0.039) than those on the asymptomatic side. CONCLUSIONS In recently symptomatic patients with bilateral carotid IPH, the symptomatic side showed stronger T1 signals, larger necrotic cores, and longer plaque length than the asymptomatic side. Serial studies on the temporal relationship between these imaging features and clinical events will eventually establish their diagnostic and prognostic value beyond the mere presence of IPH.
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Affiliation(s)
- Xianling Wang
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Jin Liu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Rui Li
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Yan Song
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Radiology, Beijing Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Biomedical Engineering, Tsinghua University, Beijing, China; Department of Bioengineering, University of Washington, Seattle, WA, USA.
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Sun J, Hatsukami TS. Plaque Imaging to Decide on Optimal Treatment: Medical Versus Carotid Endarterectomy Versus Carotid Artery Stenting. Neuroimaging Clin N Am 2016; 26:165-73. [PMID: 26610667 DOI: 10.1016/j.nic.2015.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many of the current guidelines for the management of carotid atherosclerosis are based on clinical trial findings published more than 2 decades ago. The lack of plaque information in clinical decision making represents a major shortcoming and highlights the need for contemporary trials based on characteristics of the atherosclerotic lesion itself, rather than luminal stenosis alone. This article summarizes the major dilemmas clinicians face in current practice, and discusses the rationale and evidence that plaque imaging may help to address these challenges and optimize the clinical management of carotid artery disease in the future.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican Street, Seattle, WA 98109, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, 850 Republican Street, Seattle, WA 98109, USA.
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Sun J, Canton G, Balu N, Hippe DS, Xu D, Liu J, Hatsukami TS, Yuan C. Blood Pressure Is a Major Modifiable Risk Factor Implicated in Pathogenesis of Intraplaque Hemorrhage: An In Vivo Magnetic Resonance Imaging Study. Arterioscler Thromb Vasc Biol 2016; 36:743-9. [PMID: 26848155 DOI: 10.1161/atvbaha.115.307043] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/20/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Effective prevention and management strategies of intraplaque hemorrhage (IPH) remain elusive because of our limited knowledge regarding its contributing factors. This hypothesis-generating study aimed to investigate associations between cardiovascular risk factors and IPH for improved understanding of the pathogenesis of IPH. APPROACH AND RESULTS Asymptomatic subjects with 16% to 79% stenosis on ultrasound underwent carotid magnetic resonance imaging using a large-coverage, 3-dimensional magnetic resonance imaging protocol. Individual plaques (maximum thickness >1.5 mm) in bilateral carotid arteries were identified, and presence of IPH was determined. From 80 subjects, 176 de novo plaques were measured, of which 38 (21.6%) contained IPH. Blood pressure (BP), primarily low diastolic BP, was associated with IPH in multivariate analysis adjusted for age, sex, and plaque size (odds ratio with 95% confidence interval per 10-mm Hg increase: 0.51 [0.30-0.88]), which was little changed after adjusting for antihypertensive use and systemic atherosclerosis. Antiplatelet use was associated with IPH in age and sex-adjusted models (P=0.018), for which a trend remained after considering plaque size and past medical history (odds ratio for aspirin alone versus none: 3.1 [0.66-14.8]; odds ratio for clopidogrel or dual therapy versus none: 5.3 [0.80-35.0]; P=0.083). CONCLUSIONS Low diastolic BP was independently associated with IPH, which was not attributed to treatment difference or BP changes from systemic atherosclerosis. Hemodynamic changes from lowering diastolic BP may be the pathophysiological link. Prospective serial studies are needed to assess whether BP and antiplatelet use are associated with the development of new or repeated IPH.
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Affiliation(s)
- Jie Sun
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Gador Canton
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Niranjan Balu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Dongxiang Xu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Jin Liu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Thomas S Hatsukami
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Chun Yuan
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle.
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Yu JH, Kwak HS, Chung GH, Hwang SB, Park MS, Park SH. Association of Intraplaque Hemorrhage and Acute Infarction in Patients With Basilar Artery Plaque. Stroke 2015; 46:2768-72. [PMID: 26306752 DOI: 10.1161/strokeaha.115.009412] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution magnetic resonance imaging (HRMRI) is ideal for serial examination of diseased arterial walls because it is noninvasive and has superior capability of discriminating tissue characteristics. The aim of this study is to evaluate the prevalence and clinical relevance of intraplaque hemorrhage (IPH) in patients with basilar artery (BA) atherosclerosis using HRMRI. METHODS We analyzed HRMRI and clinical data from 74 patients (45 symptomatic and 29 asymptomatic), all of whom had >50% BA stenosis. High-signal intensity within a BA plaque on magnetization-prepared rapid acquisition with gradient-echo was defined as an area with an intensity that was >150% of the signal from the adjacent muscle. The relationship between IPH within a BA plaque region and clinical presentation was analyzed. RESULTS Thirty patients were positive for IPH on HRMRI (42.3%, 24 symptomatic and 6 asymptomatic). Symptomatic lesions in the MR-positive IPH group were significantly more prevalent than in the MR-negative group (80.0% versus 48.8%; P<0.01). Also, MR-predicted IPH was significantly more prevalent in the high-grade stenosis group (P<0.001) than in the low-grade group. The relative risk of an acute focal stroke event among patients who were magnetization-prepared rapid acquisition with gradient-echo-positive for IPH compared with patients who were magnetization-prepared rapid acquisition with gradient-echo-negative was 1.64. CONCLUSIONS IPH within a BA plaque region on HRMRI is highly prevalent and is associated with acute stroke.
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Affiliation(s)
- Jin Hee Yu
- From the Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk-do, South Korea (J.H.Y., H.S.K., G.H.C., S.B.H.); and Institute for Metabolic Disease and Radiology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, South Korea (M.S.P., S.H.P.)
| | - Hyo Sung Kwak
- From the Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk-do, South Korea (J.H.Y., H.S.K., G.H.C., S.B.H.); and Institute for Metabolic Disease and Radiology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, South Korea (M.S.P., S.H.P.).
| | - Gyung Ho Chung
- From the Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk-do, South Korea (J.H.Y., H.S.K., G.H.C., S.B.H.); and Institute for Metabolic Disease and Radiology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, South Korea (M.S.P., S.H.P.)
| | - Seung Bae Hwang
- From the Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk-do, South Korea (J.H.Y., H.S.K., G.H.C., S.B.H.); and Institute for Metabolic Disease and Radiology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, South Korea (M.S.P., S.H.P.)
| | - Mi Sung Park
- From the Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk-do, South Korea (J.H.Y., H.S.K., G.H.C., S.B.H.); and Institute for Metabolic Disease and Radiology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, South Korea (M.S.P., S.H.P.)
| | - Seong Hoon Park
- From the Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk-do, South Korea (J.H.Y., H.S.K., G.H.C., S.B.H.); and Institute for Metabolic Disease and Radiology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, South Korea (M.S.P., S.H.P.)
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In vivo semi-automatic segmentation of multicontrast cardiovascular magnetic resonance for prospective cohort studies on plaque tissue composition: initial experience. Int J Cardiovasc Imaging 2015; 32:73-81. [PMID: 26169389 DOI: 10.1007/s10554-015-0704-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
Automatic in vivo segmentation of multicontrast (multisequence) carotid magnetic resonance for plaque composition has been proposed as a substitute for manual review to save time and reduce inter-reader variability in large-scale or multicenter studies. Using serial images from a prospective longitudinal study, we sought to compare a semi-automatic approach versus expert human reading in analyzing carotid atherosclerosis progression. Baseline and 6-month follow-up multicontrast carotid images from 59 asymptomatic subjects with 16-79 % carotid stenosis were reviewed by both trained radiologists with 2-4 years of specialized experience in carotid plaque characterization with MRI and a previously reported automatic atherosclerotic plaque segmentation algorithm, referred to as morphology-enhanced probabilistic plaque segmentation (MEPPS). Agreement on measurements from individual time points, as well as on compositional changes, was assessed using the intraclass correlation coefficient (ICC). There was good agreement between manual and MEPPS reviews on individual time points for calcification (CA) (area: ICC; 0.85-0.91; volume: ICC; 0.92-0.95) and lipid-rich necrotic core (LRNC) (area: ICC; 0.78-0.82; volume: ICC; 0.84-0.86). For compositional changes, agreement was good for CA volume change (ICC; 0.78) and moderate for LRNC volume change (ICC; 0.49). Factors associated with LRNC progression as detected by MEPPS review included intraplaque hemorrhage (positive association) and reduction in low-density lipoprotein cholesterol (negative association), which were consistent with previous findings from manual review. Automatic classifier for plaque composition produced results similar to expert manual review in a prospective serial MRI study of carotid atherosclerosis progression. Such 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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Park JS, Kwak HS, Lee JM, Koh EJ, Chung GH, Hwang SB. Association of carotid intraplaque hemorrhage and territorial acute infarction in patients with acute neurological symptoms using carotid magnetization-prepared rapid acquisition with gradient-echo. J Korean Neurosurg Soc 2015; 57:94-9. [PMID: 25733989 PMCID: PMC4345200 DOI: 10.3340/jkns.2015.57.2.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 02/02/2023] Open
Abstract
Objective The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods 83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction. Results Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010). Conclusion Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.
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Affiliation(s)
- Jung Soo Park
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Hyo Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jong Myong Lee
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Eun Jeong Koh
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Gyung Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seung Bae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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Sun J, Zhao XQ, Balu N, Hippe DS, Hatsukami TS, Isquith DA, Yamada K, Neradilek MB, Cantón G, Xue Y, Fleg JL, Desvigne-Nickens P, Klimas MT, Padley RJ, Vassileva MT, Wyman BT, Yuan C. Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study. Int J Cardiovasc Imaging 2014; 31:95-103. [PMID: 25216871 DOI: 10.1007/s10554-014-0532-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98-0.99) and compositional (ICC range 0.88-0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5-4.9 % for morphology, 36-44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican St Brotman 127, Seattle, WA, 98109, USA,
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van Engelen A, Niessen WJ, Klein S, Groen HC, Verhagen HJM, Wentzel JJ, van der Lugt A, de Bruijne M. Atherosclerotic plaque component segmentation in combined carotid MRI and CTA data incorporating class label uncertainty. PLoS One 2014; 9:e94840. [PMID: 24762678 PMCID: PMC3999092 DOI: 10.1371/journal.pone.0094840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/19/2014] [Indexed: 11/22/2022] Open
Abstract
Atherosclerotic plaque composition can indicate plaque vulnerability. We segment atherosclerotic plaque components from the carotid artery on a combination of in vivo MRI and CT-angiography (CTA) data using supervised voxelwise classification. In contrast to previous studies the ground truth for training is directly obtained from 3D registration with histology for fibrous and lipid-rich necrotic tissue, and with μCT for calcification. This registration does, however, not provide accurate voxelwise correspondence. We therefore evaluate three approaches that incorporate uncertainty in the ground truth used for training: I) soft labels are created by Gaussian blurring of the original binary histology segmentations to reduce weights at the boundaries between components, and are weighted by the estimated registration accuracy of the histology and in vivo imaging data (measured by overlap), II) samples are weighted by the local contour distance of the lumen and outer wall between histology and in vivo data, and III) 10% of each class is rejected by Gaussian outlier rejection. Classification was evaluated on the relative volumes (% of tissue type in the vessel wall) for calcified, fibrous and lipid-rich necrotic tissue, using linear discriminant (LDC) and support vector machine (SVM) classification. In addition, the combination of MRI and CTA data was compared to using only one imaging modality. Best results were obtained by LDC and outlier rejection: the volume error per vessel was 0.9±1.0% for calcification, 12.7±7.6% for fibrous and 12.1±8.1% for necrotic tissue, with Spearman rank correlation coefficients of 0.91 (calcification), 0.80 (fibrous) and 0.81 (necrotic). While segmentation using only MRI features yielded low accuracy for calcification, and segmentation using only CTA features yielded low accuracy for necrotic tissue, the combination of features from MRI and CTA gave good results for all studied components.
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Affiliation(s)
- Arna van Engelen
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Wiro J. Niessen
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Harald C. Groen
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Jolanda J. Wentzel
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
| | | | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Teng Z, Sadat U, Brown AJ, Gillard JH. Plaque hemorrhage in carotid artery disease: pathogenesis, clinical and biomechanical considerations. J Biomech 2014; 47:847-58. [PMID: 24485514 PMCID: PMC3994507 DOI: 10.1016/j.jbiomech.2014.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 12/21/2022]
Abstract
Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Adam J Brown
- Department of Cardiovascular Medicine, University of Cambridge, UK
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Affiliation(s)
- Farouc A Jaffer
- Massachusetts General Hospital, Harvard Medical School, Cardiovascular Research Center, Boston, Massachusetts, USA
| | - Johan W Verjans
- Massachusetts General Hospital, Harvard Medical School, Cardiovascular Research Center, Boston, Massachusetts, USA Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
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