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Huang LX, Wu XB, Liu YA, Guo X, Liu CC, Cai WQ, Wang SW, Luo B. High-resolution magnetic resonance vessel wall imaging in ischemic stroke and carotid artery atherosclerotic stenosis: A review. Heliyon 2024; 10:e27948. [PMID: 38571643 PMCID: PMC10987942 DOI: 10.1016/j.heliyon.2024.e27948] [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: 09/11/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Ischemic stroke is a significant burden on human health worldwide. Carotid Atherosclerosis stenosis plays an important role in the comprehensive assessment and prevention of ischemic stroke patients. High-resolution vessel wall magnetic resonance imaging has emerged as a successful technique for assessing carotid atherosclerosis stenosis. This advanced imaging modality has shown promise in effectively displaying a wide range of characteristics associated with the condition, leading to a comprehensive evaluation. High-resolution vessel wall magnetic resonance imaging not only enables a comprehensive evaluation of the instability of carotid atherosclerosis stenosis plaques but also provides valuable information for understanding the pathogenesis and predicting the prognosis of ischemic stroke patients. The purpose of this article is to review the application of high-resolution magnetic resonance imaging in ischemic stroke and carotid atherosclerotic stenosis.
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Affiliation(s)
- Li-Xin Huang
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiao-Bing Wu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Ao Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xin Guo
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Chi-Chen Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Wang-Qing Cai
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sheng-Wen Wang
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Lian W, Lian K, Lin T. Breast Imaging Reporting and Data System evaluation of breast lesions improved with virtual touch tissue imaging average grayscale values. Technol Health Care 2024; 32:925-936. [PMID: 37545278 DOI: 10.3233/thc-230306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Early breast cancer diagnosis is of great clinical importance for selecting treatment options, improving prognosis, and enhancing the quality of patients' survival. OBJECTIVE We investigated the value of virtual touch tissue imaging average grayscale values (VAGV) helper Breast Imaging Reporting and Data System (BI-RADS) in diagnosing breast malignancy. METHODS We retrospectively analyzed 141 breast tumors in 134 patients. All breast lesions were diagnosed pathologically by biopsy or surgical excision. All patients first underwent conventional ultrasound (US) followed by virtual touch tissue imaging (VTI). The measurement of the VAGV of the lesion was performed by Image J software. BI-RADS classification was performed for each lesion according to the US. We performed a two-by-two comparison of the diagnostic values of VAGV, BI-RADS, and BI-RADS+VAGV. RESULTS VAGV was lower in malignant tumors than in benign ones (35.82 ± 13.39 versus 73.58 ± 42.69, P< 0.001). The area under the receiver operating characteristic curve (AUC) value, sensitivity, and specificity of VAGV was 0.834, 84.09%, and 69.07%, respectively. Among BI-RADS, VAGV, and BI-RADS+VAGV, BI-RADS+VAGV had the highest AUC (0.926 versus 0.882, P= 0.0066; 0.926 versus 0.834, P= 0.0012). There was perfect agreement between the two radiologists using VAGV (ICC= 0.9796) and substantial agreement using BI-RADS (Kappa= 0.725). CONCLUSION Our study shows that VAGV can accurately diagnose breast cancer. VAGV effectively improves the diagnostic performance of BI-RADS.
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Morphological and Compositional Features of Chronic Internal Carotid Artery Occlusion in MR Vessel Wall Imaging Predict Successful Endovascular Recanalization. Diagnostics (Basel) 2023; 13:diagnostics13010147. [PMID: 36611438 PMCID: PMC9818158 DOI: 10.3390/diagnostics13010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Background: We sought to determine if the morphological and compositional features of chronic internal carotid artery occlusion (CICAO), as assessed by MR vessel wall imaging (MR-VWI), initially predict successful endovascular recanalization. Methods: Consecutive patients with CICAO scheduled for endovascular recanalization were recruited. MR-VWI was performed within 1 week prior to surgery for evaluating the following features: proximal stump morphology, extent of occlusion, occlusion with collapse, arterial tortuosity, the presence of hyperintense signals (HIS) and calcification in the occluded C1 segment. Multivariate logistic regression was used to identify features associated with technical success and construct a prediction model. Results: Eighty-three patients were recruited, of which fifty-seven (68.7%) were recanalized successfully. The morphological and compositional characteristics of CICAO were associated with successful recanalization, including occlusions limited to C1 and extensive HIS, as well as the absence of extensive calcification, absence of high tortuosity, and absence of artery collapse. The MR CICAO score that comprised the five predictors showed a high predictive ability (area under the curve: 0.888, p < 0.001). Conclusion: the MR-VWI characteristics of CICAO predicted the technical success of endovascular recanalization and may be leveraged for identifying patients with a high probability of successful recanalization.
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Association of Contrast Enhancement of Proximal Internal Carotid Artery Wall and Champagne Bottle Neck Sign with Ipsilateral Stroke in Moyamoya Disease Patients. Eur J Radiol 2022; 155:110501. [DOI: 10.1016/j.ejrad.2022.110501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
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Chen Z, Gould A, Geleri DB, Balu N, Chen L, Chu B, Pimentel K, Canton G, Hatsukami TS, Yuan C. Associations of intracranial artery length and branch number on non-contrast enhanced MRA with cognitive impairment in individuals with carotid atherosclerosis. Sci Rep 2022; 12:7456. [PMID: 35524158 PMCID: PMC9076596 DOI: 10.1038/s41598-022-11418-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Developing novel risk markers for vascular contributions to cognitive impairment and dementia is important. This study aimed to extract total length, branch number and average tortuosity of intracranial distal arteries (A2, M2, P2 and more distal) from non-contrast enhanced magnetic resonance angiography (NCE-MRA) images, and explore their associations with global cognition. In 29 subjects (aged 40-90 years) with carotid atherosclerotic disease, the 3 intracranial vascular features on two NCE-MRA techniques (i.e. time of flight, TOF and simultaneous non-contrast angiography and intraplaque hemorrhage, SNAP) were extracted using a custom-developed software named iCafe. Arterial spin labeling (ASL) and phase contrast (PC) cerebral blood flow (CBF) were measured as references. Linear regression was performed to study their associations with global cognition, measured with the Montreal Cognitive Assessment (MoCA). Intracranial artery length and number of branches on NCE-MRA, ASL CBF and PC CBF were found to be positively associated with MoCA scores (P < 0.01). The associations remained significant for artery length and number of branches on NCE-MRA after adjusting for clinical covariates and white matter hyperintensity volume. Further adjustment of confounding factors of ASL CBF or PC CBF did not abolish the significant association for artery length and number of branches on TOF. Our findings suggest that intracranial vascular features, including artery length and number of branches, on NCE-MRA may be useful markers of cerebrovascular health and provide added information over conventional brain blood flow measurements in individuals with cognitive impairment.
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Affiliation(s)
- Zhensen Chen
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA.
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA.
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
| | - Anders Gould
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Duygu Baylam Geleri
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
| | - Niranjan Balu
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Baocheng Chu
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Kristi Pimentel
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
| | - Gador Canton
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
| | | | - Chun Yuan
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA
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Wan M, Yan L, Xu Z, Hou Z, Kang K, Cui R, Yu Y, Song J, Hui F, Wang Y, Miao Z, Lou X, Ma N. Symptomatic and Asymptomatic Chronic Carotid Artery Occlusion on High-Resolution MR Vessel Wall Imaging. AJNR Am J Neuroradiol 2022; 43:110-116. [PMID: 34857516 PMCID: PMC8757554 DOI: 10.3174/ajnr.a7365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Chronic carotid artery occlusion remains a poorly understood risk factor for subsequent stroke, and potential revascularization is dependent on understanding the anatomy and nature of the occlusion. Luminal imaging cannot assess the nature of an occlusion, so the internal structure of the occlusion must be inferred. The present study examines the signal characteristics of symptomatic and asymptomatic carotid occlusion that may point to management differentiation. MATERIALS AND METHODS We prospectively recruited patients who were diagnosed with chronic carotid artery occlusion defined as longer than 4 weeks and confirmed by DSA. All patients underwent high-resolution MR vessel wall imaging examinations after enrollment. Baseline characteristics, vessel wall imaging features, and DSA features were collected and evaluated. The vessel wall imaging features included segment involvement, signal intensity, contrast enhancement, and vessel wall thickness. The symptomatic and asymptomatic chronic carotid artery occlusions were compared. RESULTS A total of 44 patients with 48 lesions were included in this study from February 2020 to December 2020. Of the 48 lesions, 35 (72.9%) were symptomatic and 13 (27.1%) were asymptomatic. There was no difference in baseline and DSA features. On vessel wall imaging, C1 and C2 were the most commonly involved segments (91.7% and 68.8%, respectively). Compared with symptomatic lesions, asymptomatic lesions were more often isointense (69.2%) in the distal segment (P = .03). Both groups had diffuse wall thickening (80% and 100%). CONCLUSIONS Signal characteristics between those with symptomatic and asymptomatic carotid artery occlusions differ in a statistically significant fashion, indicating a different structure of the occlusion.
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Affiliation(s)
- M. Wan
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China,Department of Neurology (M.W.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China
| | - L. Yan
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - Z. Xu
- Department of Neurology (Z.X.), The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Z. Hou
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - K. Kang
- Neurology (K.K., Y.W.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China,China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - R. Cui
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - Y. Yu
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - J. Song
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - F.K. Hui
- Department of Radiology and Radiological Sciences (F.K.H.), Johns Hopkins Hospital, Baltimore, Maryland
| | - Y. Wang
- Neurology (K.K., Y.W.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China,China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - Z. Miao
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
| | - X. Lou
- Department of Radiology (X.L.), Chinese PLA General Hospital, Beijing, China
| | - N. Ma
- From the Department of Interventional Neuroradiology (M.W., L.Y., Z.H., R.C., Y.Y., J.S., Z.M., N.M.),China National Clinical Research Center for Neurological Diseases (M.W., L.Y., Z.H., K.K., R.C., Y.Y., J.S., Y.W., Z.M., N.M.), Beijing, China
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Sun T, Huang S, Jiang Y, Yuan H, Wu J, Liu C, Zhang X, Tang Y, Ben X, Tang J, Zhou H, Zhang D, Xie L, Chen G, Zhao Y, Wang S, Xu H, Qiao G. Dynamic alteration in SULmax predicts early pathological tumor response and short-term prognosis in non-small cell lung cancer treated with neoadjuvant immunochemotherapy. Front Bioeng Biotechnol 2022; 10:1010672. [PMID: 36277407 PMCID: PMC9582780 DOI: 10.3389/fbioe.2022.1010672] [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: 08/03/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction: Biomarkers predicting tumor response to neoadjuvant immunochemotherapy in non-small cell lung cancer (NSCLC) are still lacking despite great efforts. We aimed to assess the effectiveness of the immune PET Response Criteria in Solid Tumors via SULmax (iPERCIST-max) in predicting tumor response to neoadjuvant immunochemotherapy and short-term survival in locally advanced NSCLC. Methods: In this prospective cohort study, we calculated SULmax, SULpeak, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and their dynamic percentage changes in a training cohort. We then investigated the correlation between alterations in these parameters and pathological tumor responses. Subsequently, iPERCIST-max defined by the proportional changes in the SULmax response (△SULmax%) was constructed and internally validated using a time-dependent receiver operating characteristic (ROC) curve and the area under the curve (AUC) value. A prospective cohort from the Sun Yat-Sen University Cancer Center (SYSUCC) was also included for external validation. The relationship between the iPERCIST-max responsiveness and event-free survival in the training cohort was also investigated. Results: Fifty-five patients with NSCLC were included in this study from May 2019 to December 2021. Significant alterations in post-treatment SULmax (p < 0.001), SULpeak (p < 0.001), SULmean (p < 0.001), MTV (p < 0.001), TLG (p < 0.001), and tumor size (p < 0.001) were observed compared to baseline values. Significant differences in SULpeak, SULmax, and SULmean between major pathological response (mPR) and non-mPR statuses were observed. The optimal cutoff values of the SULmax response rate were -70.0% and -88.0% using the X-tile software. The univariate and multivariate binary logistic regression showed that iPERCIST-max is the only significant key predictor for mPR status [OR = 84.0, 95% confidence interval (CI): 7.84-900.12, p < 0.001]. The AUC value for iPERCIST-max was 0.896 (95% CI: 0.776-1.000, p < 0.001). Further, external validation showed that the AUC value for iPERCIST-max in the SYSUCC cohort was 0.889 (95% CI: 0.698-1.000, p = 0.05). Significantly better event-free survival (EFS) in iPERCIST-max responsive disease (31.5 months, 95% CI 27.9-35.1) than that in iPERCIST-max unresponsive disease (22.2 months, 95% CI: 17.3-27.1 months, p = 0.024) was observed. Conclusion: iPERCIST-max could better predict both early pathological tumor response and short-term prognosis of NSCLC treated with neoadjuvant immunochemotherapy than commonly used criteria. Furthermore, large-scale prospective studies are required to confirm the generalizability of our findings.
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Affiliation(s)
- Taotao Sun
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Nuclear Medicine, WeiLun PET Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shujie Huang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yongluo Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Yuan
- Department of Nuclear Medicine, WeiLun PET Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junhan Wu
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Chao Liu
- Department of Pathology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaochun Zhang
- Department of Nuclear Medicine, WeiLun PET Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Tang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaosong Ben
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiming Tang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dongkun Zhang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liang Xie
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yumo Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuxia Wang
- Department of Nuclear Medicine, WeiLun PET Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hao Xu
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Hao Xu, ; Guibin Qiao,
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Hao Xu, ; Guibin Qiao,
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Liu J, Mu H, Zhang W. Diagnosis and treatment of carotid body tumors. Am J Transl Res 2021; 13:14121-14132. [PMID: 35035757 PMCID: PMC8748146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To investigate the clinical diagnosis, treatment, and complication prevention of carotid body tumors (CBTs). METHODS The medical records of 24 patients with CBTs treated in the Department of Oral and Maxillofacial Surgery in Shandong Provincial Hospital Affiliated to Shandong First Medical University from 1999 to 2014 were reviewed. All the patients had unilateral CBTs and underwent preoperative B-mode ultrasound. Before surgery, CBT diagnosis was confirmed by digital subtraction angiography (DSA) in 8 patients, magnetic resonance imaging (MRI) in 9 patients, and computed tomography angiography (CTA) in 11 patients. All the patients had surgical intervention and preoperative Matas test. The retrograde stump pressure in the internal carotid artery was monitored in all the cases during surgery. Transcranial Doppler (TCD) inspection was performed on all patients before and during surgery. Simple tumor resection was performed in 8 patients, and excision of both the tumor and external carotid artery was performed in 11 cases. Five patients received intraluminal shunt after tumor resection and partial removal of internal, external, and common carotid arteries. RESULTS The diagnostic accuracy of B-mode ultrasound, DSA, MRI, and CTA was 75%, 100%, 88.9%, and 90.9%, respectively. In the enrolled 24 patients, tumors were completely removed with no postoperative death, hemiplegia, or blindness. There were 4 cases of transient hypoglossal nerve palsy and 1 case of transient vagus nerve involvement after surgery, which were recovered after 4-8 months of follow-up. No recurrence was found in the included patients during the followed-up, varied from 3 months to 4 years. B-mode ultrasound examination can be used as a preliminary screening method. DSA, CTA, and MRI are all effective diagnostic tools for CBTs. Among them, the diagnostic coincidence rate of DSA is 100%, making it the most effective means of inspection. Surgical resection is the first choice for the treatment of CBT patients who are willing to undergo surgery. CONCLUSIONS Preoperative routine Matas test can improve the brain tolerance of patients with carotid artery occlusion, preoperative, and intraoperative TCD monitoring are beneficial to understand the intracranial circulation in the circle of Willis. Intraoperative monitoring of residual arterial pressure and intraluminal shunt can prevent or significantly reduce the incidence of serious postoperative complications.
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Affiliation(s)
- Junjie Liu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021, Shandong, China
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250021, Shandong, China
| | - Hong Mu
- Department of Otorhinolaryngology, Qi Lu Children’s Hospital of Shandong UniversityJinan 250022, Shandong, China
| | - Weidong Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021, Shandong, China
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Baylam Geleri D, Watase H, Chu B, Chen L, Zhao H, Zhao X, Hatsukami TS, Yuan C. Detection of Advanced Lesions of Atherosclerosis in Carotid Arteries Using 3-Dimensional Motion-Sensitized Driven-Equilibrium Prepared Rapid Gradient Echo (3D-MERGE) Magnetic Resonance Imaging as a Screening Tool. Stroke 2021; 53:194-200. [PMID: 34587796 DOI: 10.1161/strokeaha.120.032505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Two-dimensional high-resolution multicontrast magnetic resonance imaging (2D-MC MRI) is currently the most reliable and reproducible noninvasive carotid vessel wall imaging technique. However, the long scan time required for 2D-MC MRI restricts its practical clinical application. Alternatively, 3-dimensional motion-sensitized driven-equilibrium prepared rapid gradient echo (3D-MERGE) vessel wall MRI can provide high isotropic resolution with extensive coverage in two minutes. In this study, we sought to prove that 3D-MERGE alone can serve as a screening tool to identify advanced carotid lesions. METHODS Two hundred twenty-seven subjects suspected of recent ischemic stroke or transient ischemic attack were imaged using 2D-MC MRI with an imaging time of 30 minutes, then with 3D-MERGE with an imaging time of 2 minutes, on 3T-MRI scanners. Two experienced reviewers interpreted plaque components using 2D-MC MRI as the reference standard and categorized plaques using a modified American Heart Association lesion classification for MRI. Plaques of American Heart Association type IV and above were classified as advanced. Arteries of American Heart Association types I to II and III were categorized as normal or with early lesions, respectively. One radiologist independently reviewed only 3D-MERGE and labeled the plaques as advanced if they had a wall thickness of >2 mm with high or low signal intensity compared with the adjacent sternocleidomastoid muscle. Sensitivity, specificity, and accuracy for 3D-MERGE were calculated. RESULTS Four hundred forty-nine arteries from 227 participants (mean age 61.2 years old, 64% male) were included in the analysis. Sensitivity, specificity, and accuracy for identification of advanced lesions on 3D-MERGE were 95.0% (95% CI, 91.8-97.2), 86.9% (95% CI, 81.4-92.0), 93.8% (95% CI, 91.1-95.8), respectively. CONCLUSIONS 3D-MERGE can accurately identify advanced carotid atherosclerotic plaques in patients suspected of stroke or transient ischemic attack. It has a more extensive coverage and higher sensitivity and specificity for advanced plaque detection with a much shorter acquisition time than 2D-MC MRI. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02017756.
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Affiliation(s)
- Duygu Baylam Geleri
- Department of Radiology, University of Washington, Seattle, WA. (D.B.G, B.C., C.Y.)
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, WA. (H.W., T.S.H.)
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA. (D.B.G, B.C., C.Y.).,BioMolecular Imaging Center, University of Washington, Seattle, WA. (B.C., C.Y.)
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA. (L.C.)
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University Shanghai, China (H.Z.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (X.Z.)
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, WA. (H.W., T.S.H.)
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA. (D.B.G, B.C., C.Y.).,BioMolecular Imaging Center, University of Washington, Seattle, WA. (B.C., C.Y.)
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10
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Cao X, Tang Y, Pan L, Yang J, Wu Y, Geng D, Zhang J. Assessment of carotid atherosclerotic plaque using 3D motion-sensitized driven-equilibrium prepared rapid gradient echo: a comparative study. Quant Imaging Med Surg 2021; 11:2744-2755. [PMID: 34079738 DOI: 10.21037/qims-20-869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background 3D motion-sensitized driven-equilibrium prepared rapid gradient echo (MERGE) can characterize carotid atherosclerotic plaque morphology and composition. The present study aimed to evaluate its performance by comparing it with reference images and assessing the inter-reader agreement. Methods Eighty-four patients were prospectively recruited and scanned with 3D MERGE. Two trained magnetic resonance imaging (MRI) readers measured and calculated the maximum wall thickness (WT), maximum vessel diameter, total vessel area, lumen area, wall area, normalized wall index, plaque volume, intraplaque hemorrhage (IPH) volume, and calcification volume independently. IPH, calcification, mixed calcification, and ulceration were identified. The intraclass correlation coefficient (ICC) with 95% confidence interval (CI) was used to assess the inter-reader agreement. MERGE performance was assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, kappa value (κ), and the results of the Bland-Altman analysis and compared with reference images. Results MERGE showed excellent inter-reader agreement (All ICCs >0.90). MERGE and simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) showed excellent agreement in detecting IPH (κ=0.938) and measuring IPH volume (ICC =0.995; 95% CI: 0.991-0.997). MERGE and computed tomography angiography (CTA) showed strong consistency in detecting calcification (κ=0.814) and mixed calcification (κ=0.972), and in measuring calcification volume (ICC =0.996; 95% CI: 0.993-0.997). MERGE and digital subtraction angiography (DSA) showed relatively strong consistency in identifying ulceration (κ=0.737). Conclusions MERGE showed excellent performance in identifying and measuring IPH and calcification in carotid atherosclerotic plaques. Therefore, MERGE can be a promising imaging approach in atherosclerotic-vulnerable plaque.
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Affiliation(s)
- Xin Cao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Ye Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Pan
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinming Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifan Wu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
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11
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Chen L, Zhao H, Jiang H, Balu N, Geleri DB, Chu B, Watase H, Zhao X, Li R, Xu J, Hatsukami TS, Xu D, Hwang JN, Yuan C. Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI. Magn Reson Med 2021; 86:1662-1673. [PMID: 33885165 DOI: 10.1002/mrm.28794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/07/2021] [Accepted: 03/18/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To develop and evaluate a domain adaptive and fully automated review workflow (lesion assessment through tracklet evaluation, LATTE) for assessment of atherosclerotic disease in 3D carotid MR vessel wall imaging (MR VWI). METHODS VWI of 279 subjects with carotid atherosclerosis were used to develop LATTE, mainly convolutional neural network (CNN)-based domain adaptive lesion classification after image quality assessment and artery of interest localization. Heterogeneity in test sets from various sites usually causes inferior CNN performance. With our novel unsupervised domain adaptation (DA), LATTE was designed to accurately classify arteries into normal arteries and early and advanced lesions without additional annotations on new datasets. VWI of 271 subjects from four datasets (eight sites) with slightly different imaging parameters/signal patterns were collected to assess the effectiveness of DA of LATTE using the area under the receiver operating characteristic curve (AUC) on all lesions and advanced lesions before and after DA. RESULTS LATTE had good performance with advanced/all lesion classification, with the AUC of >0.88/0.83, significant improvements from >0.82/0.80 if without DA. CONCLUSIONS LATTE can locate target arteries and distinguish carotid atherosclerotic lesions with consistently improved performance with DA on new datasets. It may be useful for carotid atherosclerosis detection and assessment on various clinical sites.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Huilin Zhao
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjian Jiang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, Washington, 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
| | - Jianrong Xu
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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12
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Gould A, Chen Z, Geleri DB, Balu N, Zhou Z, Chen L, Chu B, Pimentel K, Canton G, Hatsukami T, Yuan C. Vessel length on SNAP MRA and TOF MRA is a potential imaging biomarker for brain blood flow. Magn Reson Imaging 2021; 79:20-27. [PMID: 33689778 DOI: 10.1016/j.mri.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To explore feasibility of using the vessel length on time-of-flight (TOF) or simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) MRA as an imaging biomarker for brain blood flow, by using arterial spin labeling (ASL) perfusion imaging and 3D phase contrast (PC) quantitative flow imaging as references. METHODS In a population of thirty subjects with carotid atherosclerotic disease, the visible intracranial arteries on TOF and SNAP were semi-automatically traced and the total length of the distal segments was calculated with a dedicated software named iCafe. ASL blood flow was calculated automatically using the recommended hemodynamic model. PC blood flow was obtained by generating cross-sectional arterial images and semi-automatically drawing the lumen contours. Pearson correlation coefficients were used to assess the associations between the different whole-brain or hemispheric blood flow measurements. RESULTS Under the imaging protocol used in this study, TOF vessel length was larger than SNAP vessel length (P < 0.001). Both whole-brain TOF and SNAP vessel length showed a correlation with whole brain ASL and 3D PC blood flow measurements, and the correlation coefficients were higher for SNAP vessel length (TOF vs ASL: R = 0.554, P = 0.002; SNAP vs ASL: R = 0.711, P < 0.001; TOF vs 3D PC: R = 0.358, P = 0.052; SNAP vs 3D PC: R = 0.425, P = 0.019). Similar correlation results were observed for the hemispheric measurements. Hemispheric asymmetry index of SNAP vessel length also showed a significant correlation with hemispheric asymmetry index of ASL cerebral blood flow (R = 0.770, P < 0.001). CONCLUSION The results suggest that length of the visible intracranial arteries on TOF or SNAP MRA can serve as a potential imaging marker for brain blood flow.
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Affiliation(s)
- Anders Gould
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Zhensen Chen
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States.
| | - Duygu Baylam Geleri
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Niranjan Balu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Zechen Zhou
- Philips Research North America, Cambridge, MA, United States
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Baocheng Chu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Kristi Pimentel
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Gador Canton
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Thomas Hatsukami
- Department of Surgery, University of Washington, Seattle, WA, United States
| | - Chun Yuan
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
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13
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Mihály Z, Vértes M, Entz L, Dósa E. Treatment and Predictors of Recurrent Internal Carotid Artery In-Stent Restenosis. Vasc Endovascular Surg 2021; 55:374-381. [PMID: 33563130 DOI: 10.1177/1538574421993716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We aimed to examine the effectiveness of different therapeutic options for and to identify the possible risk factors of recurrent internal carotid artery (ICA) in-stent restenosis (ISR). METHODS Forty-six ICA ISRs, which were reintervened at least once, were retrospectively analyzed regarding clinical and imaging characteristics, as well as invasive treatment type (percutaneous transluminal angioplasty [PTA] with a plain balloon, PTA with a drug-eluting balloon [DEB], re-stenting) used. RESULTS The median follow-up was 29.5 months (IQR, 8.5-52.8 months) in patients who underwent reintervention for ICA ISR. Stent occlusion occurred in 3 patients (6.5%). One ISR recurrence was noted in 10 patients (21.7%); reintervention was carried out in 7 cases (7/10 [70%]; PTA, N = 5; PTA with a DEB, N = 1; re-stenting, N = 1), while 3 patients (3/10; 30%) received best medical treatment. Two ISR recurrences were observed in 3 patients (6.5%); all of them underwent reintervention (PTA, N = 1; PTA with a DEB, N = 2). Three ISR recurrences were seen in 1 patient (2.2%), who was treated with PTA. No recurrence was observed in those patients, who had DEB treatment. Multiple logistic regression analysis revealed statin therapy to be a protective factor against recurrent ISR (OR, 0.17; 95% CI, 0.03-0.84; P = .029). CONCLUSION Our study suggests that PTA with a DEB is the most effective for the treatment of recurrent ISR, and confirms the importance of statin use in patients who have had a carotid reintervention.
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Affiliation(s)
- Zsuzsanna Mihály
- Heart and Vascular Center, 37637Semmelweis University, Budapest, Hungary
| | - Miklós Vértes
- Heart and Vascular Center, 37637Semmelweis University, Budapest, Hungary.,Hungarian Vascular Radiology Research Group, Budapest, Hungary
| | - László Entz
- Heart and Vascular Center, 37637Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Center, 37637Semmelweis University, Budapest, Hungary.,Hungarian Vascular Radiology Research Group, Budapest, Hungary
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14
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Gang M, Lee H, Kwak HS, Hwang SB, Chung GH. Strong enhancement on three-dimensional black-blood enhanced magnetic resonance imaging: Comparison intracranial stenosis and complete occlusion. Eur J Radiol 2021; 137:109580. [PMID: 33610077 DOI: 10.1016/j.ejrad.2021.109580] [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: 11/17/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate contrast enhancement patterns on three-dimensional (3D) black blood (BB) contrast-enhanced magnetic resonance (MR) imaging in patients with occlusion or stenosis of the anterior intracranial artery. MATERIALS AND METHODS From January 2018 to January 2020 we retrospectively reviewed stroke 3D BB contrast-enhanced MR imaging and MR angiography findings of patients visiting the emergency room for evaluation of non-traumatic brain lesions. In total, 92 patients with positive findings on 3D BB contrast-enhanced MR imaging were enrolled in this study. We divided the enrolled group according to whether MR angiography findings suggested complete occlusion, high-grade stenosis (51-99 %), or low-grade stenosis (10-50 %). RESULTS Of 92 patients, 33 had complete occlusion in the anterior intracranial artery, 36 had high-grade stenosis, and 23 had low-grade stenosis. The complete occlusion group showed concentric and segmental enhancement on 3D BB enhanced MR imaging. The high-grade stenosis group frequently showed concentric and focal enhancement. The high signal vessel sign in the complete occlusion group was significantly higher compared to the stenosis group (p < 0.001). The contrast ratio between the lesion and pituitary gland in the occlusion group was significantly lower than that of the stenosis group (p < 0.05). CONCLUSION Bright contrast enhancement and high signal vessel sign on 3D BB contrast enhanced MR imaging are related to contrast stagnation of the occlusion site and slow flow of a distal portion of the occlusion site.
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Affiliation(s)
- Myeongsuk Gang
- Jeonbuk National University Medical School, Republic of Korea
| | - Hyunjin Lee
- Jeonbuk National University Medical School, Republic of Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea.
| | - Seung Bae Hwang
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea
| | - Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea
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15
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Cui B, Yang D, Zheng W, Wu Y, Yang Q, Wang Z, Zhao X. Plaque enhancement in multi-cerebrovascular beds associates with acute cerebral infarction. Acta Radiol 2021; 62:102-112. [PMID: 32316744 DOI: 10.1177/0284185120915604] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND It is valuable to explore the relationship between plaque characteristics and stroke by using three-dimensional (3D) magnetic resonance imaging (MRI) of the vessel wall. PURPOSE To investigate the association between plaque enhancement score (PES) of co-existing intracranial and extracranial carotid plaques and ischemic stroke using 3D MRI. MATERIAL AND METHODS Symptomatic patients were recruited and underwent cerebrovascular 3D MRI of the vessel wall. The number, enhancement degree, and stenosis of plaques in intracranial and extracranial carotid arteries were evaluated. The PES calculated by summing enhancement degree of all detected plaques was compared between patients with and without acute cerebral infarction (ACI) and its association with ACI was determined. RESULTS Of 157 recruited patients, 118 (75.2%) had co-existing plaques. Patients with ACI had significantly greater PES of co-existing plaques compared with those without ACI (9, interquartile range [IQR] 5-11 vs. 5, IQR 2-7, P<0.001). The odds ratio for PES of co-existing plaques in discriminating ACI was 1.410 (95% confidence interval [CI] 1.146-1.735, P = 0.001) after adjustment for stenosis, intraplaque hemorrhage, and traditional risk factors. Receiver operating characteristic curve analysis showed that, in discriminating ACI, PES had higher area under the curve (AUC 0.693-0.764) than plaque number (AUC 0.625-0.683) and enhancement degree (AUC 0.570-0.706) alone in any vascular bed. The AUC of PES of co-existing plaques combined with stenosis, NIHSS scores, intraplaque hemorrhage, hyperlipidemia, and blood pressure reached 0.847. CONCLUSION Cerebrovascular plaque enhancement score combining plaque number and enhancement degree is independently associated with ACI. The enhancement score of co-existing plaques has higher strength in discriminating ACI compared with plaques in a single vascular bed.
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Affiliation(s)
- Bin Cui
- Department of Radiology, Aerospace Center Hospital, Beijing, PR China
| | - Dandan Yang
- Collaborative Innovation Center for Brain Disorders, Capital Medical University and Beijing Institute of Brain Disorders, Beijing, PR China
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, PR China
| | - Weimin Zheng
- Department of Radiology, Aerospace Center Hospital, Beijing, PR China
| | - Ye Wu
- Department of Radiology, Aerospace Center Hospital, Beijing, PR China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, PR China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, PR China
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16
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Normalized wall index, intraplaque hemorrhage and ulceration of carotid plaques correlate with the severity of ischemic stroke. Atherosclerosis 2020; 315:138-144. [PMID: 33183741 DOI: 10.1016/j.atherosclerosis.2020.10.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/20/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Carotid atherosclerosis is considered an important cause of ischemic stroke. Tthis study aimed to explore the relationship between plaque features and the severity of stroke, and to identify plaque risk factors for the assessment of the severity of ischemic stroke. METHODS Symptomatic patients with carotid atherosclerotic plaques were prospectively recruited and underwent high-resolution vessel wall magnetic resonance imaging (VW-MRI). Two trained MRI readers independently identified intraplaque hemorrhage (IPH), calcification (CA), surface CA, deep CA, and ulceration. They measured and calculated the maximum vessel diameter (Max VD), maximum wall thickness (Max WT), total vessel area, lumen area, normalized wall index (NWI), plaque volume, IPH volume, IPH proportion, CA volume, and CA proportion. Patients were divided into two groups according to their National Institutes of Health Stroke Scale (NIHSS) scores (NIHSS ≤1 vs. NIHSS >1). Clinical characteristics and carotid plaque features were compared using the Mann-Whitney U test or Chi-square test as appropriate. Odds ratio (OR) and corresponding 95% confidence interval (CI) of plaque features to distinguish patients with NIHSS >1 were calculated. Spearman's rank correlations or Pearson correlations were determined for plaque features and NIHSS scores. RESULTS Of the 97 included patients, 34 (35.05%) with NIHSS >1 had significantly greater NWI (p < 0.05), larger IPH volume (p < 0.01), and greater IPH proportion (p < 0.01), and higher prevalence of IPH (OR, 5.654; 95%CI, 2.272-14.070; p < 0.01) and ulceration (OR, 2.891; 95%CI, 1.090-7.667; p = 0.033) than patients with NIHSS ≤1. Max WT (r = 0.24, p = 0.018), NWI (r = 0.22, p = 0.032), IPH (r = 0.27, p = 0.007), IPH volume (r = 0.35, p < 0.01), IPH proportion (r = 0.28, p = 0.005), and ulceration (r = 0.35, p < 0.01) had positive correlations with NIHSS scores. CONCLUSIONS NWI, IPH, and ulceration of carotid atherosclerotic plaque based on high-resolution VW-MRI may be useful indicators for assessing the severity of ischemic stroke in patients with atherosclerosis. NIHSS score is related to max WT, NWI, IPH, IPH volume, IPH proportion, and ulceration.
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17
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Henningsson M, Malik S, Botnar R, Castellanos D, Hussain T, Leiner T. Black-Blood Contrast in Cardiovascular MRI. J Magn Reson Imaging 2020; 55:61-80. [PMID: 33078512 PMCID: PMC9292502 DOI: 10.1002/jmri.27399] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
MRI is a versatile technique that offers many different options for tissue contrast, including suppressing the blood signal, so‐called black‐blood contrast. This contrast mechanism is extremely useful to visualize the vessel wall with high conspicuity or for characterization of tissue adjacent to the blood pool. In this review we cover the physics of black‐blood contrast and different techniques to achieve blood suppression, from methods intrinsic to the imaging readout to magnetization preparation pulses that can be combined with arbitrary readouts, including flow‐dependent and flow‐independent techniques. We emphasize the technical challenges of black‐blood contrast that can depend on flow and motion conditions, additional contrast weighting mechanisms (T1, T2, etc.), magnetic properties of the tissue, and spatial coverage. Finally, we describe specific implementations of black‐blood contrast for different vascular beds.
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Affiliation(s)
- Markus Henningsson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shaihan Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Castellanos
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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Ospel JM, Marko M, Singh N, Goyal M, Almekhlafi MA. Prevalence of Non-Stenotic (<50%) Carotid Plaques in Acute Ischemic Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:105117. [PMID: 32912562 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Non-stenotic (<50%) carotid plaques have recently been recognized as a potential source of stroke. This meta-analysis aims to summarize the prevalence of non-stenotic carotid plaques in stroke patients in general and in patients with embolic stroke of undetermined source in particular. METHODS We performed a comprehensive systematic review of the literature and meta-analysis on acute ischemic stroke patients in whom carotid imaging was performed using the MEDLINE, Embase and Cochrane database, including studies published up to December 2019. Keywords were "stroke", "transient ischemic attack", "carotid", "plaque", "atherosclerosis" and "disease". Included studies had ≥10 patients with acute ischemic stroke and reported the prevalence of non-stenotic (<50%%stenosis) carotid plaques detected on any imaging modality. RESULTS We included forty-five studies (n = 18304 patients, 48.4% males, mean age 63.6 years) in our meta-analysis. Imaging modalities used were ultrasound (n = 26 studies), CT-angiography (n = 7), magnetic resonance-imaging (n = 8) and catheter angiography (n = 4). The overall prevalence of non-stenotic carotid plaques was 51% (95% CI: 43 - 59). 10 studies included mainly patients with embolic stroke of undetermined source (>50% of all patients). The pooled prevalence of non-stenotic carotid plaques in these studies was 55% (95% CI: 42 - 68). 23 studies explicitly reported ipsilateral non-stenotic carotid plaques, the pooled prevalence of which was 51% (95% CI: 45 - 59). CONCLUSIONS In this meta-analysis, non-stenotic carotid plaques were present in more than 50% of all acute ischemic stroke patients, with a slightly higher prevalence in ESUS patients. Given the potential role of non-stenotic carotid plaques in stroke etiology, particularly in ESUS, further research should aim to identify criteria that predict the stroke risk associated with non-stenotic carotid plaques.
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Affiliation(s)
- Johanna M Ospel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Department of Radiology, University Hospital Basel, Basel, Switzerland.
| | - Martha Marko
- Department of Radiology, University Hospital Basel, Basel, Switzerland.
| | - Nishita Singh
- Department of Radiology, University Hospital Basel, Basel, Switzerland.
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
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Tian X, Tian B, Shi Z, Wu X, Peng W, Zhang X, Malhotra A, Mossa-Basha M, Sekhar L, Liu Q, Lu J, Hu C, Zhu C. Assessment of Intracranial Atherosclerotic Plaques Using 3D Black-Blood MRI: Comparison With 3D Time-of-Flight MRA and DSA. J Magn Reson Imaging 2020; 53:469-478. [PMID: 32864816 DOI: 10.1002/jmri.27341] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Noninvasive assessment of intracranial stenosis is important to manage ischemic stroke patients. However, few previous studies have compared 3D black-blood MRI with 3D time-of-flight (TOF), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) for intracranial artery plaque assessment. PURPOSE To compare 3D black-blood MRI and 3D TOF-MRA, using DSA as the reference standard for intracranial stenosis and atherosclerotic plaque assessment in patients with posterior circulation stroke or transient ischemic attacks (TIAs). STUDY TYPE Prospective, cohort study. POPULATION One hundred and one patients with posterior circulation stroke and/or TIA (age 63 ± 10 years, 84 male) who underwent DSA and MRI within 4 weeks of each other. FIELD STRENGTH/SEQUENCE 3D fast-spin-echo MRI for intracranial vessel wall imaging (IVWI) and 3D TOF at 3T. ASSESSMENT Two radiologists independently measured the degree of stenosis on 3D IVWI and TOF, using DSA as a reference. Plaque enhancement was recorded when the plaque was stenosis-free on DSA. STATISTICAL TESTS Shapiro-Wilk's test, Student's t-test, Mann-Whitney U-test, Spearman correlation, Bland-Altman analysis, and interclass correlation coefficient (ICC). RESULTS A total of 238 intracranial plaques (203 posterior, 35 anterior) were included. 3D IVWI showed better agreement with DSA in measuring stenosis than TOF (ICC = 0.89 vs. 0.64). 3D IVWI had higher sensitivity and specificity for detecting stenosis >50% and stenosis >75% than TOF, using DSA as the standard. TOF significantly overestimated the degree of stenosis compared to DSA (65 ± 19% vs. 51 ± 15%, P < 0.001). DSA did not observe 62 nonstenotic plaques (26.1%) that were shown only on 3D IVWI, in which 36 plaques (58.1%) showed contrast enhancement. The interreader agreement for measuring stenosis were excellent, with ICCs >0.90 for all three modalities. DATA CONCLUSION 3D black-blood MRI is accurate and reproducible for quantifying intracranial artery stenosis compared with DSA, and performs better than 3D TOF. As compared to DSA, it detects more nonstenotic plaques. Level of Evidence 1 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:469-478.
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Affiliation(s)
- Xia Tian
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Radiology, Changhai Hospital, Shanghai, China
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Zhang Shi
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Xuefeng Zhang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Ajay Malhotra
- Department of Radiology, Yale University, New Haven, Connecticut, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Laligam Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
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20
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Zhang J, Ding S, Zhao H, Sun B, Li X, Zhou Y, Wan J, Degnan AJ, Xu J, Zhu C. Evaluation of chronic carotid artery occlusion by non-contrast 3D-MERGE MR vessel wall imaging: comparison with 3D-TOF-MRA, contrast-enhanced MRA, and DSA. Eur Radiol 2020; 30:5805-5814. [PMID: 32529567 DOI: 10.1007/s00330-020-06989-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To analyze the accuracy of a non-contrast MR vessel wall imaging technique, three-dimensional motion-sensitized driven equilibrium prepared rapid gradient echo (3D-MERGE) for diagnosing chronic carotid artery occlusion (CCAO) characteristics compared with 3D time-of-flight (TOF) MRA, and contrast-enhanced MRA (CE-MRA), using digital subtraction angiography (DSA) as a reference standard. METHODS Subjects diagnosed with possible CCAO by ultrasound were retrospectively analyzed. Patients underwent 3.0-T MR imaging with 3D-MERGE, 3D-TOF-MRA, and CE-MRA followed by DSA within 1 week. Diagnostic accuracy of occlusion, occlusion site, and proximal stump condition were assessed independently on 3 MRI sequences and DSA. Agreement of the above indicators was evaluated in reference to DSA. RESULTS One hundred twenty-four patients with 129 suspected CCAO (5 with bilateral occlusions) met the inclusion criteria for our study. 3D-MERGE demonstrated a sensitivity, specificity, and accuracy of 97.0%, 86.7%, and 94.6%, respectively, with excellent agreement (Cohen's κ = 0.85; 95% CI, 0.71, 0.94) for diagnosing CCAO in reference to DSA. 3D-MERGE was superior in diagnosing CCAO compared with 3D-TOF-MRA (Cohen's κ = 0.61; 95% CI, 0.42, 0.77) and similar to CE-MRA (Cohen's κ = 0.93; 95% CI, 0.86, 1.00). 3D-MERGE also had excellent agreement compared with DSA for assessing occlusion sites (Cohen's κ = 0.85; 95% CI, 0.71, 0.97) and stump condition (Cohen's κ = 0.83; 95% CI, 0.71, 0.94). Moreover, 3D-MERGE provided additional information regarding the occluded segment, such as distal lumen collapse and vessel wall lesion components. CONCLUSION 3D-MERGE can reliably assess chronic carotid occlusive characteristics and has the ability to identify other vessel wall features of the occluded segment. This non-contrast MR vessel wall imaging technique is promising for assessment of CCAO. KEY POINTS • Excellent agreement was found between 3D-MERGE and DSA for assessing chronic carotid artery occlusion, occlusion site, and proximal stump condition. • 3D-MERGE was shown to be a more accurate and efficient tool than 3D-TOF-MRA to detect the characteristics of the occluded segment. • 3D-MERGE provides not only luminal images for characterizing the proximal characteristics of occlusion but also vessel wall images for assessing the distal lumen and morphology of occlusion segment, which might help clinicians to optimize the treatment strategy for patients with chronic carotid artery occlusion.
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Affiliation(s)
- Jin Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Andrew J Degnan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,American Institute for Radiologic Pathology, Silver Spring, MD, USA.,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, USA
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21
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Jiang P, Chen Z, Hippe DS, Watase H, Sun B, Lin R, Yang Z, Xue Y, Zhao X, Yuan C. Association Between Carotid Bifurcation Geometry and Atherosclerotic Plaque Vulnerability: A Chinese Atherosclerosis Risk Evaluation Study. Arterioscler Thromb Vasc Biol 2020; 40:1383-1391. [PMID: 32160772 DOI: 10.1161/atvbaha.119.313830] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Carotid bifurcation geometry has been believed to be a risk factor for the initiation of atherosclerosis because of its influence on hemodynamics. However, the relationships between carotid bifurcation geometry and plaque vulnerability are not fully understood. This study aimed to determine the association between carotid bifurcation geometry and plaque vulnerability using magnetic resonance vessel wall imaging. Approach and Results: A total of 501 carotid arteries with nonstenotic atherosclerosis were included from the cross-sectional, multicenter CARE II study (Chinese Atherosclerosis Risk Evaluation). Four standardized carotid bifurcation geometric parameters (bifurcation angle, internal carotid artery planarity, luminal expansion FlareA, and tortuosity Tort2D) were derived from time-of-flight magnetic resonance angiography. Presence of vulnerable plaque, which was characterized by intraplaque hemorrhage, large lipid-rich necrotic core, or disrupted luminal surface, was determined based on multicontrast carotid magnetic resonance vessel wall images. Vulnerable plaques (N=43) were found to occur at more distal locations (ie, near the level of flow divider) than stable plaques (N=458). Multivariable logistic regression showed that the luminal expansion FlareA (odds ratio, 0.45 [95% CI, 0.25-0.81]; P=0.008) was associated with plaque vulnerability after adjustment for age, sex, maximum wall thickness, plaque location, and other geometric parameters. CONCLUSIONS Smaller luminal expansion at carotid bifurcation is associated with vulnerable plaque. The finding needs to be verified with longitudinal studies and the underlying mechanism should be further explored with hemodynamics measurement in the future.
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Affiliation(s)
- Peirong Jiang
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Zhensen Chen
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Daniel S Hippe
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Department of Surgery (H.W.), University of Washington, Seattle
| | - Bin Sun
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Ruolan Lin
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Zheting Yang
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Yunjing Xue
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (X.Z.)
| | - Chun Yuan
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
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22
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Wang Z, Lu M, Liu W, Zheng T, Li D, Yu W, Fan Z. Assessment of carotid atherosclerotic disease using three-dimensional cardiovascular magnetic resonance vessel wall imaging: comparison with digital subtraction angiography. J Cardiovasc Magn Reson 2020; 22:18. [PMID: 32131854 PMCID: PMC7057661 DOI: 10.1186/s12968-020-0604-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A three-dimensional (3D) cardiovascular magnetic resonance (CMR) vessel wall imaging (VWI) technique based on 3D T1 weighted (T1w) Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions (SPACE) has recently been used as a promising CMR imaging modality for evaluating extra-cranial and intra-cranial vessel walls. However, this technique is yet to be validated against the current diagnostic imaging standard. We therefore aimed to evaluate the diagnostic performance of 3D CMR VWI in characterizing carotid disease using intra-arterial digital subtraction angiography (DSA) as a reference. METHODS Consecutive patients with at least unilateral > 50% carotid stenosis on ultrasound were scheduled to undergo interventional therapy were invited to participate. The following metrics were measured using 3D CMR VWI and DSA: lumen diameter of the common carotid artery (CCA) and segments C1-C7, stenosis diameter, reference diameter, lesion length, stenosis degree, and ulceration. We assessed the diagnostic sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve of 3D CMR VWI, and used Cohen's kappa, the intraclass correlation coefficient (ICC), and Bland-Altman analyses to assess the diagnostic agreement between 3D CMR VWI and DSA. RESULTS The ICC (all ICCs ≥0.96) and Bland-Altman plots indicated excellent inter-reader agreement in all individual morphologic measurements by 3D CMR VWI. Excellent agreement in all individual morphologic measurements were also found between 3D CMR VWI and DSA. In addition, 3D CMR VWI had high sensitivity (98.4, 97.4, 80.0, 100.0%), specificity (100.0, 94.5, 99.1, 98.0%), and Cohen's kappa (0.99, 0.89, 0.84, 0.96) for detecting stenosis > 50%, stenosis > 70%, ulceration, and total occlusion, respectively, using DSA as the standard. The AUC of 3D CMR VWI for predicting stenosis > 50 and > 70% were 0.998 and 0.999, respectively. CONCLUSIONS The 3D CMR VWI technique enables accurate diagnosis and luminal feature assessment of carotid artery atherosclerosis, suggesting that this imaging modality may be useful for routine imaging workups and provide comprehensive information for both the vessel wall and lumen.
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Affiliation(s)
- Zhenjia Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029 China
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Beijing, 100010 China
| | - Mi Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029 China
| | - Wen Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029 China
| | - Tiejin Zheng
- Department of Neurosurgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029 China
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
- Department of Bioengineering, University of California, Los Angeles, CA USA
| | - Wei Yu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029 China
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
- Department of Bioengineering, University of California, Los Angeles, CA USA
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23
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Li J, Li D, Yang D, Hang H, Wu Y, Yao R, Chen X, Xu Y, Dai W, Zhou D, Zhao X. Irregularity of Carotid Plaque Surface Predicts Subsequent Vascular Event: A MRI Study. J Magn Reson Imaging 2020; 52:185-194. [PMID: 31944452 DOI: 10.1002/jmri.27038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Jin Li
- Department of RadiologyThe Affiliated BenQ Hospital of Nanjing Medical University Nanjing China
| | - Dongye Li
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen University Guangzhou China
| | - Dandan Yang
- Beijing Institute of Brain DisordersCapital Medical University Beijing China
| | - Hailun Hang
- Department of NeurologyNanjing Brain Hospital Affiliated with Nanjing Medical University Nanjing China
| | - Yawei Wu
- Department of Radiology, Clinical Medical CollegeYangzhou University Yangzhou China
| | - Rong Yao
- Department of RadiologyThe Affiliated BenQ Hospital of Nanjing Medical University Nanjing China
| | - Xiaoyi Chen
- Department of RadiologyBeijing Geriatric Hospital Beijing China
| | - Yilan Xu
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical MedicineTsinghua University Beijing China
| | - Wei Dai
- Department of NeurologyFourth Medical Center of Chinese PLA General Hospital Beijing China
| | - Dan Zhou
- Department of RadiologyThe Affiliated BenQ Hospital of Nanjing Medical University Nanjing China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical EngineeringTsinghua University School of Medicine Beijing China
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24
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Murata K, Murata N, Chu B, Watase H, Hippe DS, Balu N, Sun J, Zhao X, Hatsukami TS, Yuan C. Characterization of Carotid Atherosclerotic Plaques Using 3-Dimensional MERGE Magnetic Resonance Imaging and Correlation With Stroke Risk Factors. Stroke 2020; 51:475-480. [PMID: 31902332 DOI: 10.1161/strokeaha.119.027779] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- High-resolution magnetic resonance imaging is capable of characterizing carotid atherosclerotic plaque morphology and composition. Most reported carotid plaque imaging techniques are 2-dimensional (2D) based with limited longitudinal coverage of ≈30 mm, which may be insufficient for complete visualization of extracranial carotid atheroma. A 3D black-blood imaging technique, motion-sensitized driven equilibrium prepared rapid gradient echo technique (3D-MERGE) can provide larger coverage. We sought to use 3D-MERGE to investigate carotid atherosclerosis plaque distribution and to analyze their correlation with clinical information and stroke risk factors. Methods- From 5 hospitals in China, 97 subjects suspected of recent stroke or transient ischemic attack were imaged with 3D-MERGE within 2 weeks of symptoms using 3T magnetic resonance imaging. Images were analyzed by 2 reviewers. Plaque length was calculated and categorized as plaques within, partially outside, or completely outside of typical 2D magnetic resonance imaging coverage. Associations between plaque features and clinical information, stroke risk factors were assessed. Results- Ninety-seven subjects with 194 carotid arteries (70 men and 27 women, mean age 60 years) were analyzed. Of the 136 plaques identified, 68 (50%) were within, 46 (33.8%) were partially outside, and 22 (16.2%) were completely outside of 2D magnetic resonance imaging coverage. Total plaque length was significantly positively associated with male sex (P<0.001), hypertension (P=0.011), and history of smoking (P<0.001). Hypertensive subjects were more likely to have at least one plaque completely outside the 2D magnetic resonance imaging coverage than nonhypertensive subjects (P=0.007). Conclusions- The 3D-MERGE allows for the identification of substantially more carotid plaques than 2D black-blood techniques. The extent and distribution of plaque, identified by the larger coverage afforded by 3D-MERGE, were found to correlate significantly with male sex and risk factors that are common among patients with stroke, including hypertension and history of cigarette smoking.
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Affiliation(s)
- Kiyoko Murata
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle.,Department of Neurology, Toho University Omori Medical center, Tokyo, Japan (K.M.)
| | - Nozomu Murata
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle.,Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (N.M.)
| | - Baocheng Chu
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Department of Surgery (H.W., T.S.H.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Niranjan Balu
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Jie Sun
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (X.Z.)
| | | | - Chun Yuan
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
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25
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Zhu C, Wang X, Eisenmenger L, Tian B, Liu Q, Degnan AJ, Hess C, Saloner D, Lu J. Surveillance of Unruptured Intracranial Saccular Aneurysms Using Noncontrast 3D-Black-Blood MRI: Comparison of 3D-TOF and Contrast-Enhanced MRA with 3D-DSA. AJNR Am J Neuroradiol 2019; 40:960-966. [PMID: 31122914 DOI: 10.3174/ajnr.a6080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Patients with unruptured intracranial aneurysms routinely undergo surveillance imaging to monitor growth. Angiography is the criterion standard for aneurysm diagnosis, but it is invasive. This study aimed to evaluate the accuracy and reproducibility of a 3D noncontrast black-blood MR imaging technique for unruptured intracranial aneurysm measurement in comparison with 3D-TOF and contrast-enhanced MRA, using 3D rotational angiography as a reference standard. MATERIALS AND METHODS Sixty-four patients (57.3 ± 10.9 years of age, 41 women) with 68 saccular unruptured intracranial aneurysms were recruited. Patients underwent 3T MR imaging with 3D-TOF-MRA, 3D black-blood MR imaging, and contrast-enhanced MRA, and they underwent 3D rotational angiography within 2 weeks. The neck, width, and height of the unruptured intracranial aneurysms were measured by 2 radiologists independently on 3D rotational angiography and 3 MR imaging sequences. The accuracy and reproducibility were evaluated by Bland-Altman plots, the coefficient of variance, and the intraclass correlation coefficient. RESULTS 3D black-blood MR imaging demonstrates the best agreement with DSA, with the smallest limits of agreement and measurement error (coefficients of variance range, 5.87%-7.04%). 3D-TOF-MRA had the largest limits of agreement and measurement error (coefficients of variance range, 12.73%-15.78%). The average coefficient of variance was 6.26% for 3D black-blood MR imaging, 7.03% for contrast-enhanced MRA, and 15.54% for TOF-MRA. No bias was found among 3 MR imaging sequences compared with 3D rotational angiography. All 3 MR imaging sequences had excellent interreader agreement (intraclass correlation coefficient, >0.95). 3D black-blood MR imaging performed the best for patients with intraluminal thrombus (n = 10). CONCLUSIONS 3D black-blood MR imaging achieves better accuracy for aneurysm size measurements compared with 3D-TOF, using 3D rotational angiography as a criterion standard. This noncontrast technique is promising for surveillance of unruptured intracranial aneurysms.
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Affiliation(s)
- C Zhu
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - X Wang
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China.,Department of Radiology (X.W.), General Hospital of Northern Military Command, Liaoning, China
| | - L Eisenmenger
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - B Tian
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
| | - Q Liu
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
| | - A J Degnan
- Department of Radiology (A.J.D.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - C Hess
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - D Saloner
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - J Lu
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
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26
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Reduction of cerebral blood flow in community-based adults with subclinical cerebrovascular atherosclerosis: A 3.0T magnetic resonance imaging study. Neuroimage 2019; 188:302-308. [DOI: 10.1016/j.neuroimage.2018.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 01/21/2023] Open
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27
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Chen X, Wang J, Liu Y, Yang Y, Zhou F, Li X, Zhang B, Zhao X. Proximal internal carotid artery stenosis associates with diffuse wall thickening in petrous arterial segment of moyamoya disease patients: a three-dimensional magnetic resonance vessel wall imaging study. Neuroradiology 2018; 61:29-36. [PMID: 30402746 DOI: 10.1007/s00234-018-2124-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/26/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the association between proximal internal carotid artery (ICA) luminal narrowing and diffuse wall thickening (DWT) in ipsilateral petrous ICA in moyamoya disease (MMD) patients. METHODS Forty-one MMD (mean age 42.8 ± 11.0 years, 19 males) and 36 atherosclerotic patients (mean age 61.5 ± 7.1 years, 31 males) and 41 healthy controls were recruited and underwent carotid MR vessel wall imaging. The luminal narrowing of proximal ICA was evaluated by the diameter ratio of ICA to common carotid artery (DRICA/CCA). The wall thickness of petrous ICA was measured on T1-VISTA images. The enhancement degree of petrous ICA was recorded and graded into four grades (none to marked) on the CE-T1-VISTA images. The correlation between wall thickness in petrous ICA and DRICA/CCA was analyzed. RESULTS: In total, 81 arteries of MMD patients and 64 arteries of atherosclerotic patients were included for analysis. The DRICA/CCA was significantly correlated with the wall thickness in petrous ICA in MMD (r = - 0.434, P < 0.001) and atherosclerotic groups (r = - 0.604, P < 0.001). Logistic regression analysis revealed that odds ratio (OR) of DRICA/CCA was 4.433 (95% CI 1.980-9.925, P < 0.001) and 2.212 (95% CI 1.253-3.905, P = 0.006) in MMD and atherosclerotic groups in discriminating petrous ICA DWT after adjusting for confounding factors. An increasing trend was found in prevalence of DWT and wall thickness with enhancement grades in petrous ICA in MMD (P = 0.02 and P = 0.01) and atherosclerotic groups (P < 0.001 and P < 0.001), respectively. CONCLUSIONS The proximal ICA luminal narrowing is significantly associated with wall thickness and diffuse wall thickening in ipsilateral petrous ICA in patients with carotid steno-occlusive diseases regardless of MMD or atherosclerosis.
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Affiliation(s)
- Xiaoyi Chen
- Department of Radiology, Beijing Geriatric Hospital, Beijing, China.,Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jian Wang
- Department of Neurosurgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Liu
- Department of Radiology, The First People's Hospital of Yangzhou, Yangzhou, China
| | - Yongbo Yang
- Department of Neurosurgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Fei Zhou
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xueping Li
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Bing Zhang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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Han Y, Guan M, Zhu Z, Li D, Chen H, Yuan C, Li C, Wang W, Zhao X. Assessment of longitudinal distribution of subclinical atherosclerosis in femoral arteries by three-dimensional cardiovascular magnetic resonance vessel wall imaging. J Cardiovasc Magn Reson 2018; 20:60. [PMID: 30173671 PMCID: PMC6120082 DOI: 10.1186/s12968-018-0482-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/20/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Lower extremity peripheral artery disease has become a significant health burden worldwide. Since the treatment strategies can be different if atherosclerotic disease involves different femoral artery segments, it is important to assess plaque distribution among different segments of femoral arteries. We sought to investigate the longitudinal distribution of subclinical femoral artery atherosclerosis in asymptomatic elderly adults using cardiovascular magnetic resonance (CMR) vessel wall imaging. METHODS Asymptomatic elderly subjects underwent three-dimensional (3D) CMR vessel wall imaging for femoral arteries. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) sequence was acquired from the common femoral artery to the popliteal artery. The femoral artery was divided into 4 segments: common femoral artery (CFA), proximal superficial femoral artery (pSFA), adductor canal (AC) segment of femoral artery, and popliteal artery (PA). The morphological characteristics including lumen area, wall area, maximum and minimum wall thickness, normalized wall index (NWI = wall area / [lumen area + wall area] × 100%), and eccentricity index ([maximum wall thickness - minimum wall thickness] / maximum wall thickness), luminal stenosis, and presence of atherosclerotic plaque were evaluated and compared between bilateral sides and among different femoral artery segments in each side of femoral artery. The associations between ankle-brachial index (ABI) and cardiovascular risk factors and femoral artery plaque characteristics were also determined. RESULTS Of 107 recruited subjects (71.9 ± 5.6 years; 48 males), 70 (65.4%) were found to have femoral artery plaques. The atherosclerotic plaques were most frequently found in PA (41.1%) and CFA (40.2%) segments, followed by pSFA (31.8%) and AC (23.4%) segments (p = 0.002). Similarly, PA and CFA segments showed significantly greater maximum wall thickness and eccentricity index compared with pSFA and AC segments (all p < 0.001). Significant differences can be found in NWI among four segments of femoral arteries (p < 0.001) and PA showed the highest NWI (54.8%), followed by AC (54.3%), pSFA (52.4%) and CFA (45.9%) segments. Compared with right femoral artery, left femoral artery had significant smaller lumen area and greater NWI in most of segments (p < 0.002). There were no significant differences in ABI between subjects with and without atherosclerotic plaques (p = 0.161). The presence of subclinical atherosclerotic plaque in femoral arteries was significantly associated with cardiovascular risk factors including age (odds ratio [OR], 1.133; 95% confidence interval [CI], 1.048-1.224, p = 0.002), male gender (OR, 3.914; 95% CI, 1.612-9.501, p = 0.003), and hypertension (OR, 4.000; 95% CI, 1.700-9.411, p = 0.001), respectively. CONCLUSIONS Subclinical femoral artery atherosclerosis is prevalent in the elderly population, particularly in the left femoral artery and segments of CFA and PA, and is associated with age, male gender and hypertension. Our findings suggest that, for screening subclinical atherosclerosis, more attention needs to be paid to the specific side and segments of femoral arteries, particularly older individuals and those with these cardiovascular disease risk factors.
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Affiliation(s)
- Yongjun Han
- 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, Tsinghua University School of Medicine, Beijing, China
| | - Maobin Guan
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhu Zhu
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Dongye Li
- 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, Tsinghua University School of Medicine, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Department of Radiology, University of Washington, Seattle, USA
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Wei Wang
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Bai X, Lv P, Liu K, Li Q, Ding J, Qu J, Lin J. 3D Black-Blood Luminal Angiography Derived from High-Resolution MR Vessel Wall Imaging in Detecting MCA Stenosis: A Preliminary Study. AJNR Am J Neuroradiol 2018; 39:1827-1832. [PMID: 30139751 DOI: 10.3174/ajnr.a5770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/08/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE 3D high-resolution vessel wall imaging is increasingly used for intracranial arterial diseases. This study compared the diagnostic performance of black-blood luminal angiography derived from 3D vessel wall imaging with source images of vessel wall imaging and TOF-MRA in detecting middle cerebral artery stenosis. MATERIALS AND METHODS Sixty-two patients with suspected MCA atherosclerosis underwent TOF-MRA, vessel wall imaging, and CTA. Intracranial black-blood luminal angiography was created from source images of vessel wall imaging using minimum intensity projection. The degree and length of MCA stenosis were measured on source images of vessel wall imaging, TOF-MRA, and black-blood luminal angiography and compared using CTA as a reference standard. RESULTS The image quality of black-blood luminal angiography was diagnostic in most patients. The intra- and interobserver agreement for both stenosis degree and length measurements was excellent for black-blood luminal angiography. It was comparable with that of source images of vessel wall imaging in grading stenosis. Compared with TOF-MRA, black-blood luminal angiography showed significantly higher sensitivity for the detection of severe stenosis (89.3% versus 64.3%, P = .039) and higher specificity for the detection of occlusion (95.4% versus 84.6%, P = .039). Lesion length estimated on source images of vessel wall imaging was significantly greater than that measured by CTA and black-blood luminal angiography (P < .001 and P = .010). CONCLUSIONS Black-blood luminal angiography is better than TOF-MRA in detecting severe stenosis and occlusion of the MCA. Compared with source images of vessel wall imaging, it is more accurate in evaluating stenosis length. Black-blood luminal angiography can be produced as a derivative from vessel wall imaging and implemented as an adjunct to vessel wall imaging and TOF-MRA without extra acquisition time.
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Affiliation(s)
- X Bai
- From the Department of Radiology (X.B., P.L., K.L., J.L.), Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - P Lv
- From the Department of Radiology (X.B., P.L., K.L., J.L.), Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - K Liu
- From the Department of Radiology (X.B., P.L., K.L., J.L.), Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Q Li
- Departments of Neurosurgery (Q.L.)
| | - J Ding
- Neurology (J.D.), Zhongshan Hospital, Fudan University, Shanghai, China
| | - J Qu
- GE Healthcare (J.Q.),Shanghai, China
| | - J Lin
- From the Department of Radiology (X.B., P.L., K.L., J.L.), Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
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Cui H, Yan R, Zhai Z, Ren J, Li Z, Li Q, Wang S. Comparative analysis of 3D time-resolved contrast-enhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis. Exp Ther Med 2018; 15:1654-1659. [PMID: 29434750 DOI: 10.3892/etm.2017.5548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to compare the diagnostic value of contrast-enhanced magnetic resonance angiography (CE MRA) with 3D time-resolved imaging of contrast kinetics, color Doppler ultrasound (CDUS) and digital subtraction angiography (DSA) in extracranial carotid stenosis (CS). A total of 54 patients with symptomatic CS were subjected to CDUS, CE MRA and DSA examination. Results of DSA were defined as the standard, and a total of 216 vessels were examined. In each patient four vessels were examined, namely the bilateral common carotid arteries and the bilateral internal carotid arteries. The sensitivities and specificities of CE MRA and CDUS for various degrees of CS were also determined. It was observed that the sensitivities to mild-level (1-49%), moderate-level (50-69%) and severe-level (70-99%) CS were 85.45, 100 and 100% for CE MRA, and 78.18, 50 and 100% for CDUS, respectively. The corresponding specificities were 95.27, 98.58 and 99.53% for CE MRA, and 79.05, 93.36 and 98.10% for CDUS, respectively. In addition, the carotid sinus plaque detection rate for CDUS was significantly higher than that of DSA and CE MRA (both P<0.001). Detection rates for common carotid artery plaques and internal carotid artery plaques did not significantly differ among the three examination methods (all P>0.05). These data demonstrate that CE MRA has higher sensitivity and specificity than CDUS for the diagnosis of CS, and that CDUS has a higher carotid sinus plaque detection rate than DSA and CE MRA. Therefore, the combination of MRI and CDUS may be a 'gold standard' diagnostic method for the detection of moderate and severe CS.
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Affiliation(s)
- Hongkai Cui
- Department of Interventional Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Ruifang Yan
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Zhansheng Zhai
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Jipeng Ren
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Zheng Li
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Qiang Li
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Shouying Wang
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan 453000, P.R. China
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Sun B, Li X, Liu X, Ge X, Lu Q, Zhao X, Pu J, Xu J, Zhao H. Association between carotid plaque characteristics and acute cerebral infarction determined by MRI in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2017; 16:111. [PMID: 28893252 PMCID: PMC5594451 DOI: 10.1186/s12933-017-0592-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) might aggravate the carotid plaque vulnerability, and increase the risk for ischemic stroke. Few studies reported the acute stroke subtype with carotid plaque characteristics in T2DM patients. This study aimed to investigate the association between carotid plaque characteristics and acute cerebral infarct (ACI) lesion features determined by MRI in T2DM patients. METHODS Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited. All patients were stratified into T2DM and non-T2DM groups and underwent both carotid and brain MRI scans. Ipsilateral carotid plaque morphological and compositional characteristics, intracranial and extracranial carotid artery stenosis were also determined. Stroke subtype based on the Trial of ORG 10172 in Acute Stroke Treatment classification and ACI lesion patterns were evaluated. RESULTS Of the recruited 140 patients, 68 (48.6%) patients had T2DM (mean age 64.16 ± 11.38 years, 40 males). T2DM patients exhibited higher prevalence of carotid type IV-VI lesions, larger plaque burden as well as larger lipid-rich necrotic core (LRNC) compared with non-T2DM patients. Among the patients with carotid LRNC on symptomatic side, more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in T2DM group than those in non-T2DM group. Carotid plaque with LRNC% > 22.0% was identified as an independent risk factor for the presence of ACI lesions confined to the carotid territory in T2DM patients, regardless of other risk factors. CONCLUSIONS This study shows that more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in the T2DM patients with ipsilateral carotid LRNC plaque than those in non-T2DM patients. Quantification of the carotid plaque characteristics, particularly the LRNC% by MRI has the potential usefulness for stroke risk stratification.
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Affiliation(s)
- Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
| | - Xiaoqian Ge
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
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Shu H, Sun J, Hatsukami TS, Balu N, Hippe DS, Liu H, Kohler TR, Zhu W, Yuan C. Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging: Comparison with contrast-enhanced MR angiography for measuring carotid stenosis. J Magn Reson Imaging 2017; 46:1045-1052. [PMID: 28165646 DOI: 10.1002/jmri.25653] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/12/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate in a proof-of-concept study the feasibility of Simultaneous Noncontrast Angiography and intraPlaque hemorrhage (SNAP) imaging as a clinical magnetic resonance angiography (MRA) technique for measuring carotid stenosis. There is a growing interest in detecting intraplaque hemorrhage (IPH) during the clinical management of carotid disease, yet luminal stenosis has remained indispensable during clinical decision-making. SNAP imaging has been proposed as a novel IPH imaging technique that provides carotid MRA with no added scan time. Flowing blood shows negative signal on SNAP because of phase-sensitive inversion recovery. MATERIALS AND METHODS In all, 58 asymptomatic subjects with 16-79% stenosis on ultrasound were scanned at 3T by SNAP with 0.8 mm isotropic resolution and 16 cm longitudinal coverage. Two readers measured luminal stenosis of bilateral carotid arteries (n = 116) on minimum intensity projections of SNAP using the NASCET criteria. In the subset (48 arteries) with contrast-enhanced (CE) MRA available for comparison, luminal stenosis was also measured on maximum intensity projections of CE-MRA. RESULTS Intraclass correlation coefficients (ICCs) with 95% confidence intervals were 0.94 (0.90-0.96) and 0.93 (0.88-0.96) for intra- and interreader agreement on stenosis measurements, respectively. Corresponding kappas for grading stenosis (0-29%, 30-69%, 70-99%, and 100%) were 0.79 (0.67-0.89) and 0.80 (0.68-0.90). Agreement between SNAP and CE-MRA was high (ICC: 0.95 [0.90-0.98]; kappa: 0.82 [0.71-0.93]). CONCLUSION As a dedicated IPH-imaging sequence, SNAP also provided carotid stenosis measurement that showed high intra- and interreader consistency and excellent agreement with CE-MRA. Further comparisons with digital subtraction angiography and other noninvasive techniques are warranted. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1045-1052.
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Affiliation(s)
- Hongge Shu
- Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Haining Liu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Ted R Kohler
- Department of Surgery, University of Washington, Seattle, Washington, USA.,Surgery and Perioperative Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Bioengineering, University of Washington, Seattle, Washington, USA
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Ge X, Zhou Z, Zhao H, Li X, Sun B, Suo S, Hackett ML, Wan J, Xu J, Liu X. Evaluation of carotid plaque vulnerability in vivo: Correlation between dynamic contrast-enhanced MRI and MRI-modified AHA classification. J Magn Reson Imaging 2017; 46:870-876. [PMID: 28120364 DOI: 10.1002/jmri.25637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/03/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To noninvasively monitor carotid plaque vulnerability by exploring the relationship between pharmacokinetic parameters (PPs) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and plaque types based on MRI-modified American Heart Association (AHA) classification, as well as to assess the ability of PPs in discrimination between stable and vulnerable plaques suspected on MRI. MATERIALS AND METHODS Of 70 consecutive patients with carotid plaques who volunteered for 3.0T MRI (3D time-of-flight [TOF], T1 -weighted, T2 -weighted, 3D magnetization-prepared rapid acquisition gradient-echo [MP-RAGE] and DCE-MRI), 66 participants were available for analysis. After plaque classification according to MRI-modified AHA Lesion-Type (LT), PPs (Ktrans , kep , ve , and vp ) of DCE-MRI were measured. The Extended Tofts model was used for calculation of PPs. For participants with multiple carotid plaques, the plaque with the worst MRI-modified AHA LT was chosen for analysis. Correlations between PPs and plaque types and the ability of these parameters to distinguish stable and vulnerable plaques suspected on MRI were assessed. RESULTS Significant positive correlation between Ktrans and LT III to VI was found (ρ = 0.532, P < 0.001), as was the correlation between kep and LT III to VI (ρ = 0.409, P < 0.001). Stable and vulnerable plaques suspected on MRI could potentially be distinguished by Ktrans (sensitivity 83%, specificity 100%) and kep (sensitivity 77%, specificity 91%). CONCLUSION Ktrans and kep from DCE-MRI can provide quantitative information to monitor plaque vulnerability in vivo and differentiate vulnerable plaques suspected on MRI from stable ones. These two parameters could be adopted as imaging biomarkers for plaque characterization and risk stratification. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:870-876.
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Affiliation(s)
- Xiaoqian Ge
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Zien Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Xiao Li
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Beibei Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Shiteng Suo
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Maree L Hackett
- Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Jieqing Wan
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Xiaosheng Liu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
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Ni QQ, Chen GZ, Schoepf UJ, Klitsie MAJ, De Cecco CN, Zhou CS, Luo S, Lu GM, Zhang LJ. Cerebral CTA with Low Tube Voltage and Low Contrast Material Volume for Detection of Intracranial Aneurysms. AJNR Am J Neuroradiol 2016; 37:1774-1780. [PMID: 27151751 DOI: 10.3174/ajnr.a4803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/06/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Multidetector row CTA has become the primary imaging technique for detecting intracranial aneurysms. Technical progress enables the use of cerebral CTA with lower radiation doses and contrast media. We evaluated the diagnostic accuracy of 80-kV(peak) cerebral CTA with 30 mL of contrast agent for detecting intracranial aneurysms. MATERIALS AND METHODS Two hundred four patients were randomly divided into 2 groups. Patients in group A (n = 102) underwent 80-kVp CTA with 30 mL of contrast agent, while patients in group B (n = 102) underwent conventional CTA (120 kVp, 60 mL of contrast agent). All patients underwent DSA. Image quality, diagnostic accuracy, and radiation dose between the 2 groups were compared. RESULTS Diagnostic image quality was obtained in 100 and 99 patients in groups A and B, respectively (P = .65). With DSA as reference standard, diagnostic accuracy on a per-aneurysm basis was 89.9% for group A and 93.9% for group B. For evaluating smaller aneurysms (<3 mm), the diagnostic accuracy of groups A and B was 86.3% and 90.8%, respectively. There was no difference in diagnostic accuracy between each CTA group and DSA (all, P > .05) or between the 2 CTA groups (all, P > .05). The effective dose in group A was reduced by 72.7% compared with group B. CONCLUSIONS In detecting intracranial aneurysms with substantial radiation dose and contrast agent reduction, 80-kVp/30-mL contrast CTA provides the same diagnostic accuracy as conventional CTA.
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Affiliation(s)
- Q Q Ni
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - G Z Chen
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - U J Schoepf
- Department of Radiology and Radiological Science (U.J.S., M.A.J.K., C.N.D.C.), Medical University of South Carolina, Charleston, South Carolina
| | - M A J Klitsie
- Department of Radiology and Radiological Science (U.J.S., M.A.J.K., C.N.D.C.), Medical University of South Carolina, Charleston, South Carolina
| | - C N De Cecco
- Department of Radiology and Radiological Science (U.J.S., M.A.J.K., C.N.D.C.), Medical University of South Carolina, Charleston, South Carolina
| | - C S Zhou
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - S Luo
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - G M Lu
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - L J Zhang
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Inoue K, Maeda M, Umino M, Takase S, Yamahata T, Sakuma H. Cervical carotid plaque evaluation using 3D T1-weighted black-blood magnetic resonance imaging: Comparison of turbo field-echo and turbo spin-echo sequences. Eur J Radiol 2016; 85:1035-9. [PMID: 27130068 DOI: 10.1016/j.ejrad.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the capability of three-dimensional (3D) T1-weighted turbo field-echo (TFE) black-blood (BB) magnetic resonance imaging (MRI) and turbo-spin echo (TSE) BB MRI for discerning carotid plaques and the difference of signal intensities of the plaques from that of adjacent muscle in patients with cervical carotid stenosis. METHODS Cervical carotid stenosis was evaluated by 3.0-T MR in 43 patients (38 men and 5 women; age, 36-83 years; mean age, 70 years) during 8 months. The carotid BB MRI comprised 3D T1-weighted TSE BB (T1-TSEBB) and 3D T1-weighted TFE BB (T1-TFEBB) sequences. The delineation of the carotid plaque border was evaluated in comparison with digital subtraction angiography (DSA). The border between the plaque and vessel lumen was rated visually (4-point analysis) and quantitatively (contrast-to-noise ratio). The signal-intensity ratio (SIR) of the plaque to the adjacent muscle was also measured. Data of 3D T1-TSEBB and 3D T1-TFEBB were compared statistically using the Wilcoxon signed-rank test. RESULTS Visual and quantitative analyses revealed that the border between the plaque and vessel lumen was better delineated on 3D T1-TSEBB MRI than on 3D T1-TFEBB MRI (p<0.01, respectively). SIR of the plaque-to-adjacent muscle was higher on 3D T1- TFEBB MRI than on 3D T1-TSEBB MRI (p<0.05). High signal plaques with a SIR of >1.5 were underestimated on 3D T1-TSEBB MRI. CONCLUSIONS 3D T1-TSEBB MRI was superior to 3D T1-TFEBB MRI for delineating carotid plaques; however, high signal plaques were underestimated on 3D T1-TSEBB MRI.
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Affiliation(s)
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University School of Medicine, Japan.
| | - Maki Umino
- Depatment of Radiology, Mie University School of Medicine, Japan
| | | | | | - Hajime Sakuma
- Depatment of Radiology, Mie University School of Medicine, Japan
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37
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Abstract
There has been significant progress made in 3-dimensional (3D) carotid plaque MR imaging techniques in recent years. Three-dimensional plaque imaging clearly represents the future in clinical use. With effective flow-suppression techniques, choices of different contrast weighting acquisitions, and time-efficient imaging approaches, 3D plaque imaging offers flexible imaging plane and view angle analysis, large coverage, multivascular beds capability, and even can be used in fast screening.
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Affiliation(s)
- Chun Yuan
- Vascular Imaging Lab, Department of Radiology, Bio-Molecular Imaging Center, University of Washington, Box 358050, 850 Republican Street, Seattle, WA 98109-4714, USA.
| | - Dennis L Parker
- Department of Radiology, Imaging & Neurosciences Center, Utah Center for Advanced Imaging Research (UCAIR), University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA
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