1
|
Ristow I, Riedel C, Lenz A, Well L, Adam G, Panuccio G, Kölbel T, Bannas P. Current Imaging Strategies in Patients with Abdominal Aortic Aneurysms. ROFO-FORTSCHR RONTG 2024; 196:52-61. [PMID: 37699431 DOI: 10.1055/a-2119-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND An abdominal aortic aneurysm (AAA) is defined as a localized dilatation of the abdominal aorta of ≥ 3 cm. With a prevalence of 4-8 %, AAA is one of the most common vascular diseases in Western society. Radiological imaging is an elementary component in the diagnosis, monitoring, and treatment planning of AAA patients. METHOD This is a narrative review article on preoperative imaging strategies of AAA, incorporating expert opinions based on the current literature and standard-of-care practices from our own center. Examples are provided to illustrate clinical cases from our institution. RESULTS AND CONCLUSION Radiological imaging plays a pivotal role in the initial diagnosis and monitoring of patients with AAA. Ultrasound is the mainstay imaging modality for AAA screening and surveillance. Contrast-enhanced CT angiography is currently considered the gold standard for preoperative imaging and image-based treatment planning in AAA repair. New non-contrast MR angiography techniques are robustly applicable and allow precise determination of aortic diameters, which is of critical importance, particularly with regard to current diameter-based surgical treatment guidelines. 3D imaging with multiplanar reformation and automatic centerline positioning enables more accurate assessment of the maximum aortic diameter. Modern imaging techniques such as 4D flow MRI have the potential to further improve individualized risk stratification in patients with AAA. KEY POINTS · Ultrasound is the mainstay imaging modality for AAA screening and monitoring. · Contrast-enhanced CT angiography is the gold standard for preoperative imaging in AAA repair. · Non-contrast MR angiography allows for accurate monitoring of aortic diameters in AAA patients. · Measurement of aortic diameters is more accurate with 3D-CT/MRI compared to ultrasound. · Research seeks new quantitative imaging biomarkers for AAA risk stratification, e. g., using 4D flow MRI.
Collapse
Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Zhang Y, Taylor E, Huang N, Hamilton J, Cheng JX. Survival intravascular photoacoustic imaging of lipid-rich plaque in cholesterol fed rabbits. TRANSLATIONAL BIOPHOTONICS 2022; 4:e202200012. [PMID: 38283396 PMCID: PMC10812843 DOI: 10.1002/tbio.202200012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
Intravascular photoacoustic (IVPA) imaging is a promising modality for quantitative assessment of lipid-laden atherosclerotic plaques. Yet, survival IVPA imaging of the same plaque in the same animal is not demonstrated. Here, using a sheathed IVUS/PA catheter of 0.9 mm in diameter, we demonstrate MRI-guided survival IVPA imaging of same plaque in an aorta of a well-established rabbit model mimicking atherosclerosis in human patients. The IVUS/PA results were confirmed by histology. These advances open the opportunity to evaluate the effectiveness of a therapy that aims to reduce the size of atherosclerotic plaques and demonstrates the potential of translating the IVPA catheter into clinic for detection of lipid-rich plaques that are at high risk for thrombosis.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Physics, Boston University, Boston, 02215, USA
| | - Erik Taylor
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, 02118, USA
| | - Nasi Huang
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, 02118, USA
| | - James Hamilton
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, 02118, USA
| | - Ji-Xin Cheng
- Department of Physics, Boston University, Boston, 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, 02215, USA
- Department of Electrical and Computer Engineering, Boston University, Boston, 02215, USA
| |
Collapse
|
3
|
Mizutani K, Torimoto I, Sekikawa Z, Nishii T, Kawasaki T, Kasama K, Goto T, Takebayashi S. Semiautomatic Volumetry of Low Attenuation of Thoracic Aortic Plaques on Curved Planar Reformations Using MDCT Angiographic Data with 0.5 mm Collimation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3563817. [PMID: 29951535 PMCID: PMC5987240 DOI: 10.1155/2018/3563817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/15/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022]
Abstract
To evaluate the relationship of aortic low attenuation plaque volume (LAPV) on multidetector computed tomography (MDCT) with the abdominal aortic aneurysm (AAA), the coronary arterial disease (CAD, ≥50% stenosis), severe (≥90% stenosis) CAD, hypertension, and long-term (≥10 years) hypertension. Curved planar reformations (CPR) of three segments (the ascending, the arch, and the upper descending aorta) of the thoracic aorta were generated with attenuation-dependent color codes to measure LAPV with 0~29 HU and total noncalcified plaque volume (TNPV) with 0~150 HU in 95 patients. Correlation coefficients were employed to assess the impact of each LAPV and TNPV on AAA, CAD, severe CAD, hypertension, and long-term hypertension. Each Mean LAPV/cm and TNPV/cm was statistically greater in the aortic arch than the ascending (p < 0.001 on each) or the proximal descending segment (p < 0.001 on each). LAPV in the aortic arch has moderate correlations with AAA, severe CAD, and long-term hypertension (r = 0.643, 0.639, 0.662, resp.). Plaque volumes in each aortic segment can be measured clinically and the increasing LAPV in the arch may be a significant factor associated with the development of severe atherosclerosis underlying AAA, severe CAD, and long-term hypertension.
Collapse
Affiliation(s)
- Kenji Mizutani
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Izumi Torimoto
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Zenjiro Sekikawa
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Nishii
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawasaki
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiichiro Kasama
- Department of Cardiovascular Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigeo Takebayashi
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| |
Collapse
|
4
|
Kim M, Sahu A, Kim GB, Nam GH, Um W, Shin SJ, Jeong YY, Kim IS, Kim K, Kwon IC, Tae G. Comparison of in vivo targeting ability between cRGD and collagen-targeting peptide conjugated nano-carriers for atherosclerosis. J Control Release 2017; 269:337-346. [PMID: 29175140 DOI: 10.1016/j.jconrel.2017.11.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023]
Abstract
Atherosclerosis plaque is a major cause of cardiovascular diseases across the globe and a silent killer. There are no physical symptoms of the disease in its early stage and current diagnostic techniques cannot detect the small plaques effectively or safely. Plaques formed in blood vessels can cause serious clinical problems such as impaired blood flow or sudden death, regardless of their size. Thus, detecting early stage of plaques is especially more important to effectively reduce the risk of atherosclerosis. Nanoparticle based delivery systems are recognized as a promising option to fight against this disease, and various targeting ligands are typically used to improve their efficiency. So, the choice of appropriate targeting ligand is a crucial factor for optimal targeting efficiency. cRGD peptide and collagen IV targeting peptide, which binds with the αvβ3 integrin overexpressed in the neovasculature of the plaque and collagen type IV present in the plaque, respectively, are frequently used for the targeting of nanoparticles. However, at present no study has directly compared these two peptides. Therefore, in this study, we have prepared cRGD or collagen IV targeting (Col IV-tg-) peptide conjugated and iron oxide nanoparticle (IONP) loaded Pluronic based nano-carriers for systemic comparison of their targeting ability towards in vivo atherosclerotic plaque in Apolipoprotein E deficient (Apo E-/-) mouse model. Nano-carriers with similar size, surface charge, and IONP loading content but with different targeting ligands were analyzed through in vitro and in vivo experiments. Near infrared fluorescence imaging and magnetic resonance imaging techniques as well as Prussian blue staining were used to compare the accumulation of different ligand conjugated nano-caariers in the aorta of atherosclerotic mice. Our results indicate that cRGD based targeting is more efficient than Col IV-tg-peptide in the early stage of atherosclerosis.
Collapse
Affiliation(s)
- Manse Kim
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
| | - Abhishek Sahu
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
| | - Gi Beom Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea; KU-KIST School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
| | - Gi Hoon Nam
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea; KU-KIST School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
| | - Wooram Um
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - So Jin Shin
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju 61469, Republic of Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju 61469, Republic of Korea
| | - In-San Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea; KU-KIST School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
| | - Kwangmeyung Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea; KU-KIST School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
| | - Ick Chan Kwon
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea; KU-KIST School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
| | - Giyoong Tae
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea.
| |
Collapse
|
5
|
Wehrum T, Dragonu I, Strecker C, Schuchardt F, Hennemuth A, Drexl J, Reinhard T, Böhringer D, Vach W, Hennig J, Harloff A. Aortic atheroma as a source of stroke - assessment of embolization risk using 3D CMR in stroke patients and controls. J Cardiovasc Magn Reson 2017; 19:67. [PMID: 28877718 PMCID: PMC5586056 DOI: 10.1186/s12968-017-0379-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND It was our purpose to identify vulnerable plaques in the thoracic aorta using 3D multi-contrast CMR and estimate the risk of cerebral embolization using 4D flow CMR in cryptogenic stroke patients and controls. METHODS One hundred patients (40 with cryptogenic stroke, 60 ophthalmologic controls matched for age, sex and presence of hypertension) underwent a novel 3D multi-contrast (T1w, T2w, PDw) CMR protocol at 3 Tesla for plaque detection and characterization within the thoracic aorta, which was combined with 4D flow CMR for mapping potential embolization pathways. Plaque morphology was assessed in consensus reading by two investigators and classified according to the modified American-Heart-Association (AHA) classification of atherosclerotic plaques. RESULTS In the thoracic aorta, plaques <4 mm thickness were found in a similar number of stroke patients and controls [23 (57.5%) versus 33 (55.0%); p = 0.81]. However, plaques ≥4 mm were more frequent in stroke patients [22 (55.0%) versus 10 (16.7%); p < 0.001]. Of those patients with plaques ≥4 mm, seven (17.5%) stroke patients and two (3.3%) controls (p < 0.001) had potentially vulnerable AHA type VI plaques. Six stroke patients with vulnerable AHA type VI plaques ≥4 mm had potential embolization pathways connecting the plaque, located in the aortic arch (n = 3) and proximal descending aorta (n = 3), with the individual territory of stroke, which made them the most likely source of stroke in those patients. CONCLUSIONS Our findings underline the significance of ≥4 mm thick and vulnerable plaques in the aortic arch and descending aorta as a relevant etiology of stroke. CLINICAL TRIAL REGISTRATION Unique identifier: DRKS00006234 ; date of registration: 11/06/2014.
Collapse
Affiliation(s)
- Thomas Wehrum
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Iulius Dragonu
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic Radiology – Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Strecker
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Schuchardt
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Thomas Reinhard
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Böhringer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Werner Vach
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic Radiology – Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
6
|
Li B, Li H, Kong H, Dong L, Zhang J, Fang J. Compressed sensing based simultaneous black- and gray-blood carotid vessel wall MR imaging. Magn Reson Imaging 2017; 38:214-223. [DOI: 10.1016/j.mri.2017.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
|
7
|
Wehrum T, Dragonu I, Strecker C, Hennig J, Harloff A. Multi-contrast and three-dimensional assessment of the aortic wall using 3T MRI. Eur J Radiol 2017. [PMID: 28629561 DOI: 10.1016/j.ejrad.2017.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To develop a 3D-multi-contrast MRI protocol allowing for high resolution imaging of the wall and of atheroma in the thoracic aorta. METHODS Eleven healthy volunteers and eleven acute stroke patients with aortic plaques detected by TEE underwent MRI at 3T. The MRI-protocol consisted of a T1w-bright-blood, a T2w- and a PDw-black-blood sequence (spatial resolution=1.15mm3). Image quality was assessed by two blinded investigators using a 3-point score and intra- and inter-rater agreement was tested. In patients, atherosclerotic plaques were graded according to the modified American Heart Association (AHA) classification. RESULTS Total examination time was 35:42±7:48min in volunteers and 41:07±3:15min in patients. Image quality was graded with the highest score in 80-94% of T1w, 89-96% of T2w and 79-86% of PDw datasets. Intra- and inter-rater reliability regarding image quality grading was high. Five stroke patients showed AHA type III lesions, three had AHA type VII and two had type VIII plaques. One patient had a vulnerable appearing AHA VI plaque. CONCLUSIONS 3D-multi-contrast MR-imaging of the aorta was performed with high image quality and in reasonable time. It allows evaluation of atherosclerotic plaque composition throughout the aortic arch and can be used to identify vulnerable plaques in acute stroke patients.
Collapse
Affiliation(s)
- Thomas Wehrum
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany.
| | - Iulius Dragonu
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany; Department of Radiology - MR Physics, Medical Center, University of Freiburg, Germany
| | - Christoph Strecker
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| | - Jürgen Hennig
- Department of Radiology - MR Physics, Medical Center, University of Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| |
Collapse
|
8
|
Mourmoura E, Vasilaki A, Giannoukas A, Michalodimitrakis E, Pavlidis P, Tsezou A. Evidence of deregulated cholesterol efflux in abdominal aortic aneurysm. Acta Histochem 2016; 118:97-108. [PMID: 26725543 DOI: 10.1016/j.acthis.2015.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022]
Abstract
Previous studies indicated that lipids may be associated with abdominal aortic aneurysm (AAA); however the molecular mechanism involved is unclear. Our study aimed to investigate the expression pattern of cholesterol efflux related proteins in AAA. Liver X receptors (LXRα and LXRβ), ATP-binding-cassette transporter A1 (ABCA1), Apolipoprotein AI (ApoAI), smooth muscle α-actin (α-SM) and vimentin expression levels were evaluated in human AAA, atherosclerotic (ATH) and normal abdominal aortic tissues. We found significant differences in LXRα, LXRβ and ABCA1 mRNA expression levels between AAA, ATH and normal whole aortic tissues and also within the AAA, ATH and normal "intima-media" layers. Specifically, LXRα, LXRβ and ABCA1 mRNA levels were decreased in AAA compared to ATH-whole tissues, as well as in AAA "intima-media" compared to ATH and normal "intima-media" layers. Moreover, immunohistochemical evaluation revealed that LXRα and ABCA1 immunoreactivities (IR) were reduced in the AAA media compared to the normal and ATH media layers and that they were also reduced in the intima layer of AAA and ATH tissues, whereas ApoAI-IR was increased in the AAA and ATH aortic walls compared to normal pointing to possible deregulation of the cholesterol efflux mechanism in AAA. Furthermore, double staining for vimentin and α-SM showed vimentin expression in the intima and inner media layer of AAA with sparse vimentin positive SMCs designating possible SMCs phenotype switch from contractile to synthetic form. In addition, histochemical analysis showed excessive lipid accumulation in the AAA wall, while co-staining using Oil Red O with α-SM or CD68 revealed lipid accumulation in SMCs and macrophages, respectively. Our study provides novel evidence for impaired cholesterol efflux in AAA associated with lipid accumulation in SMCs and macrophages, as well as switch of SMCs phenotype from contractile to synthetic form.
Collapse
Affiliation(s)
- Evanthia Mourmoura
- University of Thessaly, Faculty of Medicine, Department of Cytogenetics and Molecular Genetics, Biopolis, Larissa 41100, Greece
| | - Anna Vasilaki
- University of Thessaly, Faculty of Medicine, Department of Pharmacology, Biopolis, Larissa 41100, Greece
| | - Athanasios Giannoukas
- University of Thessaly, Faculty of Medicine, Department of Vascular Surgery, Mezourlo, Larissa 41100, Greece
| | | | - Pavlos Pavlidis
- Democritus University of Thrace, Faculty of Medicine, Department of Forensic Medicine, Alexandroupolis 68100, Greece
| | - Aspasia Tsezou
- University of Thessaly, Faculty of Medicine, Department of Cytogenetics and Molecular Genetics, Biopolis, Larissa 41100, Greece; University of Thessaly, Faculty of Medicine, Department of Biology, Biopolis, Larissa 41100, Greece.
| |
Collapse
|
9
|
Forsythe RO, Newby DE, Robson JMJ. Monitoring the biological activity of abdominal aortic aneurysms Beyond Ultrasound. Heart 2016; 102:817-24. [PMID: 26879242 PMCID: PMC4893091 DOI: 10.1136/heartjnl-2015-308779] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/21/2016] [Indexed: 12/27/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) are an important cause of morbidity and, when ruptured, are associated with >80% mortality. Current management decisions are based on assessment of aneurysm diameter by abdominal ultrasound. However, AAA growth is non-linear and rupture can occur at small diameters or may never occur in those with large AAAs. There is a need to develop better imaging biomarkers that can identify the potential risk of rupture independent of the aneurysm diameter. Key pathobiological processes of AAA progression and rupture include neovascularisation, necrotic inflammation, microcalcification and proteolytic degradation of the extracellular matrix. These processes represent key targets for emerging imaging techniques and may confer an increased risk of expansion or rupture over and above the known patient-related risk factors. Magnetic resonance imaging, using ultrasmall superparamagnetic particles of iron oxide, can identify and track hotspots of macrophage activity. Positron emission tomography, using a variety of targeted tracers, can detect areas of inflammation, angiogenesis, hypoxia and microcalcification. By going beyond the simple monitoring of diameter expansion using ultrasound, these cellular and molecular imaging techniques may have the potential to allow improved prediction of expansion or rupture and to better guide elective surgical intervention.
Collapse
Affiliation(s)
- Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jennifer M J Robson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
10
|
Jung C, Dučić T, Reimer R, Koziolek E, Kording F, Heine M, Adam G, Ittrich H, Kaul MG. Gadospin F-enhanced magnetic resonance imaging for diagnosis and monitoring of atherosclerosis: validation with transmission electron microscopy and x-ray fluorescence imaging in the apolipoprotein e-deficient mouse. Mol Imaging 2015; 13. [PMID: 25342533 DOI: 10.2310/7290.2014.00039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the feasibility of noninvasive monitoring of plaque burden in apolipoprotein E-deficient (ApoE-/-) mice by Gadospin F (GDF)-enhanced magnetic resonance imaging (MRI). Gadolinium uptake in plaques was controlled using transmission electron microscopy (TEM) and x-ray fluorescence (XRF) microscopy. To monitor the progression of atherosclerosis, ApoE-/- (n = 5) and wild-type (n = 2) mice were fed a Western diet and imaged at 5, 10, 15, and 20 weeks. Contrast-enhanced MRI was performed at 7 T Clinscan (Bruker, Ettlingen, Germany) before and 2 hours after intravenous injection of GDF (100 μmol/kg) to determine the blood clearance. Plaque size and contrast to noise ratio (CNR) were calculated for each time point using region of interest measurements to evaluate plaque progression. Following MRI, aortas were excised and GDF uptake was cross-validated by TEM and XRF microscopy. The best signal enhancement in aortic plaque was achieved 2 hours after application of GDF. No signal differences between pre- and postcontrast MRI were detectable in wild-type mice. We observed a gradual and considerable increase in plaque CNR and size for the different disease stages. TEM and XRF microscopy confirmed the localization of GDF within the plaque. GDF-enhanced MRI allows noninvasive and reliable estimation of plaque burden and monitoring of atherosclerotic progression in vivo.
Collapse
|
11
|
Abstract
OBJECTIVE. In this article, we review the histopathologic classification of coronary atherosclerotic plaques and describe the possibilities and limitations of CT regarding the evaluation of coronary artery plaques. CONCLUSION. The composition of atherosclerotic plaques in the coronary arteries displays substantial variability and is associated with the likelihood for rupture and downstream ischemic events. Accurate identification and quantification of coronary plaque components on CT is challenging because of the limited temporal, spatial, and contrast resolutions of current scanners. Nonetheless, CT may provide valuable information that has potential for characterization of coronary plaques. For example, the extent of calcification can be determined, lipid-rich lesions can be separated from more fibrous ones, and positive remodeling can be identified.
Collapse
|
12
|
McBride OMB, Berry C, Burns P, Chalmers RTA, Doyle B, Forsythe R, Garden OJ, Goodman K, Graham C, Hoskins P, Holdsworth R, MacGillivray TJ, McKillop G, Murray G, Oatey K, Robson JMJ, Roditi G, Semple S, Stuart W, van Beek EJR, Vesey A, Newby DE. MRI using ultrasmall superparamagnetic particles of iron oxide in patients under surveillance for abdominal aortic aneurysms to predict rupture or surgical repair: MRI for abdominal aortic aneurysms to predict rupture or surgery-the MA(3)RS study. Open Heart 2015; 2:e000190. [PMID: 25932334 PMCID: PMC4410138 DOI: 10.1136/openhrt-2014-000190] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Population screening for abdominal aortic aneurysms (AAA) halves the associated mortality and has led to the establishment of national screening programmes. Prediction of aneurysm growth and rupture is challenging and currently relies on serial diameter measurements with ultrasound. Recently, a novel MRI-based technique using ultrasmall superparamagnetic particles of iron oxide (USPIO) has demonstrated considerable promise as a method of identifying aneurysm inflammation and expansion. Methods and analysis The MA3RS study is a prospective observational multicentre cohort study of 350 patients with AAA in three centres across Scotland. All participants will undergo MRI with USPIO and aneurysm expansion will be measured over 2 years with CT in addition to standard clinical ultrasound surveillance. The relationship between mural USPIO uptake and subsequent clinical outcomes, including expansion, rupture and repair, will be evaluated and used to determine whether the technique augments standard risk prediction markers. To ensure adequate sensitivity to answer the primary question, we need to observe 130 events (composite of rupture or repair) with an estimated event rate of 41% over 2 years of follow-up. The MA3RS study is currently recruiting and expects to report in 2017. Discussion This is the first study to evaluate the use of USPIO-enhanced MRI to provide additional information to aid risk prediction models in patients with AAA. If successful, this study will lay the foundation for a large randomised controlled trial targeted at applying this technique to determine clinical management. Trial registration number Current Controlled Trials: ISRCTN76413758.
Collapse
Affiliation(s)
- Olivia M B McBride
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Paul Burns
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Roderick T A Chalmers
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Barry Doyle
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Rachael Forsythe
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - O James Garden
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Kirsteen Goodman
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Catriona Graham
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Peter Hoskins
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | | | - Thomas J MacGillivray
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Graham McKillop
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Gordon Murray
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Katherine Oatey
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Jennifer M J Robson
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Giles Roditi
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Scott Semple
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Wesley Stuart
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow , Glasgow , UK
| | - Edwin J R van Beek
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - Alex Vesey
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| | - David E Newby
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science , Edinburgh , UK
| |
Collapse
|
13
|
Komatsu S, Ohara T, Takahashi S, Takewa M, Minamiguchi H, Imai A, Kobayashi Y, Iwa N, Yutani C, Hirayama A, Kodama K. Early Detection of Vulnerable Atherosclerotic Plaque for Risk Reduction of Acute Aortic Rupture and Thromboemboli and Atheroemboli Using Non-Obstructive Angioscopy. Circ J 2015; 79:742-50. [DOI: 10.1253/circj.cj-15-0126] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Amagasaki Central Hospital
| | - Tomoki Ohara
- Cardiovascular Center, Amagasaki Central Hospital
| | | | | | - Hitoshi Minamiguchi
- Department of Cardiology, Osaka University School of Medicine
- Cardiovascular Center, Amagasaki Central Hospital
| | - Atsuko Imai
- Department of Cardiology, Osaka University School of Medicine
- Cardiovascular Center, Amagasaki Central Hospital
| | | | - Nobuzo Iwa
- Department of Pathology, Amagasaki Central Hospital
| | | | | | | |
Collapse
|
14
|
Abstract
As its outcomes improve, cardiac surgery has been performed on more and more cases which were previously considered to be difficult to deal with. However, there are still a number of problems to be solved regarding surgery on patients with severe sclerotic lesions in the ascending aorta, which we collectively call "bad aorta". Concerning a preoperative assessment of the ascending aorta, our report revealed no relationship between the severity of calcification detected with a preoperative non-enhanced CT and the aortic lesion found during the surgery. Meanwhile, an intraoperative epiaortic ultrasound enables us to make high-quality evaluations of the aorta without imposing much burden on the patient. This modality may be essential for cardiac surgery. As for surgical management for bad aorta, quite a few methods have been reported to this point, but the overall operative mortality rate and cerebrovascular accident rate are relatively high, at a little <10 %, respectively. With the recent cross-clamping method under short-term total circulatory arrest (TCA), however, the results are much better; these rates total around 5 %. Further improvement is expected in the outcome of cardiac surgery on bad aorta cases by establishing a modality to evaluate sclerotic lesions in the ascending aorta with epiaortic ultrasound and by selecting a proper procedure for each case.
Collapse
|
15
|
Allard L, Soulez G, Chayer B, Qin Z, Roy D, Cloutier G. A multimodality vascular imaging phantom of an abdominal aortic aneurysm with a visible thrombus. Med Phys 2014; 40:063701. [PMID: 23718616 DOI: 10.1118/1.4803497] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE With the continuous development of new stent grafts and implantation techniques, it has now become technically feasible to treat abdominal aortic aneurysms (AAA) with challenging anatomy using endovascular repair with standard, fenestrated, or branched stent-grafts. In vitro experimentations are very useful to improve stent-graft design and conformability or imaging guidance for stent-graft delivery or follow-up. Vascular replicas also help to better understand the limitation of endovascular approaches in challenging anatomy and possibly improve surgical planning or training by practicing high risk clinical procedures in the laboratory to improve outcomes in the operating room. Most AAA phantoms available have a very basic anatomy, which is not representative of the clinical reality. This paper presents a method of fabrication of a realistic AAA phantom with a visible thrombus, as well as some mechanical properties characterizing such phantom. METHODS A realistic AAA geometry replica of a real patient anatomy taken from a multidetector computed tomography (CT) scan was manufactured. To demonstrate the multimodality imaging capability of this new phantom with a thrombus visible in magnetic resonance (MR) angiography, CT angiography (CTA), digital subtraction angiography (DSA), and ultrasound, image acquisitions with all these modalities were performed by using standard clinical protocols. Potential use of this phantom for stent deployment was also tested. A rheometer allowed defining hyperelastic and viscoelastic properties of phantom materials. RESULTS MR imaging measurements of SNR and CNR values on T1 and T2-weighted sequences and MR angiography indicated reasonable agreement with published values of AAA thrombus and abdominal components in vivo. X-ray absorption also lay within normal ranges of AAA patients and was representative of findings observed on CTA, fluoroscopy, and DSA. Ultrasound propagation speeds for developed materials were also in concordance with the literature for vascular and abdominal tissues. CONCLUSIONS The mimicked abdominal tissues, AAA wall, and surrounding thrombus were developed to match imaging features of in vivo MR, CT, and ultrasound examinations. This phantom should be of value for image calibration, segmentation, and testing of endovascular devices for AAA endovascular repair.
Collapse
Affiliation(s)
- Louise Allard
- Laboratory of Biorheology and Medical Ultrasonics, Research Center, University of Montreal Hospital (CRCHUM), Québec H2L 2W5, Canada
| | | | | | | | | | | |
Collapse
|
16
|
Nemoto M, Hoshina K, Takayama T, Miura S, Nakazawa T, Kato M, Shigematsu K, Miyata T, Watanabe T. Statins reduce extensive aortic atheromas in patients with abdominal aortic aneurysms. Ann Vasc Dis 2013; 6:711-7. [PMID: 24386020 DOI: 10.3400/avd.oa.13-00065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/30/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Statins have been used widely to reduce dyslipidemia and recently have been reported to have pleiotropic effects such as plaque reduction and stabilization. This study retrospectively evaluated the regression of extensive thoracic atheromas ("shaggy aorta") in abdominal aortic aneurysm (AAA) patients who underwent contrast-enhanced computed tomography (CECT) before and after statin administration. MATERIALS AND METHODS CECT was used to examine thoracic aortas of 29 patients (statin group; n = 22, non-statin group; n = 7) with extensive atheromas from the ostium of the left subclavian artery to that of the more proximal renal artery. Extensive thoracic atheroma was defined by: (1) thickness >5 mm, (2) involved circumference of thoracic aorta >50%, and (3) length >30 mm. The areas of atheroma (cm(2)) were measured before and after administration of statins, and the atheroma reduction ratio (ARR) was evaluated. RESULTS The area of atheroma decreased after administration of statins, and the ARR was significant (P <0.01). The ARR increased with all cases in non-statin group. No complications associated with extensive atheroma were observed during the follow-up period. CONCLUSION This pilot study indicates statins can reduce extensive thoracic atheromas and lower lipid concentrations.
Collapse
Affiliation(s)
- Masaru Nemoto
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshio Takayama
- Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Osaka, Japan
| | - Sumio Miura
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tatsu Nakazawa
- Department of Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Osaka, Japan
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuro Miyata
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
17
|
Phinikaridou A, Andia ME, Lacerda S, Lorrio S, Makowski MR, Botnar RM. Molecular MRI of atherosclerosis. Molecules 2013; 18:14042-69. [PMID: 24232739 PMCID: PMC6270261 DOI: 10.3390/molecules181114042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 11/22/2022] Open
Abstract
Despite advances in prevention, risk assessment and treatment, coronary artery disease (CAD) remains the leading cause of morbidity and mortality in Western countries. The lion's share is due to acute coronary syndromes (ACS), which are predominantly triggered by plaque rupture or erosion and subsequent coronary thrombosis. As the majority of vulnerable plaques does not cause a significant stenosis, due to expansive remodeling, and are rather defined by their composition and biological activity, detection of vulnerable plaques with x-ray angiography has shown little success. Non-invasive vulnerable plaque detection by identifying biological features that have been associated with plaque progression, destabilization and rupture may therefore be more appropriate and may allow earlier detection, more aggressive treatment and monitoring of treatment response. MR molecular imaging with target specific molecular probes has shown great promise for the noninvasive in vivo visualization of biological processes at the molecular and cellular level in animals and humans. Compared to other imaging modalities; MRI can provide excellent spatial resolution; high soft tissue contrast and has the ability to simultaneously image anatomy; function as well as biological tissue composition and activity.
Collapse
Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Marcelo E. Andia
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 8331150, Chile
| | - Sara Lacerda
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Silvia Lorrio
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Marcus R. Makowski
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Department of Radiology, Charite, Berlin 10117, Germany
| | - René M. Botnar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Wellcome Trust and ESPRC Medical Engineering Center, King’s College London, London SE1 7EH, UK
- BHF Centre of Excellence, King’s College London, London SE1 7EH, UK
- NIHR Biomedical Research Centre, King’s College London, London SE1 7EH, UK
| |
Collapse
|
18
|
Categorization of aortic aneurysm thrombus morphology by magnetic resonance imaging. Eur J Radiol 2013; 82:e544-9. [DOI: 10.1016/j.ejrad.2013.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/29/2013] [Indexed: 11/17/2022]
|
19
|
Molecular imaging of experimental abdominal aortic aneurysms. ScientificWorldJournal 2013; 2013:973150. [PMID: 23737735 PMCID: PMC3655677 DOI: 10.1155/2013/973150] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/19/2013] [Indexed: 11/18/2022] Open
Abstract
Current laboratory research in the field of abdominal aortic aneurysm (AAA) disease often utilizes small animal experimental models induced by genetic manipulation or chemical application. This has led to the use and development of multiple high-resolution molecular imaging modalities capable of tracking disease progression, quantifying the role of inflammation, and evaluating the effects of potential therapeutics. In vivo imaging reduces the number of research animals used, provides molecular and cellular information, and allows for longitudinal studies, a necessity when tracking vessel expansion in a single animal. This review outlines developments of both established and emerging molecular imaging techniques used to study AAA disease. Beyond the typical modalities used for anatomical imaging, which include ultrasound (US) and computed tomography (CT), previous molecular imaging efforts have used magnetic resonance (MR), near-infrared fluorescence (NIRF), bioluminescence, single-photon emission computed tomography (SPECT), and positron emission tomography (PET). Mouse and rat AAA models will hopefully provide insight into potential disease mechanisms, and the development of advanced molecular imaging techniques, if clinically useful, may have translational potential. These efforts could help improve the management of aneurysms and better evaluate the therapeutic potential of new treatments for human AAA disease.
Collapse
|
20
|
Current state of experimental imaging modalities for risk assessment of abdominal aortic aneurysm. J Vasc Surg 2013; 57:851-9. [DOI: 10.1016/j.jvs.2012.10.097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 10/11/2012] [Accepted: 10/21/2012] [Indexed: 11/23/2022]
|
21
|
TENJIN H, TANIGAWA S, TAKADOU M, OGAWA T, MANDAI A, NANTO M, OSAKA Y, NAKAHARA Y, UMEDA M, HIGUCHI T. Relationship Between Preoperative Magnetic Resonance Imaging and Surgical Findings: Aneurysm Wall Thickness on High-Resolution T 1-Weighted Imaging and Contact With Surrounding Tissue on Steady-State Free Precession Imaging. Neurol Med Chir (Tokyo) 2013; 53:336-42. [DOI: 10.2176/nmc.53.336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hiroshi TENJIN
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | | | | | - Takahiro OGAWA
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Ayako MANDAI
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Masataka NANTO
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | - Yasuhiko OSAKA
- Department of Neurosurgery, Kyoto Second Red Cross Hospital
| | | | - Masahiro UMEDA
- Department of Medical Informatics, Meiji University of Integrative Medicine
| | - Toshihiro HIGUCHI
- Department of Neurosurgery, Meiji University of Integrative Medicine
| |
Collapse
|
22
|
Chatra PS. Ruptured abdominal aortic aneurysm diagnosed through non-contrast MRI. Qatar Med J 2013; 2013:45-9. [PMID: 25003065 PMCID: PMC4080494 DOI: 10.5339/qmj.2013.16] [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: 09/05/2013] [Accepted: 01/01/2014] [Indexed: 11/28/2022] Open
Abstract
Rupture of an aneurysm is a rare complication although it is considered a common cause of death. Some of these patients present with the classic triad of symptoms such as abdominal pain, pulsatile abdominal mass and shock. Most symptoms are misleading and will only present as vague abdominal pain. Here we describe one such patient with an unusual presentation of a misleading abdominal mass which was eventually diagnosed as a ruptured abdominal aortic aneurysm after an emergency MRI.
Collapse
|
23
|
Bourque JM, Schietinger BJ, Kennedy JL, Pearce EA, Christopher JM, Taylor AM, McNamara CA, Kramer CM. Usefulness of cardiovascular magnetic resonance imaging of the superficial femoral artery for screening patients with diabetes mellitus for atherosclerosis. Am J Cardiol 2012; 110:50-6. [PMID: 22459304 DOI: 10.1016/j.amjcard.2012.02.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/15/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
Abstract
Cardiovascular magnetic resonance (CMR) of the superficial femoral artery (SFA) allows direct and noninvasive visualization of atherosclerotic plaque burden. We examined atherosclerosis in 3 groups of patients without history or symptoms of peripheral arterial disease with varying expected burdens: those with diabetes mellitus (DM) and known coronary artery disease (CAD) (n = 24), those with DM and a high prevalence of CAD risk factors (n = 20), and controls of similar age without DM or CAD and few CAD risk factors (n = 15). We also assessed the diagnostic accuracy of this technique to differentiate among these 3 groups. T1-weighted spin-echocardiographic images were used to measure mean wall thickness (WT) and total wall volume indexed to total vessel volume. Diagnostic accuracy was assessed by area under receiver operating characteristics curve analysis. Patients with DM plus risk factors and DM plus CAD had higher mean WT (1.28 and 1.37 mm) and mean indexed wall volume (0.53 and 0.56) compared to controls (mean WT 1.16 mm and mean indexed wall volume 0.45; p <0.010 for all comparisons). Mean WT and indexed wall volume showed good diagnostic accuracy in discriminating controls from those with DM plus CAD (areas under curve 0.85 and 0.87, respectively, p <0.001), whereas only indexed wall volume discriminated DM plus risk factors from controls (area under curve 0.82, p <0.001). Neither could discriminate between DM plus risk factors and DM plus CAD. In conclusion, patients with DM plus risk factors and DM plus CAD had significantly greater atherosclerotic burden in the SFA on CMR imaging than controls of similar age, with good diagnostic accuracy in differentiating these groups. The high reproducibility and reliability of CMR of the SFA may facilitate improved assessment of atherosclerosis prevalence and progression/regression in studies of novel therapies.
Collapse
|
24
|
Ko Y, Kim WJ, Jang MS, Yang MH, Park JH, Choi SI, Chun EJ, Lee SJ, Han MK, Bae HJ. Is aortic atherothrombotic disease detected using multidetector-row CT associated with an increased risk of early ischemic lesion recurrence after acute ischemic stroke? Stroke 2012; 43:764-9. [PMID: 22282886 DOI: 10.1161/strokeaha.111.632182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Multidetector-row CT (MDCT) is emerging as a new tool for diagnosing aortic atherothrombotic disease (AAD). We elucidated whether MDCT-detected AAD is associated with an increased risk of early ischemic lesion recurrence on diffusion-weighted MRI after ischemic stroke. METHODS A consecutive series of patients with acute ischemic stroke confirmed using diffusion-weighted MRI who were hospitalized within 48 hours after symptom onset and underwent MDCT were identified in a prospective stroke registry database. AAD on MDCT was defined as the presence of plaque formation that was noncalcified and ≥4 mm thick, ulcerative, or soft and thrombosed (vulnerable) in the proximal aortic arch. Ischemic lesion recurrence on diffusion-weighted MRI was defined as the occurrence of any new lesion separate from the index lesion on follow-up diffusion-weighted MRI performed within 14 days after symptom onset. RESULTS A total of 138 patients was selected. MDCT detected AAD in 24 of 138 (17.4%); ≥4 mm thickness in 17 of 138 (12.3%); ulcerated plaque in 20 of 138 (14.5%); and vulnerable plaque in 16 of 138 (11.6%). With respect to diffusion-weighted MRI lesion recurrence, the crude ORs (95% CIs) were as follows: AAD, 3.56 (1.43-8.89); vulnerable plaque, 3.21 (1.11-9.30); ulcerated plaque, 3.37 (1.27-8.95); and ≥4 mm thickness of the noncalcified plaque, 4.23 (1.11-16.19). These results remained significant after adjustments for potential confounders were made. CONCLUSIONS This study shows that AAD detected by MDCT increases the risk of early ischemic lesion recurrence after acute ischemic stroke, thus supporting the role of MDCT in diagnosing AAD and assessing its contribution to recurrence.
Collapse
Affiliation(s)
- Youngchai Ko
- Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Skow G. Abdominal aortic aneurysm. JOURNAL OF MEN'S HEALTH 2011. [DOI: 10.1016/j.jomh.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
|
26
|
Peel SA, Hussain T, Cecelja M, Abbas A, Greil GF, Chowienczyk P, Spector T, Smith A, Waltham M, Botnar RM. Accelerated aortic imaging using small field of view imaging and electrocardiogram-triggered quadruple inversion recovery magnetization preparation. J Magn Reson Imaging 2011; 34:1176-83. [PMID: 21953627 DOI: 10.1002/jmri.22785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 07/27/2011] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To accelerate and optimize black blood properties of the quadruple inversion recovery (QIR) technique for imaging the abdominal aortic wall. MATERIALS AND METHODS QIR inversion delays were optimized for different heart rates in simulations and phantom studies by minimizing the steady state magnetization of blood for T(1) = 100-1400 ms. To accelerate and improve black blood properties of aortic vessel wall imaging, the QIR prepulse was combined with zoom imaging and (a) "traditional" and (b) "trailing" electrocardiogram (ECG) triggering. Ten volunteers were imaged pre- and post-contrast administration using a conventional ECG-triggered double inversion recovery (DIR) and the two QIR implementations in combination with a zoom-TSE readout. RESULTS The QIR implemented with "trailing" ECG-triggering resulted in consistently good blood suppression as the second inversion delay was timed during maximum systolic flow in the aorta. The blood signal-to-noise ratio and vessel wall to blood contrast-to-noise ratio, vessel wall sharpness, and image quality scores showed a statistically significant improvement compared with the traditional QIR implementation with and without ECG-triggering. CONCLUSION We demonstrate that aortic vessel wall imaging can be accelerated with zoom imaging and that "trailing" ECG-triggering improves black blood properties of the aorta which is subject to motion and variable blood flow during the cardiac cycle.
Collapse
Affiliation(s)
- Sarah A Peel
- Kings College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Kings Health Partners, Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Bianda N, Di Valentino M, Periat D, Segatto JM, Oberson M, Moccetti M, Sudano I, Santini P, Limoni C, Froio A, Stuber M, Corti R, Gallino A, Wyttenbach R. Progression of human carotid and femoral atherosclerosis: a prospective follow-up study by magnetic resonance vessel wall imaging. Eur Heart J 2011; 33:230-7. [DOI: 10.1093/eurheartj/ehr332] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
28
|
Kelle S, Hays AG, Hirsch GA, Gerstenblith G, Miller JM, Steinberg AM, Schär M, Texter JH, Wellnhofer E, Weiss RG, Stuber M. Coronary artery distensibility assessed by 3.0 Tesla coronary magnetic resonance imaging in subjects with and without coronary artery disease. Am J Cardiol 2011; 108:491-7. [PMID: 21624552 DOI: 10.1016/j.amjcard.2011.03.078] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 03/25/2011] [Accepted: 03/25/2011] [Indexed: 11/15/2022]
Abstract
Coronary vessel distensibility is reduced with atherosclerosis and normal aging, but direct measurements have historically required invasive measurements at cardiac catheterization. Therefore, we sought to assess coronary artery distensibility noninvasively using 3.0 Telsa coronary magnetic resonance imaging (MRI) and to test the hypothesis that this noninvasive technique can detect differences in coronary distensibility between healthy subjects and those with coronary artery disease (CAD). A total of 38 healthy, adult subjects (23 men, mean age 31 ± 10 years) and 21 patients with CAD, diagnosed using x-ray angiography (11 men, mean age 57 ± 6 years) were studied using a commercial whole-body MRI system. In each subject, the proximal segment of a coronary artery was imaged for the cross-sectional area measurements using cine spiral MRI. The distensibility (mm Hg(-1) × 10(3)) was determined as (end-systolic lumen area - end-diastolic lumen area)/(pulse pressure × end-diastolic lumen area). The pulse pressure was calculated as the difference between the systolic and diastolic brachial blood pressure. A total of 34 healthy subjects and 19 patients had adequate image quality for coronary area measurements. Coronary artery distensibility was significantly greater in the healthy subjects than in those with CAD (mean ± SD 2.4 ± 1.7 mm Hg(-1) × 10(3) vs 1.1 ± 1.1 mm Hg(-1) × 10(3), respectively, p = 0.007; median 2.2 vs 0.9 mm Hg(-1) × 10(3)). In a subgroup of 10 patients with CAD, we found a significant correlation between the coronary artery distensibility measurements assessed using MRI and x-ray coronary angiography (R = 0.65, p = 0.003). In a group of 10 healthy subjects, the repeated distensibility measurements demonstrated a significant correlation (R = 0.80, p = 0.006). In conclusion, 3.0-Tesla MRI, a reproducible noninvasive method to assess human coronary artery vessel wall distensibility, is able to detect significant differences in distensibility between healthy subjects and those with CAD.
Collapse
Affiliation(s)
- Sebastian Kelle
- Department of Medicine, Division of Cardiology, German Heart Institute, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Labruto F, Blomqvist L, Swedenborg J. Imaging the Intraluminal Thrombus of Abdominal Aortic Aneurysms: Techniques, Findings, and Clinical Implications. J Vasc Interv Radiol 2011; 22:1069-75; quiz 1075. [DOI: 10.1016/j.jvir.2011.01.454] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 01/20/2011] [Accepted: 01/30/2011] [Indexed: 10/18/2022] Open
|
30
|
Phinikaridou A, Hamilton JA. Application of MRI to detect high-risk atherosclerotic plaque. Expert Rev Cardiovasc Ther 2011; 9:545-50. [PMID: 21615314 DOI: 10.1586/erc.11.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
31
|
Abstract
Atherosclerosis and its thrombotic complications are the major cause of morbidity and mortality in the industrialized countries. Despite advances in our understanding of the pathophysiology, pathogenesis, and new treatment modalities, the absence of an adequate non-invasive imaging tool for early detection limits both the prevention and treatment of patients with various degrees and anatomical localizations of atherothrombotic disease. An ideal clinical imaging modality for atherosclerotic vascular disease should be safe, inexpensive, non-invasive or minimally invasive, accurate, and reproducible, and the results should correlate with the extent of atherosclerotic disease and have high predictive values for future clinical events. High-resolution magnetic resonance imaging (MRI) has emerged as the most promising technique for studying atherothrombotic disease in humans in vivo. Most importantly, MRI allows for the characterization of plaque composition, i.e. the discrimination of lipid core, fibrosis, calcification, and intraplaque haemorrhage deposits. Magnetic resonance imaging also allows for the detection of arterial thrombi and in defining thrombus age. Magnetic resonance imaging has been used to monitor plaque progression and regression in several animal models of atherosclerosis and in humans. Emerging MRI techniques capable of imaging biological processes, including inflammation, neovascularization, and mechanical forces, may aid in advancing our understanding of the atherothrombotic disease. Advances in diagnosis do prosper provided they march hand-in-hand with advances in treatment. We stand at the threshold of accurate non-invasive assessment of atherosclerosis. Thus, MRI opens new strategies ranging from screening of high-risk patients for early detection and treatment as well as monitoring of the target lesions for pharmacological intervention. Identification of subclinical atherosclerosis and early treatment initiation has the potential to surpass conventional risk factor assessment and management in terms of overall impact on cardiovascular morbidity and mortality. Such strategy is currently under clinical investigation.
Collapse
Affiliation(s)
- Roberto Corti
- Cardiology, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
| | | |
Collapse
|
32
|
Kramer CM, Narula J. Whither catheter-based intravascular magnetic resonance imaging of atherosclerosis? JACC Cardiovasc Imaging 2011; 3:1203-4. [PMID: 21071014 DOI: 10.1016/j.jcmg.2010.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Abstract
Abdominal aortic aneurysms (AAA) affect 5% of the population in developed countries and are characterized by progressive aortic dilatation with an unpredictable time course. This condition is more common in men than in women, and in smokers than in nonsmokers. If left untreated, AAA can result in aortic rupture and death. Pathologically, aortic extracellular matrix degradation, inflammation, and neovascularization are hallmarks of AAA. Diagnosis of AAA and subsequent surveillance utilize established aortic imaging methods, such as ultrasound, CT, and MRI. More-speculative diagnostic approaches include molecular and cellular imaging methods that interrogate the underlying pathological processes at work within the aneurysm. In this Review, we explore the current diagnostic and therapeutic strategies for the management of AAA. We also describe the diagnostic potential of new imaging techniques and therapeutic potential of new treatments for the management of small AAA.
Collapse
|
34
|
Richards JMJ, Semple SI, MacGillivray TJ, Gray C, Langrish JP, Williams M, Dweck M, Wallace W, McKillop G, Chalmers RTA, Garden OJ, Newby DE. Abdominal aortic aneurysm growth predicted by uptake of ultrasmall superparamagnetic particles of iron oxide: a pilot study. Circ Cardiovasc Imaging 2011; 4:274-81. [PMID: 21304070 DOI: 10.1161/circimaging.110.959866] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abdominal aortic aneurysms are a major cause of death. Prediction of aneurysm expansion and rupture is challenging and currently relies on the simple measure of aneurysm diameter. Using MRI, we aimed to assess whether areas of cellular inflammation correlated with the rate of abdominal aortic aneurysm expansion. METHODS AND RESULTS Stable patients (n=29; 27 male; age, 70±5 years) with asymptomatic abdominal aortic aneurysms (4.0 to 6.6 cm) were recruited from a surveillance program and imaged using a 3-T MRI scanner before and 24 to 36 hours after administration of ultrasmall superparamagnetic particles of iron oxide (USPIO). The change in T2* value on T2*-weighted imaging was used to detect accumulation of USPIO within the abdominal aortic aneurysm. Histological examination of aneurysm tissue confirmed colocalization and uptake of USPIO in areas with macrophage infiltration. Patients with distinct mural uptake of USPIO had a 3-fold higher growth rate (n=11, 0.66 cm/y; P=0.020) than those with no (n=6, 0.22 cm/y) or nonspecific USPIO uptake (n=8, 0.24 cm/y) despite having similar aneurysm diameters (5.4±0.6, 5.1±0.5, and 5.0±0.5 cm, respectively; P>0.05). In 1 patient with an inflammatory aneurysm, there was a strong and widespread uptake of USPIO extending beyond the aortic wall. CONCLUSIONS Uptake of USPIO in abdominal aortic aneurysms identifies cellular inflammation and appears to distinguish those patients with more rapidly progressive abdominal aortic aneurysm expansion. This technique holds major promise as a new method of risk-stratifying patients with abdominal aortic aneurysms that extends beyond the simple anatomic measure of aneurysm diameter. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794092.
Collapse
Affiliation(s)
- Jennifer M J Richards
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Molecular imaging with targeted contrast agents by magnetic resonance imaging (MRI) allows for the noninvasive detection and characterization of biological changes on a molecular level. In this article, the principles of molecular MRI and its applications in cardiovascular diseases are reviewed. First, basic properties of positive and negative contrast agents are introduced and their effect on signal generation in a magnetic field is described. In the next part, different types of MRI scanners and the influence of field strength on signal properties of contrast agents for molecular imaging are discussed. Additionally, the assessment, analysis, and quantification of the changes in T1 and T2* relaxation time induced by the different molecular contrast agents are reviewed. Finally, the basic mechanisms of targeting of imaging probes on a molecular level and recent applications of molecular MRI in cardiovascular disease are reviewed.
Collapse
|
36
|
Abstract
Vessel wall imaging of large vessels has the potential to identify culprit atherosclerotic plaques that lead to cardiovascular events. Comprehensive assessment of atherosclerotic plaque size, composition, and biological activity is possible with magnetic resonance imaging (MRI). Magnetic resonance imaging of the atherosclerotic plaque has demonstrated high accuracy and measurement reproducibility for plaque size. The accuracy of in vivo multicontrast MRI for identification of plaque composition has been validated against histological findings. Magnetic resonance imaging markers of plaque biological activity such as neovasculature and inflammation have been demonstrated. In contrast to other plaque imaging modalities, MRI can be used to study multiple vascular beds noninvasively over time. In this review, we compare the status of in vivo plaque imaging by MRI to competing imaging modalities. Recent MR technological improvements allow fast, accurate, and reproducible plaque imaging. An overview of current MRI techniques required for carotid plaque imaging including hardware, specialized pulse sequences, and processing algorithms are presented. In addition, the application of these techniques to coronary, aortic, and peripheral vascular beds is reviewed.
Collapse
|
37
|
Buhk JH, Finck-Wedel AK, Buchert R, Bannas P, Schnackenburg B, Beil FU, Adam G, Weber C. Screening for atherosclerotic plaques in the abdominal aorta in high-risk patients with multicontrast-weighted MRI: a prospective study at 3.0 and 1.5 tesla. Br J Radiol 2010; 84:883-9. [PMID: 21081571 DOI: 10.1259/bjr/16555263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This prospective study compares MRI of atherosclerotic plaque in the abdominal aorta at 3 T with that at 1.5 T in patients suffering from hereditary hyperlipidaemia, a major risk factor for atherosclerosis. METHODS MRI of the abdominal aorta at 1.5 and 3 T was performed in 21 patients (mean age 58 years). The study protocol consisted of proton density (PD), T(1), T(2) and fat-saturated T(2) weighted black blood images of the abdominal aorta in corresponding orientation. Two independent radiologists performed image rating. First, image quality was rated on a five-point scale. Second, atherosclerotic plaques were scored according to the modified American Heart Association (AHA) classification and analysed for field strength-related differences. Weighted κ statistics were calculated to assess interobserver agreement. RESULTS Interobserver agreement was substantial for nearly all categories. MRI at 3 T offered superior image quality in all contrast weightings, most significantly in T(1) and T(2) weighted techniques. Plaque burden in the study collective was unexpectedly moderate. The majority of plaques were classified as AHA III lesions; no lesions were classified above AHA V. There was no significant influence of the field strength regarding the AHA classification. CONCLUSION Abdominal aortal plaque screening is basically feasible at both field strengths, whereas the image quality is rated superior at 3 T. However, the role of the method in clinical practice remains uncertain, since substantial findings in the high-risk collective were scarce.
Collapse
Affiliation(s)
- J-H Buhk
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Parmar JP, Rogers WJ, Mugler JP, Baskurt E, Altes TA, Nandalur KR, Stukenborg GJ, Phillips CD, Hagspiel KD, Matsumoto AH, Dake MD, Kramer CM. Magnetic resonance imaging of carotid atherosclerotic plaque in clinically suspected acute transient ischemic attack and acute ischemic stroke. Circulation 2010; 122:2031-8. [PMID: 21041694 DOI: 10.1161/circulationaha.109.866053] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Carotid atherosclerotic plaque rupture is thought to cause transient ischemic attack (TIA) and ischemic stroke (IS). Pathological hallmarks of these plaques have been identified through observational studies. Although generally accepted, the relationship between cerebral thromboembolism and in situ atherosclerotic plaque morphology has never been directly observed noninvasively in the acute setting. METHODS AND RESULTS Consecutive acutely symptomatic patients referred for stroke protocol magnetic resonance imaging/angiography underwent additional T1- and T2-weighted carotid bifurcation imaging with the use of a 3-dimensional technique with blood signal suppression. Two blinded reviewers performed plaque gradings according to the American Heart Association classification system. Discharge outcomes and brain magnetic resonance imaging results were obtained. Image quality for plaque characterization was adequate in 86 of 106 patients (81%). Eight TIA/IS patients with noncarotid pathogenesis were excluded, yielding 78 study patients (38 men and 40 women with a mean age of 64.3 years, SD 14.7) with 156 paired watershed vessel/cerebral hemisphere observations. Thirty-seven patients had 40 TIA/IS events. There was a significant association between type VI plaque (demonstrating cap rupture, hemorrhage, and/or thrombosis) and ipsilateral TIA/IS (P<0.001). A multiple logistic regression model including standard Framingham risk factors and type VI plaque was constructed. Type VI plaque was the dominant outcome-associated observation achieving significance (P<0.0001; odds ratio, 11.66; 95% confidence interval, 5.31 to 25.60). CONCLUSIONS In situ type VI carotid bifurcation region plaque identified by magnetic resonance imaging is associated with ipsilateral acute TIA/IS as an independent identifier of events, thereby supporting the dominant disease pathophysiology.
Collapse
Affiliation(s)
- Jaywant P Parmar
- Department of Radiology, University of Virginia Health System, Charlottesville, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Kelle S, Schlendorf K, Hirsch GA, Gerstenblith G, Fleck E, Weiss RG, Stuber M. Gadolinium Enhanced MR Coronary Vessel Wall Imaging at 3.0 Tesla. Cardiol Res Pract 2010; 2010:856418. [PMID: 20981285 PMCID: PMC2963124 DOI: 10.4061/2010/856418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 07/12/2010] [Accepted: 09/16/2010] [Indexed: 11/20/2022] Open
Abstract
Purpose. We evaluated the influence of the time between low-dose gadolinium (Gd) contrast administration and coronary vessel wall enhancement (LGE) detected by 3T magnetic resonance imaging (MRI) in healthy subjects and patients with coronary artery disease (CAD). Materials and Methods. Four healthy subjects (4 men, mean age 29 ± 3 years and eleven CAD patients (6 women, mean age 61 ± 10 years) were studied on a commercial 3.0 Tesla (T) whole-body MR imaging system (Achieva 3.0 T; Philips, Best, The Netherlands). T1-weighted inversion-recovery coronary magnetic resonance imaging (MRI) was repeated up to 75 minutes after administration of low-dose Gadolinium (Gd) (0.1 mmol/kg Gd-DTPA). Results. LGE was seen in none of the healthy subjects, however in all of the CAD patients. In CAD patients, fifty-six of 62 (90.3%) segments showed LGE of the coronary artery vessel wall at time-interval 1 after contrast. At time-interval 2, 34 of 42 (81.0%) and at time-interval 3, 29 of 39 evaluable segments (74.4%) were enhanced. Conclusion. In this work, we demonstrate LGE of the coronary artery vessel wall using 3.0 T MRI after a single, low-dose Gd contrast injection in CAD patients but not in healthy subjects. In the majority of the evaluated coronary segments in CAD patients, LGE of the coronary vessel wall was already detectable 30–45 minutes after administration of the contrast agent.
Collapse
Affiliation(s)
- Sebastian Kelle
- Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
40
|
Grocott HP, Tran T. Aortic atheroma and adverse cerebral outcome: risk, diagnosis, and management options. Semin Cardiothorac Vasc Anesth 2010; 14:86-94. [PMID: 20478948 DOI: 10.1177/1089253210371522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic atheromatous disease is a common finding in the patient presenting for cardiac surgery. Adverse neurologic outcome has been closely linked to the extent of aortic atherosclerosis. In order to optimize perioperative outcomes, the location and severity of disease needs accurate characterization using multimodal techniques. Although various preoperative radiographic techniques have variably identified patients with significant atheroma, intraoperative echocardiographic imaging has proven most useful in localizing and characterizing the degree of aortic atheroma. Epiaortic assessment of the ascending aorta has been utilized in guiding surgical modifications and interventions aimed at reducing the risk of neurologic injury. Although no particular technique has been definitely studied, avoidance of the identifiable atheromatous aortic region has been a main feature of the various modifications employed to optimize neurologic outcome after cardiac surgery.
Collapse
Affiliation(s)
- Hilary P Grocott
- Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | |
Collapse
|
41
|
Capmany RP, Ibañez MO, Pesquer XJ. Complex atheromatosis of the aortic arch in cerebral infarction. Curr Cardiol Rev 2010; 6:184-93. [PMID: 21804777 PMCID: PMC2994110 DOI: 10.2174/157340310791658712] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/10/2010] [Accepted: 05/25/2010] [Indexed: 12/13/2022] Open
Abstract
In many stroke patients it is not possible to establish the etiology of stroke. However, in the last two decades, the use of transesophageal echocardiography in patients with stroke of uncertain etiology reveals atherosclerotic plaques in the aortic arch, which often protrude into the lumen and have mobile components in a high percentage of cases. Several autopsy series and retrospective studies of cases and controls have shown an association between aortic arch atheroma and arterial embolism, which was later confirmed by prospectively designed studies. The association with ischemic stroke was particularly strong when atheromas were located proximal to the ostium of the left subclavian artery, when the plaque was ≥ 4 mm thick and particularly when mobile components are present. In these cases, aspirin might not prevent adequately new arterial ischemic events especially stroke. Here we review the evidence of aortic arch atheroma as an independent risk factor for stroke and arterial embolism, including clinical and pathological data on atherosclerosis of the thoracic aorta as an embolic source. In addition, the impact of complex plaques (≥ 4 mm thick, or with mobile components) on increasing the risk of stroke is also reviewed. In non-randomized retrospective studies anticoagulation was superior to antiplatelet therapy in patients with stroke and aortic arch plaques with mobile components. In a retrospective case-control study, statins significantly reduced the relative risk of new vascular events. However, given the limited data available and its retrospective nature, randomized prospective studies are needed to establish the optimal secondary prevention therapeutic regimens in these high risk patients.
Collapse
Affiliation(s)
- Ramón Pujadas Capmany
- Department of Cardiology, Hospital Universitari del Sagrat Cor, Address: Viladomat 288, E-08027 Barcelona, Spain
| | | | | |
Collapse
|
42
|
Li F, McDermott MM, Li D, Carroll TJ, Hippe DS, Kramer CM, Fan Z, Zhao X, Hatsukami TS, Chu B, Wang J, Yuan C. The association of lesion eccentricity with plaque morphology and components in the superficial femoral artery: a high-spatial-resolution, multi-contrast weighted CMR study. J Cardiovasc Magn Reson 2010; 12:37. [PMID: 20591197 PMCID: PMC2904754 DOI: 10.1186/1532-429x-12-37] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 07/01/2010] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Atherosclerotic plaque morphology and components are predictors of subsequent cardiovascular events. However, associations of plaque eccentricity with plaque morphology and plaque composition are unclear. This study investigated associations of plaque eccentricity with plaque components and morphology in the proximal superficial femoral artery using cardiovascular magnetic resonance (CMR). METHODS Twenty-eight subjects with an ankle-brachial index less than 1.00 were examined with 1.5 T high-spatial-resolution, multi-contrast weighted CMR. One hundred and eighty diseased locations of the proximal superficial femoral artery (about 40 mm) were analyzed. The eccentric lesion was defined as [(Maximum wall thickness- Minimum wall thickness)/Maximum wall thickness] >or= 0.5. The arterial morphology and plaque components were measured using semi-automatic image analysis software. RESULTS One hundred and fifteen locations were identified as eccentric lesions and sixty-five as concentric lesions. The eccentric lesions had larger wall but similar lumen areas, larger mean and maximum wall thicknesses, and more calcification and lipid rich necrotic core, compared to concentric lesions. For lesions with the same lumen area, the degree of eccentricity was associated with an increased wall area. Eccentricity (dichotomous as eccentric or concentric) was independently correlated with the prevalence of calcification (odds ratio 3.78, 95% CI 1.47-9.70) after adjustment for atherosclerotic risk factors and wall area. CONCLUSIONS Plaque eccentricity is associated with preserved lumen size and advanced plaque features such as larger plaque burden, more lipid content, and increased calcification in the superficial femoral artery.
Collapse
Affiliation(s)
- Feiyu Li
- Department of Radiology, Peking University First Hospital, Beijing, China
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Mary McGrae McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Debiao Li
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Timothy J Carroll
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Christopher M Kramer
- Departments of Radiology and Medicine, University of Virginia, Charlottesville, VA, USA
| | - Zhaoyang Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Il, USA
| | - Xihai Zhao
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, NY, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
43
|
Phinikaridou A, Ruberg FL, Hallock KJ, Qiao Y, Hua N, Viereck J, Hamilton JA. In vivo Detection of Vulnerable Atherosclerotic Plaque by MRI in a Rabbit Model. Circ Cardiovasc Imaging 2010; 3:323-32. [DOI: 10.1161/circimaging.109.918524] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alkystis Phinikaridou
- From the Department of Physiology and Biophysics (A.P., Y.Q., N.H., J.A.H.), the Department of Medicine (F.L.R.), Section of Cardiology, the Department of Radiology (F.L.R.), the Department of Anatomy and Neurobiology (K.J.H.), and the Department of Neurology (J.V.), Boston University School of Medicine, Boston, Mass; and the Department of Biomedical Engineering (J.A.H.), Boston University, Boston, Mass
| | - Frederick L. Ruberg
- From the Department of Physiology and Biophysics (A.P., Y.Q., N.H., J.A.H.), the Department of Medicine (F.L.R.), Section of Cardiology, the Department of Radiology (F.L.R.), the Department of Anatomy and Neurobiology (K.J.H.), and the Department of Neurology (J.V.), Boston University School of Medicine, Boston, Mass; and the Department of Biomedical Engineering (J.A.H.), Boston University, Boston, Mass
| | - Kevin J. Hallock
- From the Department of Physiology and Biophysics (A.P., Y.Q., N.H., J.A.H.), the Department of Medicine (F.L.R.), Section of Cardiology, the Department of Radiology (F.L.R.), the Department of Anatomy and Neurobiology (K.J.H.), and the Department of Neurology (J.V.), Boston University School of Medicine, Boston, Mass; and the Department of Biomedical Engineering (J.A.H.), Boston University, Boston, Mass
| | - Ye Qiao
- From the Department of Physiology and Biophysics (A.P., Y.Q., N.H., J.A.H.), the Department of Medicine (F.L.R.), Section of Cardiology, the Department of Radiology (F.L.R.), the Department of Anatomy and Neurobiology (K.J.H.), and the Department of Neurology (J.V.), Boston University School of Medicine, Boston, Mass; and the Department of Biomedical Engineering (J.A.H.), Boston University, Boston, Mass
| | - Ning Hua
- From the Department of Physiology and Biophysics (A.P., Y.Q., N.H., J.A.H.), the Department of Medicine (F.L.R.), Section of Cardiology, the Department of Radiology (F.L.R.), the Department of Anatomy and Neurobiology (K.J.H.), and the Department of Neurology (J.V.), Boston University School of Medicine, Boston, Mass; and the Department of Biomedical Engineering (J.A.H.), Boston University, Boston, Mass
| | - Jason Viereck
- From the Department of Physiology and Biophysics (A.P., Y.Q., N.H., J.A.H.), the Department of Medicine (F.L.R.), Section of Cardiology, the Department of Radiology (F.L.R.), the Department of Anatomy and Neurobiology (K.J.H.), and the Department of Neurology (J.V.), Boston University School of Medicine, Boston, Mass; and the Department of Biomedical Engineering (J.A.H.), Boston University, Boston, Mass
| | - James A. Hamilton
- From the Department of Physiology and Biophysics (A.P., Y.Q., N.H., J.A.H.), the Department of Medicine (F.L.R.), Section of Cardiology, the Department of Radiology (F.L.R.), the Department of Anatomy and Neurobiology (K.J.H.), and the Department of Neurology (J.V.), Boston University School of Medicine, Boston, Mass; and the Department of Biomedical Engineering (J.A.H.), Boston University, Boston, Mass
| |
Collapse
|
44
|
Nchimi A, Defawe O, Brisbois D, Broussaud TKY, Defraigne JO, Magotteaux P, Massart B, Serfaty JM, Houard X, Michel JB, Sakalihasan N. MR Imaging of Iron Phagocytosis in Intraluminal Thrombi of Abdominal Aortic Aneurysms in Humans. Radiology 2010; 254:973-81. [DOI: 10.1148/radiol.09090657] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
45
|
Harloff A, Markl M, Frydrychowicz A, Hennig J, Weiller C. [Diagnosing stroke aetiologies. Morphologic and functional analysis of the aorta and carotid arteries by MRI]. DER NERVENARZT 2009; 80:929-40. [PMID: 19319500 DOI: 10.1007/s00115-009-2679-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Magnetic resonance imaging allows detailed visualization of the thoracic aorta and is not limited by air artefacts or insonation angles like transoesophageal echocardiography (TEE). Thus the aortic arch can be investigated with higher accuracy, and additional embolic high-risk sources such as complex plaques can be additionally detected by MRI in patients with cryptogenic stroke. Furthermore, MRI provides exact 3D plaque localisation and can be combined with multidirectional 3D MRI velocity mapping. In this way, previously not demonstrable retrograde flow paths originating at complex descending aortic plaques reaching the supra-aortic great arteries can be identified as the probable stroke mechanism in certain patients. The same technique can also be applied to the carotid arteries. This allows analysing the complex 3D helical flow within the internal carotid artery as well as measuring absolute flow velocities and wall shear stress in combination with data on vessel anatomy derived from conventional MR angiography. It is the purpose of this work to describe the state of the art of these modern MR imaging techniques and their potential to identify potential stroke mechanisms, and to analyse the particular role of individual haemodynamic factors on the development of local atherosclerosis.
Collapse
Affiliation(s)
- A Harloff
- Abteilung Neurologie, Neurozentrum, Universitätsklinikum, Breisacher Str. 64, 79106 Freiburg.
| | | | | | | | | |
Collapse
|
46
|
Li D, Fayad ZA, Bluemke DA. Can contrast-enhanced cardiac magnetic resonance assess inflammation of the coronary wall? JACC Cardiovasc Imaging 2009; 2:589-91. [PMID: 19442945 DOI: 10.1016/j.jcmg.2009.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
|
47
|
Ota H, Yu W, Underhill HR, Oikawa M, Dong L, Zhao X, Polissar NL, Neradilek B, Gao T, Zhang Z, Yan Z, Guo M, Zhang Z, Hatsukami TS, Yuan C. Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study. Arterioscler Thromb Vasc Biol 2009; 29:1696-701. [PMID: 19608971 DOI: 10.1161/atvbaha.109.192179] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Histological studies suggest associations between hemorrhage and large lipid-rich/necrotic cores with thin or ruptured fibrous caps in advanced atherosclerosis. We investigated these associations in carotid arteries with mild to severe stenosis by in vivo 3T MRI. METHODS AND RESULTS Seventy-seven patients with >or=50% carotid stenosis in at least one side by duplex ultrasound underwent bilateral multi-contrast carotid MRI scans. Measurements for wall and lipid-rich/necrotic core sizes, presence of hemorrhage, and fibrous cap status (classified as intact thick, intact thin or ruptured) were recorded. Arteries with poor image quality, occlusion, or no detectable lipid-rich/necrotic core were excluded. For the 798 MRI slices included, multivariate ordinal regression analysis demonstrated larger %lipid-rich/necrotic core (odds ratio for 10% increase, 1.49; P=0.02) and presence of hemorrhage (odds ratio, 5.91; P<0.001) were independently associated with a worse (intact thin or ruptured) stage of fibrous cap status. For artery-based multivariate analysis, a larger maximum %lipid-rich/necrotic core and presence of hemorrhage independently associated with worse fibrous cap status (P<0.001, for both). No hemorrhage was detected in arteries with thick fibrous caps. CONCLUSIONS Hemorrhage and larger %lipid-rich/necrotic core were independently associated with a thin or ruptured fibrous cap status at an early to advanced stage of carotid atherosclerosis.
Collapse
Affiliation(s)
- Hideki Ota
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Wang XF, Jin PP, Tong Zhou, Zhao YP, Ding QL, Wang DB, Zhao GM, Jing-Dai, Wang HL, Ge HL. MR molecular imaging of thrombus: development and application of a Gd-based novel contrast agent targeting to P-selectin. Clin Appl Thromb Hemost 2009; 16:177-83. [PMID: 19141485 DOI: 10.1177/1076029608330470] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Molecular imaging of thrombus formation at initial stage requires a robust thrombus-specific contrast agent with high sensitivity. In this study, we report a novel P-selectin-targeted paramagnetic molecular imaging agent and the agent's potential to sensitively detect occult microthrombi on the intimal surface of endothelium. Platelet clots and blood clots targeted in vitro with paramagnetic nanoparticles presented a highly detectable, homogeneous T1-weighted contrast enhancement that was improved with increasing gadolinium level. In vivo contrast enhancement under part of circulation conditions was assessed in dogs. The micro-thrombi around the femoral vein of dog demonstrated higher signal intensities than the control clots and the adjacent muscle. Histology was performed on regions likely to contain thrombus as indicated by MRI. These results suggest that molecular imaging of P-selectin-targeted paramagnetic nanoparticles can provide sensitive detection and localization of P-selectin and may allow for early, direct identification of microthrombi, leading to early diagnosis.
Collapse
Affiliation(s)
- Xue-Feng Wang
- Ruijin Hospital and Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- Chun Yuan
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, Seattle 98019, USA.
| | | | | | | |
Collapse
|
50
|
Larose E, Kinlay S, Selwyn AP, Yeghiazarians Y, Yucel EK, Kacher DF, Libby P, Ganz P. Improved characterization of atherosclerotic plaques by gadolinium contrast during intravascular magnetic resonance imaging of human arteries. Atherosclerosis 2008; 196:919-25. [PMID: 17391676 DOI: 10.1016/j.atherosclerosis.2007.02.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/06/2007] [Accepted: 02/08/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine whether gadolinium-DTPA (Gd-DTPA) facilitates discrimination of fibrous, lipid or calcified constituents during intravascular magnetic resonance imaging (IVMRI) of human atherosclerotic arteries. BACKGROUND Atherosclerotic plaques that cause fatal thrombosis due to rupture have high content of lipid relative to fibrous tissue. We recently demonstrated that IVMRI identifies lipid, fibrous, and calcified components within atherosclerotic human arteries with favorable sensitivity and specificity. Gd-DTPA, a T1-shortening agent, selectively amplifies the signal from fibrous tissue on T1 weighted (T1w) surface MRI. METHODS A 0.030 in. diameter receiver coil coupled to a 1.5T MR scanner was positioned in iliac arteries of nine subjects with atherosclerosis. Previously validated multi-parametric analysis of T1w and moderate T2w images identified 137 fibrous, lipid and calcified regions of interest within 37 arterial segments. T1w imaging was repeated following 0.1 mmol/kg IV Gd-DTPA infusion. RESULTS Computer-derived mean gray value in fibrous regions increased by 34.2% with Gd-DTPA (95% CI 24.3-43.5%, p=0.0001) while lipid and calcified regions showed only a non-significant increase of 4.3% (95% CI -0.6 to 9.2%, p=0.0825) and 3.8% (95% CI -1.1 to 7.7%, p=0.103), respectively. The increase in mean gray value with Gd-DTPA was greater for fibrous than for lipid or calcified regions (p=0.0001). CONCLUSIONS Gd-DTPA selectively enhances signal intensity of fibrous constituents during IVMRI of human atherosclerotic arteries and thus identifies key tissue characteristics associated with plaque stability. These findings have important implications for the assessment of plaque-stabilizing therapies and ultimately for reducing cardiovascular events.
Collapse
Affiliation(s)
- Eric Larose
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | | | | | | | | | | | | | | |
Collapse
|