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Huo R, Yuan W, Xu H, Yang D, Qiao H, Han H, Wang T, Liu Y, Yuan H, Zhao X. Investigating the Association of Carotid Atherosclerotic Plaque MRI Features and Silent Stroke After Carotid Endarterectomy. J Magn Reson Imaging 2024; 60:138-149. [PMID: 38018669 DOI: 10.1002/jmri.29115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The predictive value of carotid plaque characteristics for silent stroke (SS) after carotid endarterectomy (CEA) is unclear. OBJECTIVE To investigate the associations between carotid plaque characteristics and postoperative SS in patients undergoing CEA. STUDY TYPE Prospective. POPULATION One hundred fifty-three patients (mean age: 65.4 ± 7.9 years; 126 males) with unilateral moderate-to-severe carotid stenosis (evaluated by CT angiography) referred for CEA. FIELD STRENGTH/SEQUENCE 3 T, brain-MRI:T2-PROPELLER, T1-/T2-FLAIR, diffusion weighted imaging (DWI) and T2*, carotid-MRI:black-blood T1-/T2W, 3D TOF, Simultaneous Non-contrast Angiography intraplaque hemorrhage. ASSESSMENT Patients underwent carotid-MRI within 1-week before CEA, and brain-MRI within 48-hours pre-/post-CEA. The presence and size (volume, maximum-area-percentage) of carotid lipid-rich necrotic core (LRNC), intraplaque hemorrhage (Type-I/Type-II IPH) and calcification were evaluated on carotid-MR images. Postoperative SS was assessed from pre-/post-CEA brain DWI. Patients were divided into moderate-carotid-stenosis (50%-69%) and severe-carotid-stenosis (70%-99%) groups and the associations between carotid plaque characteristics and SS were analyzed. STATISTICAL TESTS Independent t test, Mann-Whitney U-test, chi-square test and logistic regressions (OR: odds ratio, CI: confidence interval). P value <0.05 was considered statistically significant. RESULTS SS was found in 8 (16.3%) of the 49 patients with moderate-carotid-stenosis and 21 (20.2%) of the 104 patients with severe-carotid-stenosis. In patients with severe-carotid-stenosis, those with SS had significantly higher IPH (66.7% vs. 39.8%) and Type-I IPH (66.7% vs. 38.6%) than those without. The presence of IPH (OR 3.030, 95% CI 1.106-8.305) and Type-I IPH (OR 3.187, 95% CI 1.162-8.745) was significantly associated with SS. After adjustment, the associations of SS with presence of IPH (OR 3.294, 95% CI 1.122-9.669) and Type-I IPH (OR 3.633, 95% CI 1.216-10.859) remained significant. Moreover, the volume of Type-II IPH (OR 1.014, 95% CI 1.001-1.028), and maximum-area-percentage of Type-II IPH (OR 1.070, 95% CI 1.002-1.142) and LRNC (OR 1.030, 95% CI 1.000-1.061) were significantly associated with SS after adjustment. No significant (P range: 0.203-0.980) associations were found between carotid plaque characteristics and SS in patients with moderate-carotid-stenosis. DATA CONCLUSIONS In patients with unilateral severe-carotid-stenosis, carotid vulnerable plaque MR features, particularly presence and size of IPH, might be effective predictors for SS after CEA. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ran Huo
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Wanzhong Yuan
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Dandan Yang
- Department of Radiology, Beijing Geriatric Hospital, Beijing, China
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Ying Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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2
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Peret A, Romero-Sanchez G, Dabiri M, McNally JS, Johnson KM, Mossa-Basha M, Eisenmenger LB. MR Angiography of Extracranial Carotid Disease. Magn Reson Imaging Clin N Am 2023; 31:395-411. [PMID: 37414468 DOI: 10.1016/j.mric.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Magnetic resonance angiography sequences, such as time-of-flight and contrast-enhanced angiography, provide clear depiction of vessel lumen, traditionally used to evaluate carotid pathologic conditions such as stenosis, dissection, and occlusion; however, atherosclerotic plaques with a similar degree of stenosis may vary tremendously from a histopathological standpoint. MR vessel wall imaging is a promising noninvasive method to evaluate the content of the vessel wall at high spatial resolution. This is particularly interesting in the case of atherosclerosis as vessel wall imaging can identify higher risk, vulnerable plaques as well as has potential applications in the evaluation of other carotid pathologic conditions.
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Affiliation(s)
- Anthony Peret
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Ciudad de México, Mexico City, Mexico
| | - Mona Dabiri
- Radiology Department, Children's Medical Center, Tehran University of Medical Science, No 63, Gharib Avenue, Keshavarz Blv, Tehran 1419733151, Iran
| | - Joseph Scott McNally
- Department of Radiology, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA.
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3
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Tao L, Wang XH, Li XQ, Dai YJ, Yang BQ, Chen HS. Intracranial plaque with large lipid core is associated with embolic stroke of undetermined source. Ann Clin Transl Neurol 2023; 10:363-372. [PMID: 36599316 PMCID: PMC10014002 DOI: 10.1002/acn3.51726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate an association between percentage lipid-rich necrotic core (LRNC) and an index ischemic stroke in an embolic stroke of undetermined source (ESUS) cohort. METHODS A total of 167 ESUS patients with 259 non-stenotic intracranial plaques including 155 ipsilateral and 104 contralateral to stroke were finally enrolled in the current analysis. The multi-dimensional parameters involving remodeling index (RI), plaque burden (PB), LRNC, discontinuity of plaque surface (DPS), intraplaque hemorrhage (IPH), and vulnerable plaque defined as presence of complicated plaque were evaluated by high-resolution magnetic resonance imaging. RESULTS We found that %LRNC was an independent predictor for ESUS in model 1 (OR: 2.574, 95% CI: 1.854-3.573, P < 0.001), and model 2 (OR: 2.550, 95% CI: 1.835-3.545, P < 0.001), but the association was not seen in PB. In receiver operating characteristic curve analysis, the discrimination of LRNC for ESUS was significantly superior to that of PB (absolute difference: 0.121, 95% CI: 0.056-0.205, P < 0.001). Importantly, a significantly positive synergy between the remodeling pattern and LRNC in response to plaque vulnerability was found by Sankey diagram (P for interaction = 0.001). CONCLUSION This is the first report that LRNC, beyond PB, may be correlated with an index ESUS, and a synergistic effect between positive remodeling and larger LRNC could promote plaque vulnerability. The findings suggest that a potential target subgroup may benefit from stroke prevention with intensive statin, although this must be confirmed in future.
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Affiliation(s)
- Lin Tao
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Xiao-Qiu Li
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Ying-Jie Dai
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Ben-Qiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, ShenYang, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
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4
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Singh A, Nasir U, Segal J, Waheed TA, Ameen M, Hafeez H. The utility of ultrasound and computed tomography in the assessment of carotid artery plaque vulnerability-A mini review. Front Cardiovasc Med 2022; 9:1023562. [PMID: 36465468 PMCID: PMC9709330 DOI: 10.3389/fcvm.2022.1023562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 08/27/2023] Open
Abstract
As the burden of cardiovascular and cerebrovascular events continues to increase, emerging evidence supports the concept of plaque vulnerability as a strong marker of plaque rupture, and embolization. Qualitative assessment of the plaque can identify the degree of plaque instability. Ultrasound and computed tomography (CT) have emerged as safe and accurate techniques for the assessment of plaque vulnerability. Plaque features including but not limited to surface ulceration, large lipid core, thin fibrous cap (FC), intraplaque neovascularization and hemorrhage can be assessed and are linked to plaque instability.
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Affiliation(s)
- Aniruddha Singh
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Usama Nasir
- Tower Health, West Reading, PA, United States
| | - Jared Segal
- Tower Health, West Reading, PA, United States
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5
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Kaczynski J, Sellers S, Seidman MA, Syed M, Dennis M, Mcnaught G, Jansen M, Semple SI, Alcaide-Corral C, Tavares AAS, MacGillivray T, Debono S, Forsythe R, Tambyraja A, Slomka PJ, Leipsic J, Dweck MR, Whiteley W, Wardlaw J, van Beek EJR, Newby DE, Williams MC. 18F-NaF PET/MRI for Detection of Carotid Atheroma in Acute Neurovascular Syndrome. Radiology 2022; 305:137-148. [PMID: 35670715 PMCID: PMC9523682 DOI: 10.1148/radiol.212283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/28/2022] [Accepted: 04/21/2022] [Indexed: 12/17/2022]
Abstract
Background MRI and fluorine 18-labeled sodium fluoride (18F-NaF) PET can be used to identify features of plaque instability, rupture, and disease activity, but large studies have not been performed. Purpose To evaluate the association between 18F-NaF activity and culprit carotid plaque in acute neurovascular syndrome. Materials and Methods In this prospective observational cohort study (October 2017 to January 2020), participants underwent 18F-NaF PET/MRI. An experienced clinician determined the culprit carotid artery based on symptoms and record review. 18F-NaF uptake was quantified using standardized uptake values and tissue-to-background ratios. Statistical significance was assessed with the Welch, χ2, Wilcoxon, or Fisher test. Multivariable models were used to evaluate the relationship between the imaging markers and the culprit versus nonculprit vessel. Results A total of 110 participants were evaluated (mean age, 68 years ± 10 [SD]; 70 men and 40 women). Of the 110, 34 (32%) had prior cerebrovascular disease, and 26 (24%) presented with amaurosis fugax, 54 (49%) with transient ischemic attack, and 30 (27%) with stroke. Compared with nonculprit carotids, culprit carotids had greater stenoses (≥50% stenosis: 30% vs 15% [P = .02]; ≥70% stenosis: 25% vs 4.5% [P < .001]) and had increased prevalence of MRI-derived adverse plaque features, including intraplaque hemorrhage (42% vs 23%; P = .004), necrotic core (36% vs 18%; P = .004), thrombus (7.3% vs 0%; P = .01), ulceration (18% vs 3.6%; P = .001), and higher 18F-NaF uptake (maximum tissue-to-background ratio, 1.38 [IQR, 1.12-1.82] vs 1.26 [IQR, 0.99-1.66], respectively; P = .04). Higher 18F-NaF uptake was positively associated with necrosis, intraplaque hemorrhage, ulceration, and calcification and inversely associated with fibrosis (P = .04 to P < .001). In multivariable analysis, carotid stenosis at or over 70% (odds ratio, 5.72 [95% CI: 2.2, 18]) and MRI-derived adverse plaque characteristics (odds ratio, 2.16 [95% CI: 1.2, 3.9]) were both associated with the culprit versus nonculprit carotid vessel. Conclusion Fluorine 18-labeled sodium fluoride PET/MRI characteristics were associated with the culprit carotid vessel in study participants with acute neurovascular syndrome. Clinical trial registration no. NCT03215550 and NCT03215563 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Jakub Kaczynski
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Stephanie Sellers
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Michael A. Seidman
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Maaz Syed
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Martin Dennis
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Gillian Mcnaught
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Maurits Jansen
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Scott I. Semple
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Carlos Alcaide-Corral
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Adriana A. S. Tavares
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Thomas MacGillivray
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Samuel Debono
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Rachael Forsythe
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Andrew Tambyraja
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Piotr J. Slomka
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Jonathon Leipsic
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Marc R. Dweck
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - William Whiteley
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Joanna Wardlaw
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Edwin J. R. van Beek
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - David E. Newby
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
| | - Michelle C. Williams
- From the BHF Centre for Cardiovascular Science, University of
Edinburgh, The Chancellor’s Building, 49 Little France Crescent,
EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C.,
A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung
Innovation, St Paul’s Hospital and University of British Columbia,
Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health
Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of
Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh
Imaging, Queen’s Medical Research Institute, Edinburgh, Scotland (G.M.,
S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division
of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los
Angeles, Calif (P.J.S.)
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6
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Yang R, Yuan J, Chen X, Xie X, Ye Z, Qin C. Vessel wall magnetic resonance imaging of symptomatic middle cerebral artery atherosclerosis: A systematic review and meta-analysis. Clin Imaging 2022; 90:90-96. [DOI: 10.1016/j.clinimag.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
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7
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Semiautomated Segmentation and Volume Measurements of Cervical Carotid High-Signal Plaques Using 3D Turbo Spin-Echo T1-Weighted Black-Blood Vessel Wall Imaging: A Preliminary Study. Diagnostics (Basel) 2022; 12:diagnostics12041014. [PMID: 35454062 PMCID: PMC9026945 DOI: 10.3390/diagnostics12041014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
Unstable carotid plaques are visualized as high-signal plaques (HSPs) on 3D turbo spin-echo T1-weighted black-blood vessel wall imaging (3D TSE T1-BB VWI). The purpose of this study was to compare manual segmentation and semiautomated segmentation for the quantification of carotid HSPs using 3D TSE T1-BB VWI. Twenty cervical carotid plaque lesions in 19 patients with a plaque contrast ratio of > 1.3 compared to adjacent muscle were studied. Using the mean voxel value for the adjacent muscle multiplied by 1.3 as a threshold value, the semiautomated software exclusively segmented and measured the HSP volume. Manual and semiautomated HSP volumes were well correlated (r = 0.965). Regarding reproducibility, the inter-rater ICC was 0.959 (bias: 24.63, 95% limit of agreement: −96.07, 146.35) for the manual method and 0.998 (bias: 15.2, 95% limit of agreement: −17.83, 48.23) for the semiautomated method, indicating improved reproducibility by the semiautomated method compared to the manual method. The time required for semiautomated segmentation was significantly shorter than that of manual segmentation times (81.7 ± 7.8 s versus 189.5 ± 49.6 s; p < 0.01). The results obtained in this study demonstrate that the semiautomated segmentation method allows for reliable assessment of the HSP volume in patients with carotid plaque lesions, with reduced time and effort for the analysis.
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8
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Zhang M, Xie Z, Long H, Ren K, Hou L, Wang Y, Xu X, Lei W, Yang Z, Ahmed S, Zhang H, Zhao G. Current advances in the imaging of atherosclerotic vulnerable plaque using nanoparticles. Mater Today Bio 2022; 14:100236. [PMID: 35341094 PMCID: PMC8943324 DOI: 10.1016/j.mtbio.2022.100236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/13/2022] [Accepted: 03/05/2022] [Indexed: 01/29/2023]
Abstract
Vulnerable atherosclerotic plaques of the artery wall that pose a significant risk of cardio-cerebral vascular accidents remain the global leading cause of morbidity and mortality. Thus, early delineation of vulnerable atherosclerotic plaques is of clinical importance for prevention and treatment. The currently available imaging technologies mainly focus on the structural assessment of the vascular wall. Unfortunately, several disadvantages in these strategies limit the improvement in imaging effect. Nanoparticle technology is a novel diagnostic strategy for targeting and imaging pathological biomarkers. New functionalized nanoparticles that detect hallmarks of vulnerable plaques are promising for advance further control of this critical illness. The review aims to address the current opportunities and challenges for the use of nanoparticle technology in imagining vulnerable plaques.
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Telichko AV, Dahl JJ, Herickhoff CD. Cylindrical Transducer Array for Intravascular Shear Wave Elasticity Imaging: Preliminary Development. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1077-1087. [PMID: 34990357 DOI: 10.1109/tuffc.2022.3140976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We present an intravascular ultrasound (IVUS) transducer array designed to enable shear wave elasticity imaging (SWEI) of arteries for the detection and characterization of atherosclerotic soft plaques. Using a custom dicing fixture, we have fabricated single-element and axially-segmented array transducer prototypes from 4.6-Fr to 7.6-Fr piezoceramic tubes, respectively. Focused excitation of the array prototype at 4 MHz yielded a focal gain of 5× in intensity, for an estimated 60 mW/cm2 [Formula: see text] and 1.6-MPa negative peak pressure at 4.5-mm range in water. The single-element transducer generated a peak radial displacement of [Formula: see text] in a uniform elasticity phantom, with axial shear waves detectable by an external linear array probe up to 5 mm away from the excitation plane. In a vessel phantom with a soft inclusion, the array prototype generated peak displacements of 2.2 and [Formula: see text] in the soft inclusion and vessel wall regions, respectively. A SWEI image of the vessel phantom was reconstructed, with measured shear wave speed (SWS) of 1.66 ± 0.91 m/s and 0.97 ± 0.59 m/s for the soft inclusion and vessel wall regions, respectively. The array prototype was also used to obtain a SWEI image of an ex vivo porcine artery, with a mean SWS of 3.97 ± 1.12 m/s. These results suggest that a cylindrical intravascular ultrasound (IVUS) transducer array could be made capable of SWEI for atherosclerotic plaque detection in coronary arteries.
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10
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Xin R, Yang D, Xu H, Han H, Li J, Miao Y, Du Z, Ding Q, Deng S, Ning Z, Shen R, Li R, Li C, Yuan C, Zhao X. Comparing Symptomatic and Asymptomatic Carotid Artery Atherosclerosis in Patients With Bilateral Carotid Vulnerable Plaques Using Magnetic Resonance Imaging. Angiology 2021; 73:104-111. [PMID: 34018407 DOI: 10.1177/00033197211012531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared plaque characteristics between symptomatic and asymptomatic sides in patients with bilateral carotid vulnerable plaques using magnetic resonance imaging (MRI). Participants (n = 67; mean age: 65.8 ± 7.7 years, 61 males) with bilateral carotid vulnerable plaques were included. Vulnerable plaques were characterized by intraplaque hemorrhage (IPH), large lipid-rich necrotic core (LRNC), or fibrous cap rupture (FCR) on MRI. Symptomatic vulnerable plaques showed greater plaque burden, LRNC volume (median: 221.4 vs 134.8 mm3, P = .003), IPH volume (median: 32.2 vs 22.5 mm3, P = .030), maximum percentage (Max%) LRNC (median: 51.3% vs 41.8%, P = .002), Max%IPH (median: 13.4% vs 9.5%, P = .022), cumulative slices of LRNC (median: 10 vs 8, P = .005), and more juxtaluminal IPH and/or thrombus (29.9% vs 6.0%, P = .001) and FCR (37.3% vs 16.4%, P = .007) than asymptomatic ones. After adjusting for plaque burden, differences in juxtaluminal IPH and/or thrombus (odds ratio [OR]: 5.49, 95% CI: 1.61-18.75, P = .007) and FCR (OR: 2.90, 95% CI: 1.16-7.24, P = .022) between bilateral sides remained statistically significant. For patients with bilateral carotid vulnerable plaques, symptomatic plaques had greater burden, more juxtaluminal IPH and/or thrombus, and FCR compared with asymptomatic ones. The differences in juxtaluminal IPH and/or thrombus and FCR between bilateral sides were independent of plaque burden.
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Affiliation(s)
- Ruijing Xin
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Dandan Yang
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute of Brain Disorders, Beijing, China
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Jin Li
- Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yingyu Miao
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Ziwei Du
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Qian Ding
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Shasha Deng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Chun Yuan
- Department of Radiology, 7284University of Washington, Seattle, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
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11
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Tao L, Li XQ, Hou XW, Yang BQ, Xia C, Ntaios G, Chen HS. Intracranial Atherosclerotic Plaque as a Potential Cause of Embolic Stroke of Undetermined Source. J Am Coll Cardiol 2021; 77:680-691. [PMID: 33573737 DOI: 10.1016/j.jacc.2020.12.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies investigated the potential mechanism of embolic stroke of undetermined source (ESUS) from extracranial artery plaque, but there has been no study other than a case report on high-risk intracranial plaque in ESUS. OBJECTIVES The aim of this study was to investigate the issue by evaluating the morphology and composition of intracranial plaque in patients with ESUS and small-vessel disease (SVD) using 3.0-T high-resolution magnetic resonance imaging. METHODS Two hundred forty-three consecutive patients with ESUS and 160 patients with SVD-associated stroke between January 2015 and December 2019 were retrospectively enrolled. Multidimensional parameters involving the presence of plaque on both sides, including remodeling index (RI), plaque burden, presence of discontinuity of plaque surface, thick fibrous cap, intraplaque hemorrhage, and complicated American Heart Association type VI plaque at the maximal luminal narrowing site, were evaluated using intracranial high-resolution magnetic resonance imaging. RESULTS Among 243 patients with ESUS, the prevalence of intracranial plaque was much higher in the ipsilateral than the contralateral side (63.8% vs. 42.8%; odds ratio [OR]: 5.25; 95% confidence interval [CI]: 2.83 to 9.73), a finding that was not evident in patients with SVD (35.6% vs. 30.6%; OR: 2.14; 95% CI: 0.87 to 5.26; p = 0.134). Logistic analysis showed that RI was independently associated with ESUS in model 1 (OR: 2.329; 95% CI: 1.686 to 3.217; p < 0.001) and model 2 (OR: 2.295; 95% CI: 1.661 to 3.172; p < 0.001). RI alone with an optimal cutoff of 1.162, corresponding to an area under the curve of 0.740, had good diagnostic efficiency for ESUS. CONCLUSIONS The present study supports an etiologic role of high-risk nonstenotic intracranial plaque in ESUS.
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Affiliation(s)
- Lin Tao
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, China
| | - Xiao-Qiu Li
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, China
| | - Xiao-Wen Hou
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, China
| | - Ben-Qiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shen Yang, China
| | - Cheng Xia
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, China
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, China.
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12
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Advances in Multimodality Carotid Plaque Imaging: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:16-26. [PMID: 33438455 DOI: 10.2214/ajr.20.24869] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Contemporary imaging methods provide detailed visualization of carotid athero-sclerotic plaque, enabling a major evolution of in vivo carotid plaque imaging evaluation. The degree of luminal stenosis in the carotid artery bifurcation, as assessed by ultrasound, has historically served as the primary imaging feature for determining ischemic stroke risk and the potential need for surgery. However, stroke risk may be more strongly driven by the presence of specific characteristics of vulnerable plaque, as visualized on CT and MRI, than by traditional ultrasound-based assessment of luminal narrowing. This review highlights six promising imaging-based plaque characteristics that harbor unique information regarding plaque vulnerability: maximum plaque thickness and volume, calcification, ulceration, intraplaque hemorrhage, lipid-rich necrotic core, and thin or ruptured fibrous cap. Increasing evidence supports the association of these plaque characteristics with risk of ischemic stroke, although these characteristics have varying suitability for clinical implementation. Key aspects of CT and MRI protocols for carotid plaque imaging are also considered. Practical next steps and hurdles are explored for implementing routine imaging assessment of these plaque characteristics in addition to, or even as replacement for, traditional assessment of the degree of vascular stenosis on ultrasound, in the identification of individuals at high risk of ischemic stroke.
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13
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Li Z, Wang Y, Wu X, Liu X, Huang S, He Y, Liu S, Ren L. Studying the Factors of Human Carotid Atherosclerotic Plaque Rupture, by Calculating Stress/Strain in the Plaque, Based on CEUS Images: A Numerical Study. Front Neuroinform 2020; 14:596340. [PMID: 33324188 PMCID: PMC7721669 DOI: 10.3389/fninf.2020.596340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023] Open
Abstract
Carotid plaque neovascularization is one of the major factors for the classification of vulnerable plaque, but the axial force effects of the pulsatile blood flow on the plaque with neovessel and intraplaque hemorrhage was unclear. Together with the severity of stenosis, the fibrous cap thickness, large lipid core, and the neovascularization followed by intraplaque hemorrhage (IPH) have been regarded as high-risk features of plaque rupture. In this work, the effects of these factors were evaluated on the progression and rupture of the carotid atherosclerotic plaques. Five geometries of carotid artery plaque were developed based on contrast-enhanced ultrasound (CEUS) images, which contain two types of neovessel and IPH, and geometry without neovessel and IPH. A one-way fluid-structure interaction model was applied to compute the maximum principal stress and strain in the plaque. For that hyper-elastic and non-linear material, Yeoh 3rd Order strain energy density function was used for components of the plaque. The simulation results indicated that the maximum principal stress of plaque in the carotid artery was higher when the degree of the luminal stenosis increased and the thickness of the fibrous cap decreased. The neovessels within the plaque could introduce a 2.5% increments of deformation in the plaque under the pulsatile blood flow pressure. The IPH also contributed to the increased risk of plaque rupture that a gain of stress was 8.983, 14.526, and 34.47 kPa for the plaque with 50, 65, and 75%, respectively, when comparing stress in the plaque with IPH distributed at the middle to the shoulder of the plaque. In conclusion, neovascularization in the plaque could reduce the stability of the plaque by increasing the stress within the plaque. Also, the risk of plaque rupture increased when large luminal stenosis, thin fibrous cap, and IPH were observed.
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Affiliation(s)
- Zhenzhou Li
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yongfeng Wang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Xinyin Wu
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xin Liu
- Guangdong Academy Research on Virtual Reality (VR) Industry, Foshan University, Foshan, China
| | - Shanshan Huang
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yi He
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Shuyu Liu
- School of Pharmacy, Sun Yat-sen University, Guangzhou, China
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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14
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Hop H, Potze JH, van den Berg-Faaij S, Borra RJH, Zheng KH, Nederveen AJ, Meijer K, Kamphuisen PW. Carotid plaque composition in persons with hemophilia: An explorative study with multi-contrast MRI. Thromb Res 2020; 197:138-140. [PMID: 33212381 DOI: 10.1016/j.thromres.2020.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/11/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Hilde Hop
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Jan-Hendrik Potze
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Sandra van den Berg-Faaij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, the Netherlands
| | - Ronald J H Borra
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Kang H Zheng
- Department of Vascular Medicine, Amsterdam University Medical Center, location AMC, the Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, the Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Pieter Willem Kamphuisen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Internal Medicine, Tergooi Hospital, location Hilversum, the Netherlands
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15
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Porcu M, Mannelli L, Melis M, Suri JS, Gerosa C, Cerrone G, Defazio G, Faa G, Saba L. Carotid plaque imaging profiling in subjects with risk factors (diabetes and hypertension). Cardiovasc Diagn Ther 2020; 10:1005-1018. [PMID: 32968657 DOI: 10.21037/cdt.2020.01.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Carotid artery stenosis (CAS) due to the presence of atherosclerotic plaque (AP) is a frequent medical condition and a known risk factor for stroke, and it is also known from literature that several risk factors promote the AP development, in particular aging, smoke, male sex, hypertension, hyperlipidemia, smoke, diabetes type 1 and 2, and genetic factors. The study of carotid atherosclerosis is continuously evolving: even if the strategies of treatment still depends mainly on the degree of stenosis (DoS) determined by the plaque, in the last years the attention has moved to the study of the plaque components in order to identify the so called "vulnerable" plaque: features like the fibrous cap status and thickness, the volume of the lipid-rich necrotic core and the presence of intraplaque hemorrhage (IPH) are risk factors for plaque rupture, that can be studied with modern imaging techniques. The aim of this review is to give a general overview of the principle histological and imaging features of the subcomponent of carotid AP (CAP), focalizing in particular on the features of CAP of patients affected by hypertension and diabetes (in particular type 2 diabetes mellitus).
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Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| | | | - Marta Melis
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Jasjit S Suri
- Diagnostic and Monitoring Division, AtheroPoint, Roseville, California, USA
| | - Clara Gerosa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giulia Cerrone
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
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16
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Zhu G, Hom J, Li Y, Jiang B, Rodriguez F, Fleischmann D, Saloner D, Porcu M, Zhang Y, Saba L, Wintermark M. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020; 10:1048-1067. [PMID: 32968660 DOI: 10.21037/cdt.2020.03.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Carotid artery plaque is a measure of atherosclerosis and is associated with future risk of atherosclerotic cardiovascular disease (ASCVD), which encompasses coronary, cerebrovascular, and peripheral arterial diseases. With advanced imaging techniques, computerized tomography (CT) and magnetic resonance imaging (MRI) have shown their potential superiority to routine ultrasound to detect features of carotid plaque vulnerability, such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC), and calcification. The correlation between imaging features and histological changes of carotid plaques has been investigated. Imaging of carotid features has been used to predict the risk of cardiovascular events. Other techniques such as nuclear imaging and intra-vascular ultrasound (IVUS) have also been proposed to better understand the vulnerable carotid plaque features. In this article, we review the studies of imaging specific carotid plaque components and their correlation with risk scores.
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Affiliation(s)
- Guangming Zhu
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ying Li
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA.,Clinical Medical Research Center, Luye Pharma Group Ltd., Beijing 100000, China
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Dominik Fleischmann
- Department of Radiology, Cardiovascular Imaging Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Saloner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Michele Porcu
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Yanrong Zhang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
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17
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Fedak A, Ciuk K, Urbanik A. Ultrasonography of vulnerable atherosclerotic plaque in the carotid arteries: B-mode imaging. J Ultrason 2020; 20:e135-e145. [PMID: 32609972 PMCID: PMC7418858 DOI: 10.15557/jou.2020.0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/30/2020] [Indexed: 11/22/2022] Open
Abstract
The most common type of stroke, i.e. ischemic stroke, is a great challenge for contemporary medicine as it poses both diagnostic and therapeutic difficulties. Atherosclerosis, which is rapidly beginning to affect more and more social groups, is the main cause of cerebrovascular accidents. Atherosclerosis is currently defined as a generalized, dynamic and heterogeneous inflammatory and immune process affecting arterial walls. Atherosclerotic plaque is the emanation of this disease. As the paradigm of the diagnosis of atherosclerosis has changed, it has become crucial to properly identify plaque instability within the carotid arteries by evaluating parameters and phenomena that signify a developing cascade of complications, eventually leading to stroke. Irrespective of the ultrasound technique employed, proper morphological evaluation of atherosclerotic plaque, involving observation of its echogenicity, i.e. subjective analysis of its structure, with the classification to Gray-Weale–Nicolaides types as well as assessment of the integrity of its surface, makes it possible to roughly evaluate plaque morphology and thereby its stability. This enables treatment planning and therapy monitoring. This evaluation should be a prelude to further diagnostic work-up, which involves non-invasive examinations that enable unambiguous assessment of plaque stability. These examinations include contrast-enhanced ultrasound to assess progression or recession of inflammation, which presents as plaque neovascularization, or shear wave elastography to objectively define tissue stiffness, and thereby its mineralization.
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Affiliation(s)
- Andrzej Fedak
- Department of Radiology, Jagiellonian University Medical College , Krakow , Poland
| | - Katarzyna Ciuk
- Students' Scientific Group at the Department of Radiology, Jagiellonian University Medical College , Krakow , Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College , Krakow , Poland
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18
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Qiao H, Li D, Cao J, Qi H, Han Y, Han H, Xu H, Wang T, Chen S, Chen H, Wang Y, Zhao X. Quantitative evaluation of carotid atherosclerotic vulnerable plaques using in vivo T1 mapping cardiovascular magnetic resonaonce: validation by histology. J Cardiovasc Magn Reson 2020; 22:38. [PMID: 32434582 PMCID: PMC7240932 DOI: 10.1186/s12968-020-00624-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It has been proved that multi-contrast cardiovascular magnetic resonance (CMR) vessel wall imaging could be used to characterize carotid vulnerable plaque components according to the signal intensity on different contrast images. The signal intensity of plaque components is mainly dependent on the values of T1 and T2 relaxation. T1 mapping recently showed a potential in identifying plaque components but it is not well validated by histology. This study aimed to validate the usefulness of in vivo T1 mapping in assessing carotid vulnerable plaque components by histology. METHODS Thirty-four subjects (mean age, 64.0 ± 8.9 years; 26 males) with carotid plaques referred to carotid endarterectomy were prospectively enrolled and underwent 3 T CMR imaging from May 2017 to October 2017. The T1 values of intraplaque hemorrhage (IPH), necrotic core (NC) and loose matrix (LM) which were identified on multi-contrast vessel wall images or histology were measured on in-vivo T1 mapping. The IPHs were divided into two types based on the proportion of the area of fresh hemorrhage on histology. The T1 values of different plaque components were compared using Mann-Whitney U test and the agreement between T1 mapping and histology in identifying and quantifying IPH was analyzed with Cohen's Kappa and intraclass correlation coefficient (ICC). RESULTS Of 34 subjects, 19 had histological specimens matched with CMR imaging. The mean T1 values of IPH (651 ± 253 ms), NC (1161 ± 182 ms) and LM (1447 ± 310 ms) identified by histology were significantly different. The T1 values of Type 1 IPH were significantly shorter than that of Type 2 IPH (456 ± 193 ms vs. 775 ± 205 ms, p < 0.001). Moderate to excellent agreement was found in identification (kappa = 0.51, p < 0.001), classification (kappa = 0.40, p = 0.028) and segmentation (ICC = 0.816, 95% CI 0.679-0.894) of IPHs between T1 mapping and histology. CONCLUSIONS The T1 values of carotid plaque components, particularly for intraplaque hemorrhage, are differentiable, and the stage of intraplaque hemorrhage can be classified according to T1 values, suggesting the potential capability of assessment of vulnerable plaque components by T1 mapping.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Dongye Li
- Department of Radiology, Sun Yat-sen Memorial hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingli Cao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haikun Qi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Yongjun Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Yajie Wang
- Department of Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China.
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19
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Corti A, Chiastra C, Colombo M, Garbey M, Migliavacca F, Casarin S. A fully coupled computational fluid dynamics – agent-based model of atherosclerotic plaque development: Multiscale modeling framework and parameter sensitivity analysis. Comput Biol Med 2020; 118:103623. [DOI: 10.1016/j.compbiomed.2020.103623] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
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20
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Baradaran H, Gupta A. Carotid Vessel Wall Imaging on CTA. AJNR Am J Neuroradiol 2020; 41:380-386. [PMID: 32029468 DOI: 10.3174/ajnr.a6403] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
Abstract
Vessel wall imaging has been increasingly used to characterize plaque beyond luminal narrowing to identify patients who may be at the highest risk of cerebrovascular ischemia. Although detailed plaque information can be obtained from many imaging modalities, CTA is particularly appealing for carotid plaque imaging due to its relatively low cost, wide availability, operator independence, and ability to discern high-risk features. The present Review Article describes the current understanding of plaque characteristics on CTA by describing commonly encountered plaque features, including calcified and soft plaque, surface irregularities, neovascularization, and inflammation. The goal of this Review Article was to provide a more robust understanding of clinically relevant plaque features detectable on routine CTA of the carotid arteries.
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Affiliation(s)
- H Baradaran
- From the Department of Radiology (H.B.), University of Utah, Salt Lake City, Utah
| | - A Gupta
- Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
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21
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Crombag GAJC, van Hoof RHM, Holtackers RJ, Schreuder FHBM, Truijman MTB, Schreuder TAHCML, van Orshoven NP, Mess WH, Hofman PAM, van Oostenbrugge RJ, Wildberger JE, Kooi ME. Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast-Enhanced Magnetic Resonance Imaging Study. J Am Heart Assoc 2019; 8:e011832. [PMID: 30971168 PMCID: PMC6507193 DOI: 10.1161/jaha.118.011832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Rupture of a vulnerable carotid atherosclerotic plaque is an important underlying cause of ischemic stroke. Increased leaky plaque microvasculature may contribute to plaque vulnerability. These immature microvessels may facilitate entrance of inflammatory cells into the plaque. The objective of the present study is to investigate whether there is a difference in plaque microvasculature (the volume transfer coefficient Ktrans) between the ipsilateral symptomatic and contralateral asymptomatic carotid plaque using noninvasive dynamic contrast‐enhanced magnetic resonance imaging. Methods and Results Eighty‐eight patients with recent transient ischemic attack or ischemic stroke and ipsilateral >2 mm carotid plaque underwent 3 T magnetic resonance imaging to identify plaque components and to determine characteristics of plaque microvasculature. The volume transfer coefficient Ktrans, indicative for microvascular density, flow, and permeability, was calculated for the ipsilateral and asymptomatic plaque, using a pharmacokinetic model (Patlak). Presence of a lipid‐rich necrotic core, intraplaque hemorrhage, and a thin and/or ruptured fibrous cap was assessed on multisequence magnetic resonance imaging. We found significantly lower Ktrans in the symptomatic carotid plaque compared with the asymptomatic side (0.057±0.002 min−1 versus 0.062±0.002 min−1; P=0.033). There was an increased number of slices with intraplaque hemorrhage (0.9±1.6 versus 0.3±0.8, P=0.002) and lipid‐rich necrotic core (1.4±1.9 versus 0.8±1.4, P=0.016) and a higher prevalence of plaques with a thin and/or ruptured fibrous cap (32% versus 17%, P=0.023) at the symptomatic side. Conclusions Ktrans was significantly lower in symptomatic carotid plaques, indicative for a decrease of plaque microvasculature in symptomatic plaques. This could be related to a larger amount of necrotic tissue in symptomatic plaques. Clinical Trial Registration URL: http://www.clinicaltrials.gov.uk. Unique identifier: NCT01208025.
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Affiliation(s)
- Geneviève A J C Crombag
- 1 Department of Radiology and Nuclear Medicine Maastricht University Medical Centre Maastricht The Netherlands.,4 CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands
| | - Raf H M van Hoof
- 1 Department of Radiology and Nuclear Medicine Maastricht University Medical Centre Maastricht The Netherlands.,4 CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands.,5 Control Systems Technology Department of Mechanical Engineering Eindhoven University of Technology Eindhoven The Netherlands
| | - Robert J Holtackers
- 1 Department of Radiology and Nuclear Medicine Maastricht University Medical Centre Maastricht The Netherlands.,4 CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands
| | - Floris H B M Schreuder
- 6 Department of Neurology Donders Institute for Brain Cognition & Behaviour Radboud University Medical Centre Nijmegen The Netherlands
| | - Martine T B Truijman
- 2 Department of Neurology Maastricht University Medical Centre Maastricht The Netherlands
| | | | | | - Werner H Mess
- 3 Department of Clinical Neurophysiology Maastricht University Medical Centre Maastricht The Netherlands.,4 CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands
| | - Paul A M Hofman
- 1 Department of Radiology and Nuclear Medicine Maastricht University Medical Centre Maastricht The Netherlands
| | - Robert J van Oostenbrugge
- 2 Department of Neurology Maastricht University Medical Centre Maastricht The Netherlands.,4 CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands
| | - Joachim E Wildberger
- 1 Department of Radiology and Nuclear Medicine Maastricht University Medical Centre Maastricht The Netherlands.,4 CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands
| | - M Eline Kooi
- 1 Department of Radiology and Nuclear Medicine Maastricht University Medical Centre Maastricht The Netherlands.,4 CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands
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22
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Belikov AV. Age-related diseases as vicious cycles. Ageing Res Rev 2019; 49:11-26. [PMID: 30458244 DOI: 10.1016/j.arr.2018.11.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 10/05/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023]
Abstract
The mortality rates of age-related diseases (ARDs) increase exponentially with age. Processes described by the exponential growth function typically involve a branching chain reaction or, more generally, a positive feedback loop. Here I propose that each ARD is mediated by one or several positive feedback loops (vicious cycles). I then identify critical vicious cycles in five major ARDs: atherosclerosis, hypertension, diabetes, Alzheimer's and Parkinson's. I also propose that the progression of ARDs can be halted by selectively interrupting the vicious cycles and suggest the most promising targets.
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Affiliation(s)
- Aleksey V Belikov
- Laboratory of Innovative Medicine, School of Biological and Medical Physics, Moscow Institute of Physics and Technology, Institutsky per., 9, 141701 Dolgoprudny, Moscow Region, Russia.
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23
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Saba L, Lai L, Lucatelli P, Sanfilippo R, Montisci R, S Suri J, Faa G. Association between carotid artery plaque inflammation and brain MRI. J Neuroradiol 2018; 47:203-209. [PMID: 30439395 DOI: 10.1016/j.neurad.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/10/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To explore the association between presence of inflammatory cells in the carotid plaques surgically treated and brain MRI findings. MATERIAL AND METHODS Forty consecutive patients were prospectively analyzed. Brain MRI was performed with a 1.5 Tesla scanner and infacts (lacuna and non-lacunar) pertinence of the anterior circulation were recorded. All patients underwent carotid endarterectomy "en bloc"; carotid plaques histological sections were prepared and immuno-cytochemical analysis was performed to characterize and quantify the presence of inflammatory cells. ROC curve analysis, Pearson Rho correlation and Mann-Whitney test were applied. RESULTS The immuno-cytochemical analysis demonstrated that plaques of symptomatic patients (stroke\TIA; n = 25) had more inflammatory cells, mainly macrophages (CD68) compared with plaques of patients without symptoms (Mann-Whitney = P < 0.001, ROC curve area = 0.901). Correlation analysis showed a statistically significant association between the number of brain non-lacunar infarcts and the entity of macrophages (P < 0.001); whereas no association with lacunar infarcts (P = 0.1934) was found. CONCLUSION Results of this preliminary study suggest that the presence and amount of inflammatory cells within carotid artery plaque is associated with cerebrovascular events and with the number of MRI brain detectable infarct.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, ss. 554 Monserrato (Cagliari) 09045, Italy.
| | - Letizia Lai
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato. ss. 554 Monserrato (Cagliari) 09045, Italy
| | | | - Roberto Sanfilippo
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, ss. 554 Monserrato (Cagliari) 09045, Italy
| | - Roberto Montisci
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, ss. 554 Monserrato (Cagliari) 09045, Italy
| | - Jasjit S Suri
- Diagnostic and monitoring division AtheroPoint, Roseville, CA, USA
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato. ss. 554 Monserrato (Cagliari) 09045, Italy
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24
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Ota H, Tamura H, Itabashi R, Yazawa Y, Nakamura Y, Hisamatsu K, Takamatsu M, Endo H, Niizuma K, Enomoto Y, Nagasaka T, Kajita K, Watanabe M, Yoshimura S, Yuan C. Quantitative characterization of carotid plaque components using MR apparent diffusion coefficients and longitudinal relaxation rates at 3T: A comparison with histology. J Magn Reson Imaging 2018; 48:1657-1667. [DOI: 10.1002/jmri.26216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/22/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology; Tohoku University Hospital; Miyagi Japan
| | - Hajime Tamura
- Division of Medical Physics; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Ryo Itabashi
- Department of Stroke Neurology; Kohnan Hospital; Miyagi Japan
| | - Yukako Yazawa
- Department of Stroke Neurology; Kohnan Hospital; Miyagi Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine; Tohoku Medical and Pharmaceutical University, Miyagi, Japan; Miyagi Japan
| | - Kenji Hisamatsu
- Pathology Division; Gifu University Hospital; Gifu Japan
- Department of Tumor Pathology; Gifu University Graduate School of Medicine; Gifu Japan
| | - Manabu Takamatsu
- Department of Pathology; The Cancer Institute Hospital, Japanese Foundation for Cancer Research; Tokyo Japan
| | - Hidenori Endo
- Department of Neurosurgery; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Yukiko Enomoto
- Department of Neurosurgery; Gifu University Graduate School of Medicine; Gifu Japan
| | - Tatsuo Nagasaka
- Department of Radiological Technology; Tohoku University Hospital; Miyagi Japan
| | - Kimihiro Kajita
- Department of Radiology service; Gifu University Hospital; Gifu Japan
| | - Mika Watanabe
- Department of Pathology; Tohoku University Hospital; Miyagi Japan
| | | | - Chun Yuan
- Department of Radiology; University of Washington; Seattle Washington USA
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25
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Khosa F, Clough RE, Wang X, Madhuranthakam AJ, Greenman RL. The potential role of IDEAL MRI for identification of lipids and hemorrhage in carotid artery plaques. Magn Reson Imaging 2018; 49:25-31. [DOI: 10.1016/j.mri.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/03/2017] [Indexed: 02/06/2023]
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26
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Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA. Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2018; 39:E9-E31. [PMID: 29326139 DOI: 10.3174/ajnr.a5488] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
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Affiliation(s)
- L Saba
- From the Department of Medical Imaging (L.S.), University of Cagliari, Cagliari, Italy
| | - C Yuan
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - T Saam
- Department of Radiology (T.S.), Ludwig-Maximilian University Hospital, Munich, Germany
| | - A R Moody
- Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D Li
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - C C Matouk
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - H R Jäger
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | | | - M E Kooi
- Department of Radiology (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Z Fan
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - D Saloner
- Department of Radiology and Biomedical Imaging (D.S.), University of California, San Francisco, California
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - D J Mikulis
- Division of Neuroradiology (D.J.M.), Department of Medical Imaging, University Health Network
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
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Sun J, Zhao XQ, Balu N, Neradilek MB, Isquith DA, Yamada K, Cantón G, Crouse JR, Anderson TJ, Huston J, O'Brien K, Hippe DS, Polissar NL, Yuan C, Hatsukami TS. Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes: The MRI Substudy in AIM-HIGH. JACC Cardiovasc Imaging 2017; 10:241-249. [PMID: 28279371 DOI: 10.1016/j.jcmg.2016.06.017] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. BACKGROUND Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. METHODS As part of the event-driven clinical trial AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes), subjects with clinically established atherosclerotic disease underwent multicontrast carotid magnetic resonance imaging (MRI) to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazards survival models. RESULTS Of the 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (82% male, mean age 61 ± 9 years, 94% statin use). During median follow-up of 35.1 months, 18 subjects (8.4%) reached the AIM-HIGH endpoint. High lipid content (hazard ratio [HR] per 1 SD increase in percent lipid core volume: 1.57; p = 0.002) and thin/ruptured fibrous cap (HR: 4.31; p = 0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (HR: 3.00; p = 0.053). High calcification content (HR per 1 SD increase in percent calcification volume: 0.66; p = 0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment. CONCLUSIONS Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Xue-Qiao Zhao
- Department of Medicine, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Daniel A Isquith
- Department of Medicine, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Gádor Cantón
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - John R Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J Anderson
- Libin Cardiovascular Institute of Alberta and Cumming School of Medicine, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin O'Brien
- Department of Medicine, University of Washington, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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Near-infrared autofluorescence induced by intraplaque hemorrhage and heme degradation as marker for high-risk atherosclerotic plaques. Nat Commun 2017; 8:75. [PMID: 28706202 PMCID: PMC5509677 DOI: 10.1038/s41467-017-00138-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/02/2017] [Indexed: 12/19/2022] Open
Abstract
Atherosclerosis is a major cause of mortality and morbidity, which is mainly driven by complications such as myocardial infarction and stroke. These complications are caused by thrombotic arterial occlusion localized at the site of high-risk atherosclerotic plaques, of which early detection and therapeutic stabilization are urgently needed. Here we show that near-infrared autofluorescence is associated with the presence of intraplaque hemorrhage and heme degradation products, particularly bilirubin by using our recently created mouse model, which uniquely reflects plaque instability as seen in humans, and human carotid endarterectomy samples. Fluorescence emission computed tomography detecting near-infrared autofluorescence allows in vivo monitoring of intraplaque hemorrhage, establishing a preclinical technology to assess and monitor plaque instability and thereby test potential plaque-stabilizing drugs. We suggest that near-infrared autofluorescence imaging is a novel technology that allows identification of atherosclerotic plaques with intraplaque hemorrhage and ultimately holds promise for detection of high-risk plaques in patients. Atherosclerosis diagnosis relies primarily on imaging and early detection of high-risk atherosclerotic plaques is important for risk stratification of patients and stabilization therapies. Here Htun et al. demonstrate that vulnerable atherosclerotic plaques generate near-infrared autofluorescence that can be detected via emission computed tomography.
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Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review. Phys Med 2017; 33:1-15. [DOI: 10.1016/j.ejmp.2016.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 02/08/2023] Open
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Muraki M, Mikami T, Yoshimoto T, Fujimoto S, Kitaguchi M, Kaga S, Sugawara T, Tokuda K, Kaneko S, Kashiwaba T. Sonographic Detection of Abnormal Plaque Motion of the Carotid Artery: Its Usefulness in Diagnosing High-Risk Lesions Ranging from Plaque Rupture to Ulcer Formation. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:358-364. [PMID: 26589531 DOI: 10.1016/j.ultrasmedbio.2015.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/18/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
We investigated the feasibility of using sonography of abnormal plaque motion to diagnose high-risk carotid lesions ranging from plaque rupture to ulcer formation. Fifty consecutive carotid arteries of 49 patients (71 ± 7 y, 37 males) who underwent carotid endarterectomy were investigated by carotid sonography to find a plaque concavity (sonographic ulcer [SU]), fine trembling motion inside the plaque (FTMI) and systolic retractive motion of the plaque surface (SRMS). Plaque rupture or ulcer, necrotic core and intra-plaque hemorrhage were determined at carotid endarterectomy. Twenty-two SUs, 41 cases of FTMI and 20 cases of SRMS were detected by carotid sonography. The sensitivity and specificity of SU in diagnosing plaque rupture or ulcer at carotid endarterectomy were 48% and 90%, and those of FTMI were 93% and 60%. Plaques with SRMS more frequently had both a necrotic core and intra-plaque hemorrhage than those without SRMS (80% vs. 30%, p = 0.0005). Abnormal plaque motion detected by carotid sonography is useful in detecting a ruptured or ulcerated plaque with a necrotic core and/or hemorrhage.
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Affiliation(s)
- Mutsuko Muraki
- Sonographic Laboratory, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Taisei Mikami
- Faculty of Health Sciences, Hokkaido University School of Medicine, Sapporo, Japan.
| | | | - Shin Fujimoto
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Mayumi Kitaguchi
- Sonographic Laboratory, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University School of Medicine, Sapporo, Japan
| | - Tomoko Sugawara
- Department of Cardiovascular Medicine, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Kouichi Tokuda
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Sadao Kaneko
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Takeshi Kashiwaba
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
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Population imaging in neuroepidemiology. Neuroepidemiology 2016. [DOI: 10.1016/b978-0-12-802973-2.00005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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32
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Usman A, Sadat U, Graves MJ, Gillard JH. Magnetic resonance imaging of atherothrombotic plaques. J Clin Neurosci 2015; 22:1722-6. [PMID: 26254092 DOI: 10.1016/j.jocn.2015.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/28/2015] [Indexed: 11/27/2022]
Abstract
Atherosclerosis remains the leading cause of long term morbidity and mortality worldwide, despite significant advances in its management. Vulnerable atherothrombotic plaques are predominantly responsible for thromboembolic ischaemic events in arterial beds, such as the carotid, coronary and lower limb arteries. MRI has emerged as a non-invasive, non-irradiating and highly reproducible imaging technique which allows detailed morphological and functional assessment of such plaques. It also has the potential to monitor the efficacy of established and evolving anti-atherosclerosis drugs. It is envisaged that by careful identification and understanding of the underlying cellular and molecular mechanisms that govern atherosclerosis, novel treatment strategies can be formulated which may reduce the persistent high mortality and morbidity rates associated with this disease. MRI shows promise in achieving this goal.
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Affiliation(s)
- Ammara Usman
- University Department of Radiology, Addenbrooke's Hospital, Post Office Box 218, Level 5, Hills Road, Cambridge CB20QQ, UK.
| | - Umar Sadat
- Cambridge Vascular Unit, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Martin J Graves
- University Department of Radiology, Addenbrooke's Hospital, Post Office Box 218, Level 5, Hills Road, Cambridge CB20QQ, UK
| | - Jonathan H Gillard
- University Department of Radiology, Addenbrooke's Hospital, Post Office Box 218, Level 5, Hills Road, Cambridge CB20QQ, UK
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Nieuwstadt HA, van der Lugt A, Kassar ZAM, Breeuwer M, van der Steen AFW, Gijsen FJH. Atherosclerotic plaque fibrous cap assessment under an oblique scan plane orientation in carotid MRI. Quant Imaging Med Surg 2014; 4:216-24. [PMID: 25202656 DOI: 10.3978/j.issn.2223-4292.2014.07.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/04/2014] [Indexed: 11/14/2022]
Abstract
Carotid magnetic resonance imaging (MRI) is used to noninvasively assess atherosclerotic plaque fibrous cap (FC) status, which is closely related to ischemic stroke. Acquiring anisotropic voxels improves in-plane visualization, however, an oblique scan plane orientation could then obscure a FC (i.e., contrast below the noise level) and thus impair a reliable status assessment. To quantify this, we performed single-slice numerical simulations of a clinical 3.0T, 2D T1-weighted, black-blood, contrast-enhanced pulse sequence with various voxel dimensions: in-plane voxel size of 0.62 mm × 0.62 mm and 0.31 mm × 0.31 mm, slice thickness of 1, 2, and 3 mm. Idealized plaque models (FC thickness of 0.5, 1, and 1.5 mm) were imaged at various scan plane angles (0°-40° in steps of 10°), and the FC contrast was quantified. We found that when imaging thin FCs with anisotropic voxels, the FC contrast decreased when the scan plane orientation angle increased. However, a reduced in-plane voxel size at the cost of an increased slice thickness often led to enhanced FC contrast even in the presence of scan plane orientation angles of up to 40°. It can be concluded that while isotropic-voxel imaging eliminates the issue of scan plane obliqueness, it comes at the cost of reduced FC contrast, thus likely decreasing the reliability of FC status assessment in carotid MRI. If scan plane orientation obliquity at the slice of interest is moderate (<40°) or otherwise diminished through careful scan planning, voxel anisotropy could increase FC contrast and, in effect, increase the reliability of FC status assessment.
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Affiliation(s)
- Harm A Nieuwstadt
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Aad van der Lugt
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Zaid A M Kassar
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Marcel Breeuwer
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Anton F W van der Steen
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
| | - Frank J H Gijsen
- 1 Department of Biomedical Engineering, 2 Department of Radiology, Erasmus MC, Rotterdam, the Netherlands ; 3 Department of MR Clinical Science, Philips Healthcare, Best, the Netherlands ; 4 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands ; 5 Department of Imaging Science and Technology, Delft University of Technology, Delft, the Netherlands
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Polonsky TS, Liu K, Tian L, Carr J, Carroll TJ, Berry J, Criqui MH, Ferrucci L, Guralnik JM, Kibbe MR, Kramer CM, Li F, Xu D, Zhao X, Yuan C, McDermott MM. High-risk plaque in the superficial femoral artery of people with peripheral artery disease: prevalence and associated clinical characteristics. Atherosclerosis 2014; 237:169-76. [PMID: 25240112 DOI: 10.1016/j.atherosclerosis.2014.08.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 07/23/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We used magnetic resonance imaging (MRI) to study the prevalence and associated clinical characteristics of high-risk plaque (defined as presence of lipid-rich necrotic core [LRNC] and intraplaque hemorrhage) in the superficial femoral arteries (SFA) among people with peripheral artery disease (PAD). BACKGROUND The prevalence and clinical characteristics associated with high-risk plaque in the SFA are unknown. METHODS Three-hundred-three participants with PAD underwent MRI of the proximal SFA using a 1.5 T S platform. Twelve contiguous 2.5 mm cross-sectional images were obtained. RESULTS LRNC was present in 68 (22.4%) participants. Only one had intra-plaque hemorrhage. After adjusting for age and sex, smoking prevalence was higher among adults with LRNC than among those without LRNC (35.9% vs. 21.4%, p = 0.02). Among participants with vs. without LRNC there were no differences in mean percent lumen area (31% vs. 33%, p = 0.42), normalized mean wall area (0.71 vs. 0.70, p = 0.67) or maximum wall area (0.96 vs. 0.92, p = 0.54) in the SFA. Among participants with LRNC, cross-sectional images containing LRNC had a smaller percent lumen area (33% ± 1% vs. 39% ± 1%, p < 0.001), greater normalized mean wall thickness (0.25 ± 0.01 vs. 0.22 ± 0.01, p < 0.001), and greater normalized maximum wall thickness (0.41 ± 0.01 vs. 0.31 ± 0.01, p < 0.001), compared to cross-sectional images without LRNC. CONCLUSIONS Fewer than 25% of adults with PAD had high-risk plaque in the proximal SFA using MRI. Smoking was the only clinical characteristic associated with presence of LRNC. Further study is needed to determine the prognostic significance of LRNC in the SFA. CLINICAL TRIAL REGISTRATION-URL http://www.clinicaltrials.gov. Unique identifier: NCT00520312.
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Affiliation(s)
- Tamar S Polonsky
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - James Carr
- Department of Biomedical Engineering and Radiology, Northwestern University, Chicago, IL, USA.
| | - Timothy J Carroll
- Department of Biomedical Engineering and Radiology, Northwestern University, Chicago, IL, USA.
| | - Jarett Berry
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California at San Diego, San Diego, CA, USA.
| | - Luigi Ferrucci
- Laboratory of Clinical Epidemiology, National Institute on Aging, Bethesda, MD, USA.
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Melina R Kibbe
- Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Christopher M Kramer
- Department of Radiology and Medicine, University of Virginia Health System, Charlottesville, VA, USA.
| | - Feiyu Li
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Xihao Zhao
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Mary M McDermott
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
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DeMarco JK, Huston J. Imaging of high-risk carotid artery plaques: current status and future directions. Neurosurg Focus 2014; 36:E1. [PMID: 24380475 DOI: 10.3171/2013.10.focus13384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper, the authors review the definition of high-risk plaque as developed by experienced researchers in atherosclerosis, including pathologists, clinicians, molecular biologists, and imaging scientists. Current concepts of vulnerable plaque are based on histological studies of coronary and carotid artery plaque as well as natural history studies and include the presence of a lipid-rich necrotic core with an overlying thin fibrous cap, plaque inflammation, fissured plaque, and intraplaque hemorrhage. The extension of these histologically identified high-risk carotid plaque features to human in vivo MRI is reviewed as well. The authors also assess the ability of in vivo MRI to depict these vulnerable carotid plaque features. Next, the ability of these MRI-demonstrated high-risk carotid plaque features to predict the risk of ipsilateral carotid thromboembolic events is reviewed and compared with the risk assessment provided by simple carotid artery stenosis measurements. Lastly, future directions of high-risk carotid plaque MRI are discussed, including the potential for increased clinical availability and more automated analysis of carotid plaque MRI. The ultimate goal of high-risk plaque imaging is to design and run future multicenter trials using carotid plaque MRI to guide individual patient selection and decisions about optimal atherosclerotic treatment strategies.
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Affiliation(s)
- J Kevin DeMarco
- Department of Radiology, Michigan State University, East Lansing, Michigan; and
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Sun J, Underhill HR, Hippe DS, Xue Y, Yuan C, Hatsukami TS. Sustained acceleration in carotid atherosclerotic plaque progression with intraplaque hemorrhage: a long-term time course study. JACC Cardiovasc Imaging 2013; 5:798-804. [PMID: 22897993 DOI: 10.1016/j.jcmg.2012.03.014] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/08/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to determine the immediate and long-term effects of intraplaque hemorrhage (IPH) on plaque progression in the carotid artery. BACKGROUND Previous studies have associated IPH in the carotid artery with more rapid plaque progression. However, the time course and long-term effect remain unknown. Carotid magnetic resonance imaging is a noninvasive imaging technique that has been validated with histology for the accurate in vivo detection of IPH and measurement of plaque burden. METHODS Asymptomatic subjects with 50% to 79% carotid stenosis underwent carotid magnetic resonance imaging at baseline and then serially every 18 months for a total of 54 months. Subjects with IPH present in at least 1 carotid artery at 54 months were selected. Subsequently, presence/absence of IPH and wall volume were determined independently in all time points for both sides. A piece-wise progression curve was fit by using a linear mixed model to compare progression rates described as annualized changes in wall volume between periods defined by their relationship to IPH development. RESULTS From 14 subjects who exhibited IPH at 54 months, 12 arteries were found to have developed IPH during the study period. The progression rates were -20.5 ± 13.1, 20.5 ± 13.6, and 16.5 ± 10.8 mm(3)/year before, during, and after IPH development, respectively. The progression rate during IPH development tended to be higher than the period before (p = 0.080) but comparable to the period after (p = 0.845). The progression rate in the combined period during/after IPH development was 18.3 ± 6.5 mm(3)/year, which indicated significant progression (p = 0.008 compared with a slope of 0) and was higher than the period before IPH development (p = 0.018). No coincident ischemic events were noted for new IPH. CONCLUSIONS The development of IPH posed an immediate and long-term promoting effect on plaque progression. IPH seems to alter the biology and natural history of carotid atherosclerosis. Early identification of patients with IPH may prove invaluable in optimizing management to minimize future sequelae.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
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High-resolution magnetic resonance imaging of carotid atherosclerosis identifies vulnerable carotid plaques. J Vasc Surg 2013; 57:1046-1051.e2. [PMID: 23375613 DOI: 10.1016/j.jvs.2012.10.088] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/05/2012] [Accepted: 10/14/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Carotid magnetic resonance imaging (MRI) may be a useful tool in characterizing carotid plaque vulnerability, but large studies are still lacking. The purpose of this study was to assess carotid MRI features of vulnerable plaque in a large study and the changes in carotid plaque morphology with respect to time since the neurological event. METHODS We included 161 patients with carotid plaque more than 3 mm thick. All patients underwent carotid MRI to obtain 3-T high-resolution magnetic resonance sequences. Large lipid core, intraplaque hemorrhage (IPH), fibrous cap rupture (FCR), and gadolinium enhancement (GE) were assessed and classified as present or absent. Prevalences of these features were then compared between symptomatic and asymptomatic patients and time since stroke. RESULTS Seven patients were excluded because of poor image quality. Of the remaining 154 patients, 52 were symptomatic and 102 were asymptomatic. The prevalences of IPH (39 vs 16%; P = .002), FCR (30 vs 9%; P = .001), and GE (75 vs 55%; P = .015) were significantly higher in symptomatic than asymptomatic patients. After multivariate analysis, the prevalences of IPH (odds ratio, 2.6; P = .023) and FCR (odds ratio, 2.8; P = .038) were still significantly higher. The prevalence of IPH was significantly higher in symptomatic patients with plaque regardless of the time since the neurological event. For FCR, the difference between symptomatic and asymptomatic patients was significant only during the first 15 days after the neurological event. CONCLUSIONS Carotid MRI can identify plaque features that are associated with symptomatic presentation and may be indicative of plaque vulnerability. These features may ultimately be used in the management of extracranial carotid stenosis.
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Appel AA, Chou CY, Greisler HP, Larson JC, Vasireddi S, Zhong Z, Anastasio MA, Brey EM. Analyzer-based phase-contrast x-ray imaging of carotid plaque microstructure. Am J Surg 2013; 204:631-6. [PMID: 23140828 DOI: 10.1016/j.amjsurg.2012.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Plaque vulnerability depends, in part, on composition. Imaging techniques are needed that can aid the prediction of plaque stability. High-contrast images of soft-tissue structure have been obtained with x-ray phase-contrast (PC) imaging. This research investigates multiple image radiography (MIR), an x-ray PC imaging technique, for evaluation of human carotid artery plaques. METHODS Carotid plaques were imaged with ultrasound and subsequently excised and formalin fixed. MIR imaging was performed. By using synchrotron radiation, conventional radiographs were acquired for comparison. Image texture measures were computed for soft-tissue regions of the plaques. RESULTS Ultrasound evaluation identified plaques as homogeneous without calcifications. MIR images revealed complex heterogeneous structure with multiple microcalcifications consistent with histology, and possessed more image texture in specific regions than conventional radiographs (P < .05). MIR refraction images allowed imaging of the geometric structure of tissue interfaces within the plaques, while scatter images contained more texture in soft-tissue regions than absorption or refraction images. CONCLUSIONS X-ray PC imaging better depicts plaque soft-tissue heterogeneity than ultrasound or conventional radiographs. MIR imaging technique should be investigated further as a viable imaging technique to identify high-risk plaques.
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Affiliation(s)
- Alyssa A Appel
- Department of Research, Hines VA Hospital, Hines, IL 60616-3793, USA
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Lahousse L, van den Bouwhuijsen QJA, Loth DW, Joos GF, Hofman A, Witteman JCM, van der Lugt A, Brusselle GG, Stricker BH. Chronic Obstructive Pulmonary Disease and Lipid Core Carotid Artery Plaques in the Elderly. Am J Respir Crit Care Med 2013; 187:58-64. [DOI: 10.1164/rccm.201206-1046oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Carotid plaque high-resolution MRI at 3 T: evaluation of a new imaging score for symptomatic plaque assessment. Magn Reson Imaging 2012; 30:1424-31. [DOI: 10.1016/j.mri.2012.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/23/2012] [Accepted: 04/18/2012] [Indexed: 11/21/2022]
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den Hartog AG, Bovens SM, Koning W, Hendrikse J, Pasterkamp G, Moll FL, de Borst GJ. PLACD-7T Study: Atherosclerotic Carotid Plaque Components Correlated with Cerebral Damage at 7 Tesla Magnetic Resonance Imaging. Curr Cardiol Rev 2012; 7:28-34. [PMID: 22294972 PMCID: PMC3131713 DOI: 10.2174/157340311795677743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 10/16/2010] [Accepted: 01/07/2011] [Indexed: 11/22/2022] Open
Abstract
Introduction: In patients with carotid artery stenosis histological plaque composition is associated with plaque stability and with presenting symptomatology. Preferentially, plaque vulnerability should be taken into account in pre-operative work-up of patients with severe carotid artery stenosis. However, currently no appropriate and conclusive (non-) invasive technique to differentiate between the high and low risk carotid artery plaque in vivo is available. We propose that 7 Tesla human high resolution MRI scanning will visualize carotid plaque characteristics more precisely and will enable correlation of these specific components with cerebral damage. Study objective: The aim of the PlaCD-7T study is 1: to correlate 7T imaging with carotid plaque histology (gold standard); and 2: to correlate plaque characteristics with cerebral damage ((clinically silent) cerebral (micro) infarcts or bleeds) on 7 Tesla high resolution (HR) MRI. Design: We propose a single center prospective study for either symptomatic or asymptomatic patients with haemodynamic significant (70%) stenosis of at least one of the carotid arteries. The Athero-Express (AE) biobank histological analysis will be derived according to standard protocol. Patients included in the AE and our prospective study will undergo a pre-operative 7 Tesla HR-MRI scan of both the head and neck area. Discussion: We hypothesize that the 7 Tesla MRI scanner will allow early identification of high risk carotid plaques being associated with micro infarcted cerebral areas, and will thus be able to identify patients with a high risk of periprocedural stroke, by identification of surrogate measures of increased cardiovascular risk.
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Affiliation(s)
- A G den Hartog
- Departments of Vascular Surgery, Utrecht, the Netherlands, Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
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Teng Z, He J, Degnan AJ, Chen S, Sadat U, Bahaei NS, Rudd JHF, Gillard JH. Critical mechanical conditions around neovessels in carotid atherosclerotic plaque may promote intraplaque hemorrhage. Atherosclerosis 2012; 223:321-6. [PMID: 22762729 PMCID: PMC3437553 DOI: 10.1016/j.atherosclerosis.2012.06.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/01/2012] [Accepted: 06/11/2012] [Indexed: 12/02/2022]
Abstract
Objective Intraplaque hemorrhage is an increasingly recognized contributor to plaque instability. Neovascularization of plaque is believed to facilitate the entry of inflammatory and red blood cells (RBC). Under physiological conditions, neovessels are subject to mechanical loading from the deformation of atherosclerotic plaque by blood pressure and flow. Local mechanical environments around neovessels and their relevant pathophysiologic significance have not yet been examined. Methods and results Four carotid plaque samples removed at endarcterectomy were collected for histopathological examination. Neovessels and other components were manually segmented to build numerical models for mechanical analysis. Each component was assumed to be non-linear isotropic, piecewise homogeneous and incompressible. The results indicated that local maximum principal stress and stretch and their variations during one cardiac cycle were greatest around neovessels. Neovessels surrounded by RBC underwent a much larger stretch during systole than those without RBCs present nearby (median [inter quartile range]; 1.089 [1.056, 1.131] vs. 1.034 [1.020, 1.067]; p < 0.0001) and much larger stress (5.3 kPa [3.4, 8.3] vs. 3.1 kPa [1.6, 5.5]; p < 0.0001) and stretch (0.0282 [0.0190, 0.0427] vs. 0.0087 [0.0045, 0.0185]; p < 0.0001) variations during the cardiac cycle. Conclusions Local critical mechanical conditions may lead to the rupture of neovessels resulting in the formation and expansion of intraplaque hemorrhage.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, UK.
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Plummer EM, Thomas D, Destito G, Shriver LP, Manchester M. Interaction of cowpea mosaic virus nanoparticles with surface vimentin and inflammatory cells in atherosclerotic lesions. Nanomedicine (Lond) 2012; 7:877-88. [PMID: 22394183 DOI: 10.2217/nnm.11.185] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Detection of atherosclerosis has generally been limited to the late stages of development, after cardiovascular symptoms present or a clinical event occurs. One possibility for early detection is the use of functionalized nanoparticles. The aim of this study was the early imaging of atherosclerosis using nanoparticles with a natural affinity for inflammatory cells in the lesion. MATERIALS & METHODS We investigated uptake of cowpea mosaic virus by macrophages and foam cells in vitro and correlated this with vimentin expression. We also examined the ability of cowpea mosaic virus to interact with atherosclerotic lesions in a murine model of atherosclerosis. RESULTS & CONCLUSION We found that uptake of cowpea mosaic virus is increased in areas of atherosclerotic lesion. This correlated with increased surface vimentin in the lesion compared with nonlesion vasculature. In conclusion, cowpea mosaic virus and its vimentin-binding region holds potential for use as a targeting ligand for early atherosclerotic lesions, and as a probe for detecting upregulation of surface vimentin during inflammation.
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Affiliation(s)
- Emily M Plummer
- University of California, San Diego, Skaggs School of Pharmacy, La Jolla, CA 92093-0749, USA
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Xu WH, Li ML, Gao S, Ni J, Yao M, Zhou LX, Peng B, Feng F, Jin ZY, Cui LY. Middle cerebral artery intraplaque hemorrhage: Prevalence and Clinical Relevance. Ann Neurol 2012; 71:195-8. [PMID: 22367991 DOI: 10.1002/ana.22626] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wei-Hai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Mughal MM, Khan MK, DeMarco JK, Majid A, Shamoun F, Abela GS. Symptomatic and asymptomatic carotid artery plaque. Expert Rev Cardiovasc Ther 2012; 9:1315-30. [PMID: 21985544 DOI: 10.1586/erc.11.120] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Carotid atherosclerotic plaques represent both stable and unstable atheromatous lesions. Atherosclerotic plaques that are prone to rupture owing to their intrinsic composition such as a large lipid core, thin fibrous cap and intraplaque hemorrhage are associated with subsequent thromboembolic ischemic events. At least 15-20% of all ischemic strokes are attributable to carotid artery atherosclerosis. Characterization of plaques may enhance the understanding of natural history and ultimately the treatment of atherosclerotic disease. MRI of carotid plaque and embolic signals during transcranial Doppler have identified features beyond luminal stenosis that are predictive of future transient ischemic attacks and stroke. The value of specific therapies to prevent stroke in symptomatic and asymptomatic patients with severe carotid artery stenosis are the subject of current research and analysis of recently published clinical trials that are discussed in this article.
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Affiliation(s)
- Majid M Mughal
- Department of Medicine, Division of Cardiology, Michigan State University, 138 Service Road, B208 Clinical Center, East Lansing, MI 48824, USA
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Degnan AJ, Gillard JH. Improving atherosclerosis risk assessment: looking beyond plaque accumulation to imaging of embolization and healing. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.11.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cerebrovascular and cardiovascular diseases constitute the most substantial disease burden worldwide and are only increasing in importance. Understanding how individuals with atherosclerosis may be better assessed for risk of stroke and myocardial infarction will have immense importance in deciding on therapeutic options. Carotid atherosclerosis is frequently portrayed as an orderly progression from asymptomatic plaque formation that enlarges with aging and culminates in either stable, calcified plaque or vulnerable, ruptured and inflamed plaque. New evidence suggests that atherosclerosis is better described as an equilibrium between synthetic and degradative processes. Putatively, plaques heal and decrease in size through processes such as efferocytosis in individuals unlikely to experience symptoms, whereas individuals who experience symptoms lack reparative mechanisms. Present clinically employed imaging strategies overlook plaque healing mechanisms. Other approaches that examine the downstream effects of plaque, rather than static plaque measurement, such as ultrasound emboli signal detection may address the gap between plaque that is vulnerable in appearance and that which is actually likely to cause symptoms. To ascertain the clinical risk of atherosclerosis optimally, both sides of the equation must be examined instead of relying on a unidirectional accumulative approach to atherosclerosis.
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Affiliation(s)
| | - Jonathan H Gillard
- Department of Radiology, Addenbrooke’s Hospital, University of Cambridge, Box 218, Hills Road, Cambridge, UK
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Young VEL, Sadat U, Gillard JH. Noninvasive carotid artery imaging with a focus on the vulnerable plaque. Neuroimaging Clin N Am 2011; 21:391-405, xi-xii. [PMID: 21640306 DOI: 10.1016/j.nic.2011.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Currently carotid imaging has 2 main focuses: assessment of luminal stenosis and classification of atherosclerotic plaque characteristics. Measurement of the degree of stenosis is the main assessment used for current treatment decision making, but an evolving idea that is now driving imaging is the concept of vulnerable plaque, which is where plaque components are identified and used to define which plaques are at high risk of causing symptoms compared with those at low risk. This review article covers the methods used for noninvasive assessment of carotid luminal stenosis and the options available for plaque imaging.
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Affiliation(s)
- V E L Young
- University Department of Radiology, Addenbrookes Hospital, Box 218, Hills Road, Cambridge CB2 0QQ, UK.
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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.
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Affiliation(s)
- Roberto Corti
- Cardiology, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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Underhill HR, Yuan C. Carotid MRI: a tool for monitoring individual response to cardiovascular therapy? Expert Rev Cardiovasc Ther 2011; 9:63-80. [PMID: 21166529 DOI: 10.1586/erc.10.172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke remains a leading cause of morbidity and mortality. While stroke-related mortality has declined over the past four decades, data indicate that the mortality rate has begun to plateau. This change in trend may be attributable to variation in individual response to therapies that were derived from population-based studies. Further reductions in stroke mortality may require individualized care governed by directly monitoring the effects of cardiovascular therapy. In this article, carotid MRI is considered as a tool for monitoring in vivo carotid atherosclerotic disease, a principal etiology of stroke. Carotid MRI has been previously utilized to identify specific plaque features beyond luminal stenosis that are predictive of transient ischemic attack and stroke. To gain perspective on the possibility of monitoring plaque change within the individual, clinical trials and natural history studies that have used serial carotid MRI are considered. Data from these studies indicate that patients with a lipid-rich necrotic core with or without intraplaque hemorrhage may represent the desired phenotype for monitoring treatment effects in the individual. Advances in tissue-specific sequences, acquisition resolution, scan time, and techniques for monitoring inflammation and mechanical forces are expected to enable earlier detection of response to therapy. In so doing, cost-effective multicenter studies can be conducted to confirm the anticipated positive effects on outcomes of using carotid MRI for individualized care in patients with carotid atherosclerosis. In accordance, carotid MRI is poised to emerge as a powerful clinical tool for individualized management of carotid atherosclerotic disease to prevent stroke.
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Affiliation(s)
- Hunter R Underhill
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K253, Box 357720, Seattle, WA 98195, USA.
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Yoshino H. Analysis of the Biomechanical Stress of Hemorrhagic and Non-Hemorrhagic Plaques. Circ J 2011; 75:783. [DOI: 10.1253/circj.cj-11-0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideaki Yoshino
- Second Department of Internal Medicine, Cardiology, Kyorin University School of Medicine
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