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Basiak M, Hachula M, Kosowski M, Machnik G, Maliglowka M, Dziubinska-Basiak M, Krysiak R, Okopien B. The Effect of PCSK9 Inhibition on the Stabilization of Atherosclerotic Plaque Determined by Biochemical and Diagnostic Imaging Methods. Molecules 2023; 28:5928. [PMID: 37570897 PMCID: PMC10421011 DOI: 10.3390/molecules28155928] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Atherosclerosis is a multifactorial, progressive, chronic inflammatory disease. Ultrasound and magnetic resonance imaging are the most accurate predictors of atherosclerotic plaque instability (MRI). Cytokines such as osteopontin, osteoprotegerin, and metalloproteinase 9 could be used as the most recent markers to identify and track the efficacy of anti-atherosclerotic therapy. Patients with USG and MRI-verified unstable atherosclerotic plaque were included in the study. Biomarker concentrations were measured and compared before and after PCSK9 inhibitor therapy. Additionally, concentrations prior to treatment were correlated with MRI images of the carotid artery. After treatment with alirocumab, the concentrations of MMP-9 (p < 0.01) and OPN, OPG (p < 0.05) decreased significantly. Furthermore, the results of OPN, OPG, and MMP 9 varied significantly depending on the type of atherosclerotic plaque in the MRI assay. In stable atherosclerotic plaques, the concentrations of OPN and OPG were greater (p < 0.01), whereas the concentration of MMP9 correlated with the instability of the plaque (p < 0.05). We demonstrated, probably for the first time, that alirocumab therapy significantly decreased the serum concentration of atherosclerotic plaque markers. In addition, we demonstrated the relationship between the type of atherosclerotic plaque as determined by carotid MRI and the concentration of these markers.
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Affiliation(s)
- Marcin Basiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Marcin Hachula
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Michal Kosowski
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Grzegorz Machnik
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Mateusz Maliglowka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | | | - Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Boguslaw Okopien
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
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Obaid DR, Okonji I, Cheng SF, Giannopoulos AA, Kamalathevan P, Halcox J, Rodriguez-Justo M, Richards T. Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps. Br J Radiol 2023:20220982. [PMID: 37183910 DOI: 10.1259/bjr.20220982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histologically proven vulnerable plaques. METHODS Seventy patients underwent carotid CT angiography and carotid endarterectomy. A derivation cohort of 20 patients had CT images matched with histology and carotid plaque components attenuation defined. In a validation cohort of 50 patients, CT-derived plaque maps were compared in 43 symptomatic vs 40 asymptomatic carotid plaques and accuracy detecting vulnerable plaques calculated. RESULTS In 250 plaque areas co-registered with histology, the median attenuation (HU) of necrotic core 43(26-63), fibrous plaque 127(110-162) and calcified plaque 964 (816-1207) created significantly different ratios of plaque/contrast attenuation. CT-derived plaque maps revealed symptomatic plaques had larger necrotic core than asymptomatic (13.5%(5.9-33.3) vs 7.4%(2.3-14.3), p = 0.004) with large necrotic core predicting symptoms (area under ROC curve 0.68, p = 0.004). Twenty-four of 47 carotid plaques were histologically classified as most vulnerable (Starry-Type VI). Plaque maps revealed Type VI plaques had a greater necrotic core volume than Type IV/V plaques and a necrotic core/fibrous plaque ratio >0.5 distinguished Type VI plaques with sensitivity 75.0% (55.1-88.0) and specificity of 39.1% (22.2-59.2). CONCLUSIONS Carotid plaque components can be differentiated by CT using a ratio of plaque/contrast attenuation. CT-derived plaque map volumes of necrotic core help distinguished the most vulnerable plaques. ADVANCES IN KNOWLEDGE CT-derived plaque maps based on plaque/contrast attenuation may provide new markers of carotid plaque vulnerability.
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Affiliation(s)
| | - Ike Okonji
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Suk F Cheng
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Toby Richards
- Department of Surgery, University of Western Australia, Perth, Australia
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Li S, Zhang Q, Huang Z, Tao W, Zeng C, Yan L, Chen F. Comprehensive analysis of immunocyte infiltration and the key genes associated with intraplaque hemorrhage in carotid atherosclerotic plaques. Int Immunopharmacol 2022; 106:108633. [DOI: 10.1016/j.intimp.2022.108633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/11/2022]
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Svoboda N, Voldřich R, Mandys V, Hrbáč T, Kešnerová P, Roubec M, Školoudík D, Netuka D. Histological analysis of carotid plaques: The predictors of stroke risk. J Stroke Cerebrovasc Dis 2022; 31:106262. [DOI: 10.1016/j.jstrokecerebrovasdis.2021.106262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
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Mishra SC, Singh V, Gupta A, Sharma S, Tyagi L. Blocked Filter of Anti-Embolic Device During Carotid Artery Stenting: A Rare Occurrence Posing Challenging Diagnostic Dilemma. Cureus 2021; 13:e19219. [PMID: 34873545 PMCID: PMC8639398 DOI: 10.7759/cureus.19219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
The use of anti-embolic devices (AED’s) is a common practice in carotid artery stenting (CAS). It prevents the passage of blood clots and thrombi generated during the procedure from embolizing into the intracranial circulation. Disadvantages include the passage of small particles and complications related to advancement, deployment, and recovery of the filters. The filter of the AED can get clogged due to the high load of the emboli generated during CAS causing a slowing of the intracranial blood flow which normalizes once the filter is removed. Here, we are presenting a case of the filter of AED getting blocked due to entrapped thrombi or blood clots and mimicking dissection and, sharing our experiences associated with the event.
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Affiliation(s)
- Sarvesh C Mishra
- Radio-Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Vivek Singh
- Radio-Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Aviral Gupta
- Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Srishti Sharma
- Radio-Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Lavanya Tyagi
- Obstetrics and Gynecology, Javitri Hospital and Test Tube Baby Centre, Lucknow, IND
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6
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Kim SE, Parker DL, Roberts JA, Treiman GS, Alexander M, Baradaran H, de Havenon A, McNally JS. Differentiation of symptomatic and asymptomatic carotid intraplaque hemorrhage using 3D high-resolution diffusion-weighted stack of stars imaging. NMR IN BIOMEDICINE 2021; 34:e4582. [PMID: 34296793 DOI: 10.1002/nbm.4582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Ischemic events related to carotid disease are far more strongly associated with plaque instability than stenosis. 3D high-resolution diffusion-weighted (DW) imaging can provide quantitative diffusion measurements on carotid atherosclerosis and may improve detection of vulnerable intraplaque hemorrhage (IPH). The 3D DW-stack of stars (SOS) sequence was implemented with 3D SOS acquisition combined with DW preparation. After simulation of signals created from 3D DW-SOS, phantom studies were performed. Three healthy subjects and 20 patients with carotid disease were recruited. Apparent diffusion coefficient (ADC) values were statistically analyzed on three subgroups by using a two-group comparison Wilcoxon-Mann-Whitney U test with p values less than 0.05: symptomatic versus asymptomatic; IPH-positive versus IPH-negative; and IPH-positive symptomatic versus asymptomatic plaques to determine the relationship with plaque vulnerability. ADC values calculated by 3D DW-SOS provided values similar to those calculated from other techniques. Mean ADC of symptomatic plaque was significantly lower than asymptomatic plaque (0.68 ± 0.18 vs. 0.98 ± 0.16 x 10-3 mm2 /s, p < 0.001). ADC was also significantly lower in IPH-positive versus IPH-negative plaque (0.68 ± 0.13 vs. 1.04 ± 0.11 x 10-3 mm2 /s, p < 0.001). Additionally, ADC was significantly lower in symptomatic versus asymptomatic IPH-positive plaque (0.57 ± 0.09 vs. 0.75 ± 0.11 x 10-3 mm2 /s, p < 0.001). Our results provide strong evidence that ADC measurements from 3D DW-SOS correlate with the symptomatic status of extracranial internal carotid artery plaque. Further, ADC improved discrimination of symptomatic plaque in IPH. These data suggest that diffusion characteristics may improve detection of destabilized plaque leading to elevated stroke risk.
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Affiliation(s)
- Seong-Eun Kim
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - John A Roberts
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Gerald S Treiman
- Department of Veterans Affairs, VASLCHCS, Salt Lake City, Utah, USA
| | - Matthew Alexander
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Hediyeh Baradaran
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - J Scott McNally
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
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Vulnerable Plaque in Carotid Arteries Without "Significant" Stenosis: Unmasking the Hidden Links to Stroke. J Am Coll Cardiol 2021; 76:2223-2225. [PMID: 33153581 DOI: 10.1016/j.jacc.2020.09.531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/22/2022]
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Evolving determinants of carotid atherosclerosis vulnerability in asymptomatic patients from the MAGNETIC observational study. Sci Rep 2021; 11:2327. [PMID: 33504842 PMCID: PMC7840938 DOI: 10.1038/s41598-021-81247-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/28/2020] [Indexed: 11/08/2022] Open
Abstract
MRI can assess plaque composition and has demonstrated an association between some atherosclerotic risk factors (RF) and markers of plaque vulnerability in naive patients. We aimed at investigating this association in medically treated asymptomatic patients. This is a cross-sectional interim analysis (August 2013-September 2016) of a single center prospective study on carotid plaque vulnerability (MAGNETIC study). We recruited patients with asymptomatic carotid atherosclerosis (US stenosis > 30%, ECST criteria), receiving medical treatments at a tertiary cardiac rehabilitation. Atherosclerotic burden and plaque composition were quantified with 3.0 T MRI. The association between baseline characteristics and extent of lipid-rich necrotic core (LRNC), fibrous cap (CAP) and intraplaque hemorrhage (IPH) was studied with multiple regression analysis. We enrolled 260 patients (198 male, 76%) with median age of 71-y (interquartile range: 65-76). Patients were on antiplatelet therapy, ACE-inhibitors/angiotensin receptor blockers and statins (196-229, 75-88%). Median LDL-cholesterol was 78 mg/dl (59-106), blood pressure 130/70 mmHg (111-140/65-80), glycosylated hemoglobin 46 mmol/mol (39-51) and BMI 25 kg/m2 (23-28); moreover, 125 out of 187 (67%) patients were ex-smokers. Multivariate analysis of a data-set of 487 (94%) carotid arteries showed that a history of hypercholesterolemia, diabetes, hypertension or smoking did not correlate with LRNC, CAP or IPH. Conversely, maximum stenosis was the strongest independent predictor of LRNC, CAP and IPH (p < 0.001). MRI assessment of plaque composition in patients on treatment for asymptomatic carotid atherosclerosis shows no correlation between plaque vulnerability and the most well-controlled modifiable RF. Conversely, maximum stenosis exhibits a strong correlation with vulnerable features despite treatment.
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Rizvi A, Seyedsaadat SM, Alzuabi M, Murad MH, Huston J, Lehman VT, Lanzino G, Saba L, Brinjikji W. Carotid plaque vulnerability on magnetic resonance imaging and risk of future ischemic events: a systematic review and meta-analysis. J Neurosurg Sci 2020; 64:480-486. [PMID: 33236863 DOI: 10.23736/s0390-5616.20.04959-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) can characterize carotid plaque features, including intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap (TRFC), that have increased tendency to cause future cerebrovascular ischemic events. We performed a systematic review and meta-analysis of studies evaluating association of MRI-identified high-risk plaque features, including IPH, LRNC, and TRFC, with risks of subsequent ischemic events of stroke, transient ischemic attack (TIA), or amaurosis fugax (AF) over follow-up duration of ≥3 months. EVIDENCE ACQUISITION Multiple databases were searched for relevant publications between January 2000 and March 2020. Studies reporting outcomes of future ischemic events of stroke, TIA, or AF for individual MRI-identified high-risk carotid plaque features over follow-up duration of ≥3 months were included. Random effects meta-analysis was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) comparing outcomes between MRI-positive and MRI-negative groups. EVIDENCE SYNTHESIS Fifteen studies including 2350 patients were included. The annual rate of future ischemic events was 11.9% for MRI-positive IPH, 5.4% for LRNC, and 5.7% for TRFC. IPH, LRNC, and TRFC were associated with increased risk of future ischemic events (OR 6.37; 95% CI, 3.96 to 10.24), (OR 4.34; 95% CI, 1.65 to 11.42), and (OR 10.60, 95% CI 3.56 to 31.58), respectively. CONCLUSIONS The current study findings strengthen the assertion that MRI-positive "high-risk" or "vulnerable" plaque features, including IPH, LRNC, and/or TRFC can predict risks of future ischemic events of stroke, TIA, or AF.
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Affiliation(s)
- Asim Rizvi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA - .,Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA - .,-
| | | | - Muayad Alzuabi
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | | | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada
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10
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Qiao H, Cai Y, Huang M, Liu Y, Zhang Q, Huang L, Chen H, Yuan C, Zhao X. Quantitative assessment of carotid artery atherosclerosis by three-dimensional magnetic resonance and two-dimensional ultrasound imaging: a comparison study. Quant Imaging Med Surg 2020; 10:1021-1032. [PMID: 32489926 DOI: 10.21037/qims-19-818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background It has been proven that magnetic resonance (MR) and ultrasound imaging are useful tools in the quantification of carotid atherosclerotic plaques. However, there are only a few pieces of evidence to illustrate the links of quantitative measurements of carotid plaques between MR and ultrasound imaging. This study looked to compare the quantitative measurements of carotid plaques and investigate their relationship between three-dimensional (3D) MR vessel wall imaging and two-dimensional (2D) ultrasound imaging. Methods Seventy-five asymptomatic elderly subjects (mean age: 73.3±5.7 years; 45 males) with carotid atherosclerotic plaques diagnosed by both ultrasound and MR imaging were included in this study. The plaque size, including the maximum wall thickness (Max WT), plaque length, and plaque area, was measured by 3D MR and ultrasound imaging on longitudinal and cross-sectional views. The quantitative assessments of carotid plaque size were compared and correlated between 3D MR and 2D ultrasound imaging. Results In total, the quantitative measurements of 101 plaques on longitudinal views or 44 plaques on cross-sectional views of both MR and ultrasound imaging were compared. The Max WT of the plaques (longitudinal: 2.9±0.8 vs. 2.4±0.9 mm; cross-sectional: 3.2±1.1 vs. 2.6±0.7 mm) and plaque areas (longitudinal: 24.3±13.4 vs. 17.0±12.7 mm2; cross-sectional: 24.9±24.6 vs. 16.8±13.3 mm2) measured by MR imaging were found to be significantly higher than those measured by ultrasound imaging (all P<0.001). Moderate to strong correlations were found in Max WT, plaque area, plaque length between 3D MR and ultrasound imaging. Conclusions The quantitative measurements of carotid plaques using 3D MR and 2D ultrasound are significantly correlated. The plaque area and Max WT measured by 3D MR imaging are more significant than these parameters measured by 2D ultrasound imaging, which might be explained by the resolution of MR imaging and the workflow of measurements.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | - Ying Cai
- Department of Radiology, Taizhou People's Hospital, Taizhou 225400, China
| | - Manwei Huang
- Department of Ultrasound, China Meitan General Hospital, Beijing 100028, China
| | - Yang Liu
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou 225009, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | | | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Washington, Seattle, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
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Hajhosseiny R, Bahaei TS, Prieto C, Botnar RM. Molecular and Nonmolecular Magnetic Resonance Coronary and Carotid Imaging. Arterioscler Thromb Vasc Biol 2020; 39:569-582. [PMID: 30760017 DOI: 10.1161/atvbaha.118.311754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerosis is the leading cause of cardiovascular morbidity and mortality. Over the past 2 decades, increasing research attention is converging on the early detection and monitoring of atherosclerotic plaque. Among several invasive and noninvasive imaging modalities, magnetic resonance imaging (MRI) is emerging as a promising option. Advantages include its versatility, excellent soft tissue contrast for plaque characterization and lack of ionizing radiation. In this review, we will explore the recent advances in multicontrast and multiparametric imaging sequences that are bringing the aspiration of simultaneous arterial lumen, vessel wall, and plaque characterization closer to clinical feasibility. We also discuss the latest advances in molecular magnetic resonance and multimodal atherosclerosis imaging.
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Affiliation(s)
- Reza Hajhosseiny
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,National Heart and Lung Institute, Imperial College London, United Kingdom (R.H.)
| | - Tamanna S Bahaei
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.)
| | - Claudia Prieto
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
| | - René M Botnar
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
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Saba L, Micheletti G, Brinjikji W, Garofalo P, Montisci R, Balestrieri A, Suri JS, DeMarco JK, Lanzino G, Sanfilippo R. Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events. AJNR Am J Neuroradiol 2019; 40:1731-1737. [PMID: 31558503 DOI: 10.3174/ajnr.a6189] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/15/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Our aim was to assess the relationship between volume and percentage of intraplaque hemorrhage measured using CT and the occurrence of cerebrovascular events at the time of CT. MATERIALS AND METHODS One-hundred-twenty-three consecutive subjects (246 carotid arteries) with a mean age of 69 years who underwent CTA were included in this retrospective study. Plaque volume of components and subcomponents (including intraplaque hemorrhage volume) was quantified with dedicated software. RESULTS Forty-six arteries were excluded because no plaque was identified. In the remaining 200 carotid arteries, a statistically significant difference was found between presentation with cerebrovascular events and lipid volume (P = .002), intraplaque hemorrhage volume (P = .002), percentage of lipid (P = .002), percentage of calcium (P = .001), percentage of intraplaque hemorrhage (P = .001), percentage of lipid-intraplaque hemorrhage (P = .001), and intraplaque hemorrhage/lipid ratio (P = .001). The highest receiver operating characteristic area under the curve was obtained with the intraplaque hemorrhage volume with a value of 0.793 (P = .001), percentage of intraplaque hemorrhage with an area under the curve of 0.812 (P = .001), and the intraplaque hemorrhage/lipid ratio with an area under the curve value of 0.811 (P = .001). CONCLUSIONS Results of our study suggest that Hounsfield unit values <25 have a statistically significant association with the presence of cerebrovascular events and that the ratio intraplaque hemorrhage/lipid volume represents a strong parameter for the association of cerebrovascular events.
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Affiliation(s)
- L Saba
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | - G Micheletti
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | | | - P Garofalo
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | - R Montisci
- Vascular Surgery (R.M., R.S.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
| | - A Balestrieri
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | - J S Suri
- Stroke Monitoring and Diagnostic Division (J.S.S.), AtheroPoint, Roseville, California
- Point-of-Care Devices (J.S.S.), Global Biomedical Technologies, Roseville, California
- Department of Electrical Engineering (J.S.S.), University of Idaho, Moscow, Idaho (Affiliated)
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed Medical Center, Bethesda, Maryland
| | - G Lanzino
- Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - R Sanfilippo
- Vascular Surgery (R.M., R.S.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
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13
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Li Z, Xu X, Ren L, Shao Y, Luo S, Chen S, Guan X. Prospective Study About the Relationship Between CEUS of Carotid Intraplaque Neovascularization and Ischemic Stroke in TIA Patients. Front Pharmacol 2019; 10:672. [PMID: 31281254 PMCID: PMC6597676 DOI: 10.3389/fphar.2019.00672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/23/2019] [Indexed: 01/12/2023] Open
Abstract
Objective: To evaluate the relationship between contrast-enhanced ultrasonography (CEUS) of carotid intraplaque neovascularization and ischemic stroke in transient ischemic attack (TIA) patients. Methods: A total of 112 TIA patients were selected for the study. Routine carotid ultrasonic examination was performed for all the patients. CEUS was carried out for consecutive patients with plaque thicker than 2.5 mm in carotid bifurcation and follow-up for at least 24 months. The number of patients with incurrence of ischemic stroke or recurrence of TIA was obtained during the follow-up period. To detect the risk factors for incurrence of ischemic stroke or recurrence of TIA in 24 months, multivariate logistic regression analyses were performed for all the risk factors in all the selected patients. Results: Ninety-one patients underwent CEUS and were followed up at least 24 months. There were statistical differences between recurrent and non-recurrent groups about hypertension, diabetes, hyperlipemia, smoking history, family history of stroke, medication compliance, two-dimensional ultrasound, and CEUS (P < 0.05). The higher CEUS intensity in the carotid plaque was, the higher was the possibility of ischemic stroke or recurrent TIA. Multivariate logistic regression analysis showed that the CEUS characteristics of carotid plaque such as linear enhancement or diffuse enhancement were independent risk factors for ischemic stroke or recurrent TIA in TIA patients (P < 0.05). Conclusion: For carotid plaques, CEUS could evaluate the infusion mode, which could reflect the neovascularization in plaques. CEUS could predict the incurrence of ischemic stroke or recurrence of TIA in TIA patients, which is useful information when making a clinical decision.
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Affiliation(s)
- Zhenzhou Li
- Department of Ultrasound, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xianfeng Xu
- Department of Obstetrics and Gynecology, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Lijie Ren
- Department of Internal Neurology, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yufeng Shao
- Department of Internal Neurology, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shuyu Luo
- Department of Ultrasound, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shenghua Chen
- Department of Ultrasound, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaoyun Guan
- Department of Ultrasound, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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14
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Choi JY, Cha J, Jung JM, Seo WK, Oh K, Cho KH, Yu S. Left ventricular wall motion abnormality is associated with cryptogenic stroke. Int J Stroke 2019; 15:188-196. [PMID: 30982433 DOI: 10.1177/1747493019834181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Left ventricular wall motion abnormality (LVWMA) unrelated to known cardiac risk factors is an uncertain risk for stroke. AIMS We evaluated whether LVWMA was associated with cryptogenic stroke. METHODS This retrospective, observational study included 4316 acute ischemic stroke patients, and the association between cryptogenic stroke and LVWMA was examined in comparison with other stroke subtypes. RESULTS The prevalence of LVWMA was 10.0% in the study population. In a fully adjusted, binary logistic regression, LVWMA was independently associated with cryptogenic stroke compared with stroke from large artery atherosclerosis (odds ratio = 1.627, 95% confidence interval = 1.129-2.345), small vessel occlusion (odds ratio = 1.948, 95% confidence interval = 1.261-3.010), or other causes (odds ratio = 4.950, 95% confidence interval = 1.145-21.412). Meanwhile, the association of LVWMA with cryptogenic stroke was similar to the associations of LVWMA with cardioembolic stroke (odds ratio = 0.758, 95% confidence interval = 0.525-1.094) and stroke with two or more causes (odds ratio = 0.992, 95% confidence interval = 0.609-1.615). In multinomial regression, LVWMA had the strongest association with cardioembolic stroke, followed by cryptogenic stroke and stroke from two or more causes. The strength of the associations with LVWMA then decreased sequentially in patients with large artery atherosclerosis, small vessel occlusion, and other causes. CONCLUSIONS The association of LVWMA with cryptogenic stroke was comparable to that of LVWMA with cardioembolic stroke but stronger than that of LVWMA with non-cardioembolic stroke. LVWMA unrelated to known cardiac risk factors could be considered an independent risk factor for cryptogenic stroke.
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Affiliation(s)
- Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sungwook Yu
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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15
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Song J, Jiang X, Cao Y, Juan J, Wu T, Hu Y. Interaction between an ATP-Binding Cassette A1 (ABCA1) Variant and Egg Consumption for the Risk of Ischemic Stroke and Carotid Atherosclerosis: a Family-Based Study in the Chinese Population. J Atheroscler Thromb 2019; 26:835-845. [PMID: 30828007 PMCID: PMC6753237 DOI: 10.5551/jat.46615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aims: ATP-binding cassette A1 (ABCA1) plays an important role in reducing the risk of stroke. Egg is the major source of dietary cholesterol and is known to be associated with the risk of stroke and atherosclerosis. We aimed to assess the effects of interaction between an ABCA1 variant (rs2066715) and egg consumption on the risk of ischemic stroke (IS), carotid plaque, and carotid-intima media thickness (CIMT) in the Chinese population. Methods: In total, 5869 subjects (including 1213 IS cases) across 1128 families were enrolled and divided into two groups based on the median egg consumption (4 eggs per week). In the analyses for the presence of carotid plaque and CIMT, 3171 out of 4656 IS-free controls without self-reported history of coronary heart disease and lipid-lowering medications were included. Multilevel logistic regression models were used to model the genetic association of rs2066715 with the risk of IS, and mixed-effect linear regression for the genetic association of rs2066715 with carotid plaque, and CIMT. The gene-by-egg cross-product term was included in the regression model for interaction analysis. Results: We found that rs2066715 was associated with the increased risk of carotid plaque among those who consumed < 4 eggs per week after adjustment (odds ratio [95% confidence interval]: 1.61 [1.08, 2.39], P = 0.019). A significant effect of interaction between rs2066715 and egg consumption on the risk of carotid plaque was identified (P = 0.011). Conclusion: rs2066715 was found to interact with egg consumption in modifying the risk of carotid plaque in the Chinese population.
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Affiliation(s)
- Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Xia Jiang
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health.,Unit of Cardiovascular Epidemiology, Institute of Environmental Health, Karolinska Institute
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Juan Juan
- Department of Obstetrics and Gynecology, Peking University First Hospital
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
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16
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Li Q, Liu M, Fu R, Cao Q, Wang Y, Han S, Hu W, Li H, Hu C, Wu L, Zhang L, Deng J, Wang Y. Alteration of circulating innate lymphoid cells in patients with atherosclerotic cerebral infarction. Am J Transl Res 2018; 10:4322-4330. [PMID: 30662674 PMCID: PMC6325527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/18/2018] [Indexed: 06/09/2023]
Abstract
Innate lymphoid cells (ILCs) are associated with innate immunity and tissue remodeling. However, the changes in ILCs and their role in acute cerebral infarction (ACI) remain unexplored. This study aimed to examine the expression of ILCs in patients with ACI and explore the mechanism underlying changes in ILCs induced by the atherosclerotic factor oxidized low-density lipoprotein (ox-LDL). The levels of ILC1, ILC2, and ILC3 in the blood of patients with ACI and controls were examined at the time of admission. The correlation of serum levels of ox-LDL and inflammatory biomarkers with the level of ILCs and the effects of ox-LDL on ILCs in vitro were analyzed. Our results showed that the levels of ILC1 increased while the levels of ILC2 decreased in patients with ACI compared with controls. Serum levels of ox-LDL, LDL-C, and biochemical biomarkers correlated positively with the levels of ILC1 and ILC1/ILC2 ratio but negatively with the levels of ILC2. The in vitro incubation of peripheral blood mononuclear cells (PBMC) with ox-LDL resulted in an elevation of the levels of ILC1s and a marked reduction in the levels of ILC2s in a dose-dependent manner. ILC1s and ILC2s were more susceptible to ox-LDL-mediated alterations in patients with ACI than in controls. Furthermore, the expression of Interleukin 18 (IL-18), IL-33 and IL-23 in PBMCs was detected by real-time PCR, which showed the change trends of related key cytokines were highly consistent with the variation of ILC subsets. These results suggested that the levels of ILC1s and ILC2s appeared to be a novel, sensitive indicator for diagnosing ACI. Ox-LDL directly affected ILC1s and ILC2s, thus contributing to the alternations of ILC1 and ILC2 and occurrence of ACI.
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Affiliation(s)
- Qing Li
- The Central Laboratory of Medical Research Center, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
- The Central Laboratory of Medical Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefei 230001, Anhui, P.R. China
| | - Mengdie Liu
- The Central Laboratory of Medical Research Center, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
| | - Rui Fu
- The Central Laboratory of Medical Research Center, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
| | - Qi Cao
- The Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of SydneyNSW, Australia
| | - Yuanmin Wang
- Centre for Kidney Research, Children’s Hospital at WestmeadSydney, NSW, Australia
| | - Shuxin Han
- Case Cardiovascular Research Institute, Case Western Reserve University, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical CenterCleveland, Ohio 44106, USA
| | - Wei Hu
- Department of Neurology, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
| | - Hongqi Li
- Department of Geriatric Cardiology, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
| | - Chaojie Hu
- The Central Laboratory of Medical Research Center, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
- The Central Laboratory of Medical Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefei 230001, Anhui, P.R. China
| | - Li Wu
- The Central Laboratory of Medical Research Center, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
| | - Liang Zhang
- The Central Laboratory of Medical Research Center, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
| | - Jie Deng
- The Central Laboratory of Medical Research Center, Anhui Provincial Hospital, Anhui Medical UniversityHefei 230001, Anhui, P.R. China
| | - Yiping Wang
- The Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of SydneyNSW, Australia
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17
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Jiang B, He D, Zhang L, Ye M. Risk prediction of cerebrovascular events with carotid plaque magneitc resonance analysis: A meta-analysis. J Neuroradiol 2018; 46:117-123. [PMID: 29920350 DOI: 10.1016/j.neurad.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/04/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND PURPOSE It is not conclusive that magnetic resonance (MR)-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. We aimed to systematically summarize the association of MR imaging (MRI)-determined intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thinning/rupture of the fibrous cap (TRFC) with subsequent ischemic events. MATERIALS AND METHODS We performed a comprehensive literature search evaluating the association of MRI-based carotid plaque composition with ischemic outcomes. We included cohort studies examining IPH, LRNC, or TRFC with mean follow-up of≥6 months and an outcome measure of ipsilateral ischemic events. A meta-analysis was done according to the Cochrane guideline. RESULTS We identified 13 studies including 1.150 patients and 1.208 analyzed carotid arteries, with mean follow-up of 21.1 months. The hazard ratios (HR) for IPH, LRNC, and TRFC as predictors of subsequent ischemic events were 4.41 (95% CI: 2.87, 6.79), 3.00 (95% CI: 1.51, 5.95), and 5.94 (95% CI: 2.66, 13.28), respectively. The predictive value of carotid plaque MRI for ischemic events was acceptable, with sensitivity of 0.80 (95% CI: 0.66, 0.90) and specificity of 0.63 (95% CI: 0.57, 0.68). However, it was limited to confirm or exclude future ischemic events in clinical context, with positive likelihood ratio (LR) of 2.2 (95% CI: 1.9, 2.5) and negative LR of 0.31 (95% CI: 0.18, 0.55). No statistically significant heterogeneity or publication bias was observed. CONCLUSION The presence of IPH, LRNC, and TRFC determined by MRI is associated with increased risk of future ischemic events, but its predictive value is moderate and should not be used for confirmation or exclusion of future ischemic events in clinical context.
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Affiliation(s)
- Binghu Jiang
- Department of radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, 637000 Nanchong, China
| | - Dongmei He
- Department of neurology, BenQ Medical Center, Nanjing Medical University, N(o) 71, Hexi avenue, Jianye District, Nanjing 210019, China
| | - Liwen Zhang
- Department of neurology, BenQ Medical Center, Nanjing Medical University, N(o) 71, Hexi avenue, Jianye District, Nanjing 210019, China
| | - Min Ye
- Department of neurology, BenQ Medical Center, Nanjing Medical University, N(o) 71, Hexi avenue, Jianye District, Nanjing 210019, China.
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18
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Cai Y, Zeng C, Su Q, Zhou J, Li P, Dai M, Wang D, Long F. Association of RTEL1 gene polymorphisms with stroke risk in a Chinese Han population. Oncotarget 2017; 8:114995-115001. [PMID: 29383136 PMCID: PMC5777748 DOI: 10.18632/oncotarget.22980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/15/2017] [Indexed: 01/14/2023] Open
Abstract
We investigated the associations between single nucleotide polymorphisms (SNPs) in the regulator of telomere elongation helicase 1 (RTEL1) gene and stroke in the Chinese population. A total of 400 stroke patients and 395 healthy participants were included in this study. Five SNPs in RTEL1 were genotyped and the association with stroke risk was analyzed. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using unconditional logistic regression analysis. Multivariate logistic regression analysis was used to identify SNPs that correlated with stroke. Rs2297441 was associated with an increased risk of stroke in an allele model (odds ratio [OR] = 1.24, 95% confidence interval [95% CI] = 1.01-1.52, p = 0.043). Rs6089953 was associated with an increased risk of stroke under the genotype model ([OR] = 1.862, [CI] = 1.123-3.085, p = 0.016). Rs2297441 was associated with an increased risk of stroke in an additive model (OR = 1.234, 95% CI = 1.005, p = 0.045, Rs6089953, Rs6010620 and Rs6010621 were associated with an increased risk of stroke in the recessive model (Rs6089953:OR = 1.825, 95% CI = 1.121-2.969, p =0.01546; Rs6010620: OR = 1.64, 95% CI = 1.008-2.669, p =0.04656;Rs6010621:OR = 1.661, 95% CI = 1.014-2.722, p =0.04389). Our findings reveal a possible association between SNPs in the RTEL1 gene and stroke risk in Chinese population.
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Affiliation(s)
- Yi Cai
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
| | - Chaosheng Zeng
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
| | - Qingjie Su
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
| | - Jingxia Zhou
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
| | - Pengxiang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
| | - Mingming Dai
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
| | - Desheng Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
| | - Faqing Long
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical College, Hainan 570311, China
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19
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Saba L, Francone M, Bassareo PP, Lai L, Sanfilippo R, Montisci R, Suri JS, De Cecco CN, Faa G. CT Attenuation Analysis of Carotid Intraplaque Hemorrhage. AJNR Am J Neuroradiol 2017; 39:131-137. [PMID: 29191874 DOI: 10.3174/ajnr.a5461] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/20/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage. MATERIALS AND METHODS This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm2). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed. RESULTS A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively). CONCLUSIONS The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.
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Affiliation(s)
- L Saba
- From the Departments of Radiology (L.S.)
| | | | | | - L Lai
- Department of Radiological, Oncological, and Pathological Sciences (L.L.), Sapienza University of Rome, Rome, Italy
| | - R Sanfilippo
- Vascular Surgery (R.S., R.M.), Azienda Ospedaliero Universitaria of Cagliari - Polo di Monserrato, Cagliari, Italy
| | - R Montisci
- Vascular Surgery (R.S., R.M.), Azienda Ospedaliero Universitaria of Cagliari - Polo di Monserrato, Cagliari, Italy
| | - J S Suri
- Point of Care Devices (J.S.S.), Global Biomedical Technologies, Roseville, California.,AtheroPoint (J.S.S.), Roseville, California.,Department of Electrical Engineering (J.S.S.), Idaho State University, Pocatello, Idaho
| | - C N De Cecco
- Department of Radiology and Radiological Science (C.N.D.C.), Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina
| | - G Faa
- Cardiology (M.F., P.P.B., G.F.)
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20
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Guo L, Cheng L, He W, Ju Y, Zhao X. Ideal Cardiovascular Health and Incidence of Carotid Plaque among Middle-Aged and Elderly Adults. J Stroke Cerebrovasc Dis 2017; 27:391-396. [PMID: 29030046 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The ideal cardiovascular health (CVH) has been reported to be associated with reduced risk of ischemic stroke (IS). Atherosclerosis is a fundamental precursor in progression to IS. This study aimed to investigate the association of CVH score and atherosclerosis defined by carotid plaque in a community-based cohort. METHODS Data came from the Asymptomatic Polyvascular Abnormalities Community study. After exclusions for missing data and original carotid plaque, 1938 subjects were included. At baseline (2010), the 7 CVH factors were quantified on a 14-point scale with 2 points awarded for ideal status, 1 point for intermediate, and 0 point for poor. The incidence of carotid plaque from 2010 to 2012 was evaluated from bilateral common, internal, and external carotid arteries, and carotid bifurcations using high-resolution B-mode ultrasounds. Multivariable logistic models were used to assess the association between CVH score and carotid plaque incidence. RESULTS After 2 years' follow-up, 350 (18.06%) subjects developed carotid plaque. After adjusting for age, sex, education, and income, we observed a significant inverse association between the CVH score and incident carotid plaque. For every CVH score increase, the risk of carotid plaque incidence decreased by 8.10%. Stratified analysis showed the above association had no difference between sexes and age. CONCLUSIONS Chinese subjects with a higher CVH score had a lower risk of developing carotid plaque after 2 years. The ideal CVH concept should be further promoted for protecting the arteries from atherosclerosis.
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Affiliation(s)
- Li Guo
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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21
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Schwaiger M, Kunze K, Rischpler C, Nekolla SG. PET/MR: Yet another Tesla? J Nucl Cardiol 2017; 24:1019-1031. [PMID: 27659455 DOI: 10.1007/s12350-016-0665-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 12/20/2022]
Abstract
After the successful introduction of PET/CT as a multimodality imaging technique, PET/MR has subsequently emerged as an attractive instrumentation for applications in neurology, oncology, and cardiology. Simultaneous data acquisition combining structural, functional, and molecular imaging provides a unique platform to link various aspects of cardiac performance for the non-invasive characterization of cardiovascular disease phenotypes. Specifically, tissue characterization by MR techniques with and without contrast agents allows for functional parameters such as LGE, myocardial perfusion, and T1 maps as well as an estimate of extracellular volume. PET tracers excel by their high sensitivity and specificity, thus supplementing the functional tissue characterization by MRI. Although the clinical applications are yet to be validated , the first experience with PET/MR suggests future applications in the area of vascular imaging (unstable plaque) as well as in the characterization of inflammatory processes involving the heart. Ischemic heart disease can be comprehensively assessed by integrating regional function, perfusion, and viability. Future technical improvements leading to less costly PET/MR instrumentation are necessary to support routine clinical application of this promising technique in cardiology.
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Affiliation(s)
- Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Karl Kunze
- Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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22
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McNally JS, Kim SE, Mendes J, Hadley JR, Sakata A, De Havenon AH, Treiman GS, Parker DL. Magnetic Resonance Imaging Detection of Intraplaque Hemorrhage. MAGNETIC RESONANCE INSIGHTS 2017; 10:1-8. [PMID: 28469441 PMCID: PMC5348123 DOI: 10.1177/1178623x17694150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/25/2017] [Indexed: 11/16/2022]
Abstract
Carotid artery atherosclerosis is a major cause of ischemic stroke. For more than 30 years, future stroke risk and carotid stroke etiology have been determined using percent diameter stenosis based on clinical trials in the 1990s. In the past 10 years, magnetic resonance imaging (MRI) sequences have been developed to detect carotid intraplaque hemorrhage. By detecting carotid intraplaque hemorrhage, MRI identifies potential stroke sources that are often overlooked by lumen imaging. In addition, MRI can dramatically improve assessment of future stroke risk beyond lumen stenosis alone. In this review, we discuss the use of heavily T1-weighted MRI sequences used to detect carotid intraplaque hemorrhage. In addition, advances in ciné imaging, motion robust techniques, and specialized neck coils will be reviewed. Finally, the clinical use and future impact of MRI plaque hemorrhage imaging will be discussed.
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Affiliation(s)
- J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Seong-Eun Kim
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Jason Mendes
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - J Rock Hadley
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Akihiko Sakata
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Adam H De Havenon
- Department of Neurology, The University of Utah, Salt Lake City, UT, USA
| | - Gerald S Treiman
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
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23
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Kolodgie FD, Yahagi K, Mori H, Romero ME, Trout HH, Finn AV, Virmani R. High-risk carotid plaque: lessons learned from histopathology. Semin Vasc Surg 2017; 30:31-43. [DOI: 10.1053/j.semvascsurg.2017.04.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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24
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Zhang N, Zhang L, Yang Q, Pei A, Tong X, Chung YC, Liu X. A fast screening protocol for carotid plaques imaging using 3D multi-contrast MRI without contrast agent. Magn Reson Imaging 2016; 39:89-97. [PMID: 27989914 DOI: 10.1016/j.mri.2016.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To implement a fast (~15min) MRI protocol for carotid plaque screening using 3D multi-contrast MRI sequences without contrast agent on a 3Tesla MRI scanner. MATERIALS AND METHODS 7 healthy volunteers and 25 patients with clinically confirmed transient ischemic attack or suspected cerebrovascular ischemia were included in this study. The proposed protocol, including 3D T1-weighted and T2-weighted SPACE (variable-flip-angle 3D turbo spin echo), and T1-weighted magnetization prepared rapid acquisition gradient echo (MPRAGE) was performed first and was followed by 2D T1-weighted and T2-weighted turbo spin echo, and post-contrast T1-weighted SPACE sequences. Image quality, number of plaques, and vessel wall thicknesses measured at the intersection of the plaques were evaluated and compared between sequences. RESULTS Average examination time of the proposed protocol was 14.6min. The average image quality scores of 3D T1-weighted, T2-weighted SPACE, and T1-weighted magnetization prepared rapid acquisition gradient echo were 3.69, 3.75, and 3.48, respectively. There was no significant difference in detecting the number of plaques and vulnerable plaques using pre-contrast 3D images with or without post-contrast T1-weighted SPACE. The 3D SPACE and 2D turbo spin echo sequences had excellent agreement (R=0.96 for T1-weighted and 0.98 for T2-weighted, p<0.001) regarding vessel wall thickness measurements. CONCLUSION The proposed protocol demonstrated the feasibility of attaining carotid plaque screening within a 15-minute scan, which provided sufficient anatomical coverage and critical diagnostic information. This protocol offers the potential for rapid and reliable screening for carotid plaques without contrast agent.
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Affiliation(s)
- Na Zhang
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China; Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Lei Zhang
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China
| | - Qi Yang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Anqi Pei
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoxin Tong
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yiu-Cho Chung
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China
| | - Xin Liu
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China.
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McDermott MM, Kramer CM, Tian L, Carr J, Guralnik JM, Polonsky T, Carroll T, Kibbe M, Criqui MH, Ferrucci L, Zhao L, Hippe DS, Wilkins J, Xu D, Liao Y, McCarthy W, Yuan C. Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events. JACC Cardiovasc Imaging 2016; 10:1003-1012. [PMID: 27838307 DOI: 10.1016/j.jcmg.2016.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/21/2016] [Accepted: 08/24/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. BACKGROUND LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. METHODS Participants with ankle-brachial index (ABI) values <1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. RESULTS Of 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline >0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. CONCLUSIONS Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Christopher M Kramer
- Departments of Medicine, Radiology, and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - James Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tamar Polonsky
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Timothy Carroll
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Melina Kibbe
- Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Luigi Ferrucci
- Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel S Hippe
- Department of Radiology and Bioengineering, University of Washington, Seattle, Washington
| | - John Wilkins
- Department of Medicine Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dongxiang Xu
- Department of Radiology and Bioengineering, University of Washington, Seattle, Washington
| | - Yihua Liao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Walter McCarthy
- University Cardiovascular Surgeons, Rush University Medical Center, Chicago, Illinois
| | - Chun Yuan
- Department of Radiology and Bioengineering, University of Washington, Seattle, Washington
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Skagen K, Evensen K, Scott H, Krohg-Sørensen K, Vatnehol SA, Hol PK, Skjelland M, Russell D. Semiautomated Magnetic Resonance Imaging Assessment of Carotid Plaque Lipid Content. J Stroke Cerebrovasc Dis 2016; 25:2004-10. [PMID: 27234919 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/16/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The composition of a carotid plaque is important for plaque vulnerability and stroke risk. The main aim of this study was to assess the potential of semiautomated segmentation of carotid plaque magnetic resonance imaging (MRI) in the assessment of the size of the lipid-rich necrotic core (LRNC). METHODS Thirty-four consecutive patients with carotid stenosis of 70% or higher, who were scheduled for carotid endarterectomy, underwent a clinical neurological examination, Color duplex ultrasound, 3-T MRI with an 8-channel carotid coil, and blood tests. All examinations were performed less than 24 hours prior to surgery and plaques were assessed histologically immediately following endarterectomy. Plaques were defined as symptomatic when associated with ipsilateral cerebral ischemic symptoms within 30 days prior to inclusion. The level of agreement between the size of the LRNC and calcification on MRI to the histological estimation of the same tissue components, plaque echolucency on ultrasound, and symptoms was assessed. RESULTS The size of the LRNC on MRI was significantly correlated to the percentage amount of lipid per plaque on histological assessment (P = .010, r = .5), and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques (P = .001, r = -.7). CONCLUSIONS In this study, we found that semiautomated MRI assessments of the percentage LRNC in carotid plaques were significantly correlated to the percentage LRNC per plaque on histological assessment, and to echogenicity on ultrasound with echolucent plaques having larger LRNC than echogenic plaques.
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Affiliation(s)
- Karolina Skagen
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kristin Evensen
- Department of Neurology, Oslo University Hospital, Norway; Vestre Viken, Drammen Hospital, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital, Norway
| | | | | | - Per Kristian Hol
- Institute of Clinical Medicine, University of Oslo, Norway; The Intervention Centre, Oslo University Hospital, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Qiao H, He Q, Chen Z, Xu D, Huang L, He L, Jiang L, Li R, Luo J, Yuan C, Zhao X. Identification of early atherosclerotic lesions in carotid arteries with quantitative characteristics measured by 3D MRI. J Magn Reson Imaging 2016; 44:1270-1276. [PMID: 27079951 DOI: 10.1002/jmri.25264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the usefulness of quantitative characteristics of morphology and signal intensity of arterial wall measured by 3D multicontrast magnetic resonance vessel wall imaging (MRVWI) in identification of carotid early atherosclerosis (CEAS). MATERIALS AND METHODS In all, 61 older subjects (mean age 71.8 ± 5.6 years old; 25 males) without cardiovascular symptoms in the last 6 months were recruited. The carotid arteries without advanced plaque features on 3.0T MRI were included for analysis. Ultrasound imaging was used as a reference to identify CEAS. The morphological parameters including lumen area (LA), wall area (WA), wall thickness (WT), and normalized wall index (NWI = WA/[WA+LA] × 100%) and the signal intensity on 3.0T MR T2 -weighted images (T2 SI) of the carotid arterial wall were measured. Three regression models were built to identify CEAS with the following parameters: Model 1 with both morphological and T2 SI parameters; Model 2 with T2 SI parameters; and Model 3 with morphological parameters. All models were adjusted for age and sex. Area under the curve (AUC) was calculated to validate models. RESULTS Of the 86 carotid arteries without advanced plaques, 47 (54.7%) were found to have early plaques determined by ultrasound. Among three regression models, Model 1 showed the highest AUC values in identifying CEAS (left: AUC = 0.856, P < 0.001; right: AUC = 0.867, P < 0.001), followed by Model 2 (left: AUC = 0.843, P < 0.001; right: AUC = 0.798, P = 0.001), and Model 3 (left: AUC = 0.790, P = 0.002; right: AUC = 0.806, P < 0.001). CONCLUSION The combination of morphology and normalized T2 SI of arterial wall measured by MRVWI is more effective than each characteristic alone in identification of CEAS. J. Magn. Reson. Imaging 2016;44:1270-1276.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Qiong He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Zhensen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Lingyun Huang
- Clinical Sites Research Program, Philips Research China, Shanghai, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Li Jiang
- Philips Healthcare (Suzhou), Jiangsu, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jianwen Luo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
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Kurosaki Y, Yoshida K, Fukumitsu R, Sadamasa N, Handa A, Chin M, Yamagata S. Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity. J Neurosurg 2016; 124:736-42. [DOI: 10.3171/2015.2.jns142783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity.
METHODS
Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI< 1.40 and ERR ≥ 1.66; Group C = rSI ≥ 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group.
RESULTS
Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01).
CONCLUSIONS
In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, which should be validated by a prospective, randomized study of asymptomatic patients.
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Affiliation(s)
| | - Kazumichi Yoshida
- 2Department of Neurosurgery, Kyoto University School of Medicine, Kyoto, Japan
| | - Ryu Fukumitsu
- 2Department of Neurosurgery, Kyoto University School of Medicine, Kyoto, Japan
| | - Nobutake Sadamasa
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Akira Handa
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Masaki Chin
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Sen Yamagata
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, WA (J.S., C.Y.)
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA (J.S., C.Y.)
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Gupta A, Gialdini G, Lerario MP, Baradaran H, Giambrone A, Navi BB, Marshall RS, Iadecola C, Kamel H. Magnetic resonance angiography detection of abnormal carotid artery plaque in patients with cryptogenic stroke. J Am Heart Assoc 2015; 4:e002012. [PMID: 26077590 PMCID: PMC4599540 DOI: 10.1161/jaha.115.002012] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Magnetic resonance imaging of carotid plaque can aid in stroke risk stratification in patients with carotid stenosis. However, the prevalence of complicated carotid plaque in patients with cryptogenic stroke is uncertain, especially as assessed by plaque imaging techniques routinely included in acute stroke magnetic resonance imaging protocols. We assessed whether the magnetic resonance angiography–defined presence of intraplaque high-intensity signal (IHIS), a marker of intraplaque hemorrhage, is associated with ipsilateral cryptogenic stroke. Methods and Results Cryptogenic stroke patients with magnetic resonance imaging evidence of unilateral anterior circulation infarction and without hemodynamically significant (≥50%) stenosis of the cervical carotid artery were identified from a prospective stroke registry at a tertiary-care hospital. High-risk plaque was assessed by evaluating for IHIS on routine magnetic resonance angiography source images using a validated technique. To compare the presence of IHIS on the ipsilateral versus contralateral side within individual patients, we used McNemar’s test for correlated proportions. A total of 54 carotid arteries in 27 unique patients were included. A total of 6 patients (22.2%) had IHIS-positive nonstenosing carotid plaque ipsilateral to the side of ischemic stroke compared to 0 patients who had IHIS-positive carotid plaques contralateral to the side of stroke (P=0.01). Stroke severity measures, diagnostic evaluations, and prevalence of vascular risk factors were not different between the IHIS-positive and IHIS-negative groups. Conclusions Our findings suggest that a proportion of strokes classified as cryptogenic may be mechanistically related to complicated, nonhemodynamically significant cervical carotid artery plaque that can easily be detected by routine magnetic resonance imaging/magnetic resonance angiography acute stroke protocols.
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Affiliation(s)
- Ajay Gupta
- Department of Radiology, Weill Cornell Medical College (WCMC), New York, NY (A.G., H.B.) Feil Family Brain and Mind Research Institute, Weill Cornell Medical College (WCMC), New York, NY (A.G., G.G., B.B.N., C.I., H.K.)
| | - Gino Gialdini
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College (WCMC), New York, NY (A.G., G.G., B.B.N., C.I., H.K.)
| | - Michael P Lerario
- Department of Neurology, Weill Cornell Medical College (WCMC), New York, NY (M.P.L., B.B.N., C.I., H.K.)
| | - Hediyeh Baradaran
- Department of Radiology, Weill Cornell Medical College (WCMC), New York, NY (A.G., H.B.)
| | - Ashley Giambrone
- Department of Healthcare Policy and Research, Weill Cornell Medical College (WCMC), New York, NY (A.G.)
| | - Babak B Navi
- Department of Neurology, Weill Cornell Medical College (WCMC), New York, NY (M.P.L., B.B.N., C.I., H.K.) Feil Family Brain and Mind Research Institute, Weill Cornell Medical College (WCMC), New York, NY (A.G., G.G., B.B.N., C.I., H.K.)
| | - Randolph S Marshall
- Department of Neurology, Columbia University Medical Center, New York, NY (R.S.M.)
| | - Costantino Iadecola
- Department of Neurology, Weill Cornell Medical College (WCMC), New York, NY (M.P.L., B.B.N., C.I., H.K.) Feil Family Brain and Mind Research Institute, Weill Cornell Medical College (WCMC), New York, NY (A.G., G.G., B.B.N., C.I., H.K.)
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College (WCMC), New York, NY (M.P.L., B.B.N., C.I., H.K.) Feil Family Brain and Mind Research Institute, Weill Cornell Medical College (WCMC), New York, NY (A.G., G.G., B.B.N., C.I., H.K.)
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Treiman GS, McNally JS, Kim SE, Parker DL. Correlation of Carotid Intraplaque Hemorrhage and Stroke Using 1.5 T and 3 T MRI. MAGNETIC RESONANCE INSIGHTS 2015; 8:1-8. [PMID: 26056469 PMCID: PMC4454204 DOI: 10.4137/mri.s23560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 01/06/2023]
Abstract
Carotid therosclerotic disease causes approximately 25% of the nearly 690,000 ischemic strokes each year in the United States. Current risk stratification based on percent stenosis does not provide specific information on the actual risk of stroke for most individuals. Prospective randomized studies have found only 10 to 12% of asymptomatic patients will have a symptomatic stroke within 5 years. Measurements of percent stenosis do not determine plaque stability or composition. Reports have concluded that cerebral ischemic events associated with carotid plaque are intimately associated with plaque instability. Analysis of retrospective studies has found that plaque composition is important in risk stratification. Only MRI has the ability to identify and measure the detailed components and morphology of carotid plaque and provides more detailed information than other currently available techniques. MRI can accurately detect carotid hemorrhage, and MRI identified carotid hemorrhage correlates with acute stroke.
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Affiliation(s)
- Gerald S Treiman
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA ; Department of Surgery, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA ; Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Seong-Eun Kim
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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The application of ultrasonic velocity vector imaging technique of carotid plaque in predicting large-artery atherosclerotic stroke. J Stroke Cerebrovasc Dis 2015; 24:1351-6. [PMID: 25797431 DOI: 10.1016/j.jstrokecerebrovasdis.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Large-artery atherosclerotic stroke (LAAs) is related to carotid plaque, but the mechanical mechanism is unclear. We aimed to use ultrasonic velocity vector imaging (VVI) technique to study the mechanical difference of carotid plaque in patients with LAAs and controls. METHODS We enrolled 43 LAAs patients and 38 controls but all showing plaque on carotid ultrasonography. Ultrasonic VVI technique was used to analyze radial systolic and diastolic peak velocity (R-vs, R-vd), radial and circumferential peak strain (R-s, C-s) and radial displacement (R-dis) of carotid plaque. RESULTS Compared with controls, LAAs patients showed higher pulse pressure (P = .001), pulse pressure index (PPI, P = .006), and greater stress at carotid plaque as manifested by higher absolute value of radial diastolic peak velocity (R-vd, P = .021), radial systolic peak velocity (R-vs, P = .007), radial peak strain (R-s, P = .015), and radial displacement (R-dis, P = .022). PPI was significantly correlated with R-vs (r = -.274, P = .013), R-vd (r = .304, P = .006), and R-dis (r = -.28, P = .011). But there was no correlation between R-s and blood pressure. R-s was screened to be the most predictable parameters for LAAs (odds ratio, 1.118; 95% confidence interval, 1.012∼1.236; P = .029). The area under the curve of R-s was .627. CONCLUSIONS Radial peak strain (R-s) is a predictable parameter for the occurrence of LAAs. We predict using ultrasonic VVI technique to analyze whether the mechanics of carotid plaque is helpful to screen patients with high risks of LAAs.
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Park JS, Kwak HS, Lee JM, Koh EJ, Chung GH, Hwang SB. Association of carotid intraplaque hemorrhage and territorial acute infarction in patients with acute neurological symptoms using carotid magnetization-prepared rapid acquisition with gradient-echo. J Korean Neurosurg Soc 2015; 57:94-9. [PMID: 25733989 PMCID: PMC4345200 DOI: 10.3340/jkns.2015.57.2.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 02/02/2023] Open
Abstract
Objective The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods 83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction. Results Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010). Conclusion Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.
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Affiliation(s)
- Jung Soo Park
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Hyo Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jong Myong Lee
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Eun Jeong Koh
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Gyung Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seung Bae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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Kashiwazaki D, Akioka N, Kuwayama N, Noguchi K, Tanaka K, Kuroda S. Pathophysiology of Acute Cerebrovascular Syndrome in Patients With Carotid Artery Stenosis. Neurosurgery 2015; 76:427-33; discussion 433-4. [DOI: 10.1227/neu.0000000000000655] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
The mechanisms underlying acute cerebrovascular syndrome in patients with carotid artery stenosis remain unclear.
OBJECTIVE:
To assess the relationships among infarct localization, hemodynamics, and plaque components.
METHODS:
This prospective study included 38 patients with acute cerebrovascular syndrome resulting from ipsilateral carotid artery stenosis. Cerebral infarct localization was categorized into 3 patterns (cortical, border zone, and mixed pattern). Carotid plaque components were evaluated with T1-weighted magnetic resonance imaging and time-of-flight imaging. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were also quantified.
RESULTS:
Infarcts were identified in 38 patients with the use of diffusion-weighted magnetic resonance imaging. On the basis of the assessment of hemodynamics, the cortical pattern was seen in 18 of 21 patients with type 1 ischemia (normal CBF, normal CVR), whereas the mixed pattern was seen in 2 patients with type 2 ischemia (normal CBF, impaired CVR) and 12 of 15 patients with type 3 ischemia (impaired CBF, impaired CVR). The plaque components were categorized into fibrous (4 patients), lipid-rich (14 patients), and intraplaque hemorrhage (IPH; 20 patients). Of the patients with fibrous plaque, 2 had border-zone and 2 had mixed-pattern infarcts. Of the patients with lipid-rich plaque, 7 had cortical and 6 had mixed-pattern infarcts. Of patients with intraplaque hemorrhage, 11 had cortical and 9 had mixed-pattern infarcts.
CONCLUSION:
Cortical infarction occurs as a result of vulnerable plaque. Reduced cerebral perfusion induces border-zone infarction. Both factors are implicated in mixed-pattern infarction. Developments in noninvasive diagnostic modalities allow us to explore the mechanisms behind acute cerebrovascular syndrome in carotid artery stenosis and to determine the ideal therapies.
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Affiliation(s)
| | | | | | - Kyo Noguchi
- Radiology, Graduate School of Medicine and Pharmacological Science, University of Toyama, Toyama, Japan
| | - Kortaro Tanaka
- Department of Neurology, Toyama University Hospital, Toyama, Japan
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Fonseca AC, Ferro JM. Cryptogenic stroke. Eur J Neurol 2015; 22:618-23. [PMID: 25597418 DOI: 10.1111/ene.12673] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022]
Abstract
In about a quarter of ischaemic strokes the cause is undetermined, because the investigation is incomplete or delayed, because there are multiple causes or because the stroke is truly cryptogenic. Cryptogenic stroke can be further classified as non-embolic or embolic. Embolic stroke of undetermined source can be due to paroxysmal atrial fibrillation, minor emboligenic cardiac conditions, atheroembolism, cancer associated and paradoxical embolism through a patent foramen ovale (PFO) or less often a pulmonary fistula. Currently, risk factor control, statins and antiplatelets are the main therapeutic measures to prevent recurrent stroke. There is no evidence to implement routine closure of PFO in patients with cryptogenic stroke. Direct anticoagulants are being evaluated in randomized controlled trials including embolic stroke of undetermined source patients. Advances in high resolution ultrasound or magnetic resonance imaging of extracranial and intracranial vessels and of the heart and prolonged heart rhythm monitoring will be instrumental techniques to identify arterial and cardiac hidden causes of stroke.
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Affiliation(s)
- A C Fonseca
- Serviço de Neurologia, Department of Neurosciences, Hospital de Santa Maria, University of Lisboa, Lisboa, Portugal
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38
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He Y, Ma N, Xing C, Wang X, Xiao H, Zheng M, Han G, Chen G, Hou C, Shen B, Li Y, Jiang Z, Wang R, Hu W. Novel IL-6-secreting γδT cells increased in patients with atherosclerotic cerebral infarction. Mol Med Rep 2014; 11:1497-503. [PMID: 25351283 DOI: 10.3892/mmr.2014.2796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 09/18/2014] [Indexed: 11/06/2022] Open
Abstract
Mounting evidence has suggested that inflammation associated with interleukin (IL)‑6 and T‑helper (Th)17 cells, has a role in the development of atherosclerotic cerebral infarction (ACI). However, it remains unclear which population of cells determines the levels of IL‑6, and the role of IL‑6‑secreting cells in inducing Th17 cell production. In the present study, IL‑6 levels were determined in patients with ACI, by ELISA. The percentage of CD3+T, CD4+T, CD8+T, CD11c+ dendritic cells and γδT cells were determined by flow cytometry, and the correlation between cytokine IL‑6 and γδT cells was determined by statistical analysis. An in vitro culture assay was used to determine whether γδT cells secreted high levels of IL‑6, and induced production of Th17 cells. The patients with ACI had significantly higher levels of IL‑6 and γδT cells. Furthermore, γδT cells were associated with the secretion of a high level of IL‑6 in patients with ACI. These results indicate that γδT cells are novel IL‑6‑secreting cells, which from then on were known as γδT6 cells. In addition, the novel γδT6 cells induced Th17‑cell production, and this induction was dependent on IL‑6. Novel γδT6 cells increased the induction of Th17‑cell production in patients with ACI. The results of the present study suggest that novel γδT6 cells may be a target for strategic therapies of ACI.
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Affiliation(s)
- Youdi He
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Ning Ma
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Chen Xing
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Xiaoqian Wang
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - He Xiao
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Mingke Zheng
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Gencheng Han
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Guojiang Chen
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Chunmei Hou
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Beifen Shen
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Yan Li
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Zhenyu Jiang
- Department of Rheumatology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Renxi Wang
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing 100850, P.R. China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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39
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Grimm JM, Schindler A, Schwarz F, Cyran CC, Bayer-Karpinska A, Freilinger T, Yuan C, Linn J, Trelles M, Reiser MF, Nikolaou K, Saam T. Computed tomography angiography vs 3 T black-blood cardiovascular magnetic resonance for identification of symptomatic carotid plaques. J Cardiovasc Magn Reson 2014; 16:84. [PMID: 25315518 PMCID: PMC4189681 DOI: 10.1186/s12968-014-0084-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this prospective study was to perform a head-to-head comparison of the two methods most frequently used for evaluation of carotid plaque characteristics: Multi-detector Computed Tomography Angiography (MDCTA) and black-blood 3 T-cardiovascular magnetic resonance (bb-CMR) with respect to their ability to identify symptomatic carotid plaques. METHODS 22 stroke unit patients with unilateral symptomatic carotid disease and >50% stenosis by duplex ultrasound underwent MDCTA and bb-CMR (TOF, pre- and post-contrast fsT1w-, and fsT2w- sequences) within 15 days of symptom onset. Both symptomatic and contralateral asymptomatic sides were evaluated. By bb-CMR, plaque morphology, composition and prevalence of complicated AHA type VI lesions (AHA-LT6) were evaluated. By MDCTA, plaque type (non-calcified, mixed, calcified), plaque density in HU and presence of ulceration and/or thrombus were evaluated. Sensitivity (SE), specificity (SP), positive and negative predictive value (PPV, NPV) were calculated using a 2-by-2-table. RESULTS To distinguish between symptomatic and asymptomatic plaques AHA-LT6 was the best CMR variable and presence / absence of plaque ulceration was the best CT variable, resulting in a SE, SP, PPV and NPV of 80%, 80%, 80% and 80% for AHA-LT6 as assessed by bb-CMR and 40%, 95%, 89% and 61% for plaque ulceration as assessed by MDCTA. The combined SE, SP, PPV and NPV of bb-CMR and MDCTA was 85%, 75%, 77% and 83%, respectively. CONCLUSIONS Bb-CMR is superior to MDCTA at identifying symptomatic carotid plaques, while MDCTA offers high specificity at the cost of low sensitivity. Results were only slightly improved over bb-CMR alone when combining both techniques.
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Affiliation(s)
- Jochen M Grimm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
- Department of Medical Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Florian Schwarz
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Clemens C Cyran
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Tobias Freilinger
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Seattle, USA.
| | - Jennifer Linn
- Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Miguel Trelles
- Department of Radiology, University of Texas Medical Branch, Galveston, USA.
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Konstantin Nikolaou
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
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40
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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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41
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Salem M, Bown M, Sayers R, West K, Moore D, Nicolaides A, Robinson T, Naylor A. Identification of Patients with a Histologically Unstable Carotid Plaque Using Ultrasonic Plaque Image Analysis. Eur J Vasc Endovasc Surg 2014; 48:118-25. [DOI: 10.1016/j.ejvs.2014.05.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/07/2014] [Indexed: 11/30/2022]
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Affiliation(s)
- Vince Vacca
- Vince Vacca is a clinical nurse educator in the neuroscience intensive care unit at Brigham & Women's Hospital, Boston, Mass
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43
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Ankri R, Leshem-Lev D, Fixler D, Popovtzer R, Motiei M, Kornowski R, Hochhauser E, Lev EI. Gold Nanorods as Absorption Contrast Agents for the Noninvasive Detection of Arterial Vascular Disorders Based on Diffusion Reflection Measurements. NANO LETTERS 2014; 14:2681-7. [PMID: 24697682 DOI: 10.1021/nl500573d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Rinat Ankri
- Faculty
of Engineering and Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Dorit Leshem-Lev
- Cardiac
Research
Laboratories at the Felsenstein Medical Research Center and the Cardiology
Department, Rabin Medical Center, Petah-Tikva, Israel
| | - Dror Fixler
- Faculty
of Engineering and Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Rachela Popovtzer
- Faculty
of Engineering and Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Menachem Motiei
- Faculty
of Engineering and Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Ran Kornowski
- Cardiac
Research
Laboratories at the Felsenstein Medical Research Center and the Cardiology
Department, Rabin Medical Center, Petah-Tikva, Israel
| | - Edith Hochhauser
- Cardiac
Research
Laboratories at the Felsenstein Medical Research Center and the Cardiology
Department, Rabin Medical Center, Petah-Tikva, Israel
| | - Eli I. Lev
- Cardiac
Research
Laboratories at the Felsenstein Medical Research Center and the Cardiology
Department, Rabin Medical Center, Petah-Tikva, Israel
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44
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Bang OY, Ovbiagele B, Kim JS. Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques. Stroke 2014; 45:1186-94. [DOI: 10.1161/strokeaha.113.003720] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Oh Young Bang
- From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (O.Y.B.); Department of Neurosciences, Medical University of South Carolina, Charleston (B.O.); and Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea (J.S.K.)
| | - Bruce Ovbiagele
- From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (O.Y.B.); Department of Neurosciences, Medical University of South Carolina, Charleston (B.O.); and Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea (J.S.K.)
| | - Jong S. Kim
- From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (O.Y.B.); Department of Neurosciences, Medical University of South Carolina, Charleston (B.O.); and Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea (J.S.K.)
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45
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Ličev L, Krumnikl M, Škuta J, Babiuch M, Farana R. Advances in the development of an imaging device for plaque measurement in the area of the carotid artery. BIOTECHNOL BIOTEC EQ 2014; 28:355-359. [PMID: 26740760 PMCID: PMC4686974 DOI: 10.1080/13102818.2014.910362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/28/2014] [Indexed: 11/08/2022] Open
Abstract
This paper describes the advances in the development and subsequent testing of an imaging device for three-dimensional ultrasound measurement of atherosclerotic plaque in the carotid artery. The embolization from the atherosclerotic carotid plaque is one of the most common causes of ischemic stroke and, therefore, we consider the measurement of the plaque as extremely important. The paper describes the proposed hardware for enhancing the standard ultrasonic probe to provide a possibility of accurate probe positioning and synchronization with the cardiac activity, allowing the precise plaque measurements that were impossible with the standard equipment. The synchronization signal is derived from the output signal of the patient monitor (electrocardiogram (ECG)), processed by a microcontroller-based system, generating the control commands for the linear motion moving the probe. The controlling algorithm synchronizes the movement with the ECG waveform to obtain clear images not disturbed by the heart activity.
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Affiliation(s)
- Lačezar Ličev
- Faculty of Electrical Engineering and Computer Science, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Michal Krumnikl
- Faculty of Electrical Engineering and Computer Science, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Jaromír Škuta
- Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Marek Babiuch
- Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
| | - Radim Farana
- Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava , Ostrava-Poruba , Czech Republic
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Mugler JP. Optimized three‐dimensional fast‐spin‐echo MRI. J Magn Reson Imaging 2014; 39:745-67. [PMID: 24399498 DOI: 10.1002/jmri.24542] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/31/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- John P. Mugler
- Department of Radiology and Medical ImagingUniversity of Virginia School of MedicineCharlottesville Virginia USA
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Naim C, Douziech M, Therasse E, Robillard P, Giroux MF, Arsenault F, Cloutier G, Soulez G. Vulnerable atherosclerotic carotid plaque evaluation by ultrasound, computed tomography angiography, and magnetic resonance imaging: an overview. Can Assoc Radiol J 2013; 65:275-86. [PMID: 24360724 DOI: 10.1016/j.carj.2013.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/31/2013] [Indexed: 01/23/2023] Open
Abstract
Ischemic syndromes associated with carotid atherosclerotic disease are often related to plaque rupture. The benefit of endarterectomy for high-grade carotid stenosis in symptomatic patients has been established. However, in asymptomatic patients, the benefit of endarterectomy remains equivocal. Current research seeks to risk stratify asymptomatic patients by characterizing vulnerable, rupture-prone atherosclerotic plaques. Plaque composition, biology, and biomechanics are studied by noninvasive imaging techniques such as magnetic resonance imaging, computed tomography, ultrasound, and ultrasound elastography. These techniques are at a developmental stage and have yet to be used in clinical practice. This review will describe noninvasive techniques in ultrasound, magnetic resonance imaging, and computed tomography imaging modalities used to characterize atherosclerotic plaque, and will discuss their potential clinical applications, benefits, and drawbacks.
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Affiliation(s)
- Cyrille Naim
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada
| | - Maxime Douziech
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Eric Therasse
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Pierre Robillard
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Marie-France Giroux
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Frederic Arsenault
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Guy Cloutier
- Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada
| | - Gilles Soulez
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada.
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The carotid plaque imaging in acute stroke (CAPIAS) study: protocol and initial baseline data. BMC Neurol 2013; 13:201. [PMID: 24330333 PMCID: PMC3878777 DOI: 10.1186/1471-2377-13-201] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 12/09/2013] [Indexed: 01/24/2023] Open
Abstract
Background In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke. Methods/Design 300 patients (age >49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (<70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI plaques in cryptogenic stroke patients ipsilateral to the ischemic stroke compared to the contralateral side and to patients with defined stroke etiology. Secondary outcomes include the association of AHA-LT VI plaques with the recurrence rates of ischemic events up to 36 months, rates of new ischemic lesions on cerebral MRI (including clinically silent lesions) after 12 months and the influence of specific AHA-LT VI plaque features on the progression of atherosclerotic disease burden, on specific infarct patterns, biomarkers and aortic arch plaques. Discussion CAPIAS will provide important insights into the role of non-stenosing carotid artery plaques in cryptogenic stroke. The results might have implications for our understanding of stroke mechanism, offer new diagnostic options and provide the basis for the planning of targeted interventional studies. Trial Registration NCT01284933
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MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients. PLoS One 2013; 8:e67927. [PMID: 23894291 PMCID: PMC3722215 DOI: 10.1371/journal.pone.0067927] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I-VIII). Within these lesion types, lesion types IV-V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones. METHODS Eighty-three consecutive patients (45 male (54.2%); age 54-88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50-99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I-VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance. RESULTS Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV-V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001). CONCLUSIONS MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.
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Trelles M, Eberhardt KM, Buchholz M, Schindler A, Bayer-Karpinska A, Dichgans M, Reiser MF, Nikolaou K, Saam T. CTA for screening of complicated atherosclerotic carotid plaque--American Heart Association type VI lesions as defined by MRI. AJNR Am J Neuroradiol 2013; 34:2331-7. [PMID: 23868157 DOI: 10.3174/ajnr.a3607] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution carotid MR imaging can accurately identify complicated American Heart Association lesion type VI plaques, which are characterized by thrombus, hemorrhage, or a ruptured fibrous cap. The purpose of this study is to evaluate whether CTA can be used as screening tool to predict the presence or absence of American Heart Association lesion type VI plaques as defined by high-resolution MR imaging. METHODS Fifty-one patients with suspected ischemic stroke or TIA with carotid CTA and carotid MR imaging performed within 14 days of the event/admission from April 2008 to December 2010 were reviewed. Vessels with stents or occlusion were excluded (n = 2). Each carotid artery was assigned an American Heart Association lesion type classification by MR imaging. The maximum wall thickness, maximum soft plaque component thickness, maximum calcified component thickness, and its attenuation (if the soft plaque component thickness was >2 mm) were obtained from the CTA. RESULTS The maximum soft plaque component thickness proved the best discriminating factor to predict a complicated plaque by MR imaging, with a receiver operating characteristic area under the curve of 0.89. The optimal sensitivity and specificity for detection of complicated plaque by MR imaging was achieved with a soft plaque component thickness threshold of 4.4 mm (sensitivity, 0.65; specificity, 0.94; positive predictive value, 0.75; and negative predictive value, 0.9). No complicated plaque had a soft tissue plaque thickness <2.2 mm (negative predictive value, 1) and no simple (noncomplicated) plaque had a thickness >5.6 mm (positive predictive value, 1). CONCLUSIONS Maximum soft plaque component thickness as measured by carotid CTA is a reliable indicator of a complicated plaque, with a threshold of 2.2 mm representing little to no probability of a complicated American Heart Association lesion type VI plaque.
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Affiliation(s)
- M Trelles
- Department of Radiology, University of Texas Medical Branch, Galveston, Texas
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