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Lu R, Sun F, Zhang L, Zhang C, Du J, Hao J, Zhao L. Detection of microvascular damage of membranous nephropathy by MicroFlow imaging: a novel ultrasound technique. Quant Imaging Med Surg 2024; 14:958-971. [PMID: 38223077 PMCID: PMC10784053 DOI: 10.21037/qims-23-1010] [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: 07/15/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024]
Abstract
Background MicroFlow imaging (MFI) is a novel noninvasive ultrasound (US) technique that depicts microcirculatory blood vessels in the kidney while filtering out tissue motion and enhancing blood flow signals. We aimed to investigate the value of MFI for the detection of renal microvascular perfusion in chronic kidney disease caused by stage I-II membranous nephropathy (MN). Methods Seventy-six participants including biopsy-proven MN (n=38) and healthy volunteers (n=38) were prospectively examined using MFI from March 2020 to December 2020. In addition, patients with MN were subdivided into a mild group, a moderate group, and a severe group based on the results of vascular pathology evaluation. All MFI images were analyzed by Image Pro Plus to obtain a cortical vascular index (VI). Basic patient information, relative US parameters and laboratory results were then acquired for each participant. Finally, after the univariate analysis among multiple groups, binary logistic regression (forward LR) and ordered logistic regression were used for multivariate analysis. Significance was set at P<0.05. Results VI was significantly lower in MN patients compared with that of healthy controls (0.65±0.09 vs. 0.35±0.18, P<0.001). After multivariate analysis, we found that the exploratory diagnostic performance of VI [area under the curve (AUC): 0.94; 95% confidence interval (CI): 0.89-0.99] outperformed that of serum creatinine (Scr) (AUC: 0.87; 95% CI: 0.79-0.95) in identifying MN. We also observed considerable differences among MN groups in parameters including VI (P=0.006), estimated glomerular filtration rate (eGFR) (P=0.037), shape (P=0.013), and impression (P=0.007). In addition, in the group with mild vascular damage, the exploratory diagnostic performance of VI (AUC: 0.79; 95% CI: 0.64-0.94) was better than other parameters, such as eGFR (AUC: 0.63; 95% CI: 0.43-0.84). Conclusions MFI detected abnormal renal microvascular perfusion in patients with MN (particularly in those with early vascular damage or preserved renal function) without the use of a contrast agent. Combining MFI with B-mode US can improve the predictive performance of traditional kidney US.
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Affiliation(s)
- Renjie Lu
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Fangfang Sun
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Lili Zhang
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Chao Zhang
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Jie Du
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Jianxun Hao
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Lirong Zhao
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
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Gu SY, Zhang LN, Chen J, Li F, Yao MH, Jia CX, Wu R. Associations of plaque morphology and location with Intraplaque neovascularization in the carotid artery by contrast-enhanced ultrasound imaging. Front Neurol 2023; 14:1097070. [PMID: 37251224 PMCID: PMC10213664 DOI: 10.3389/fneur.2023.1097070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Intraplaque neovascularization (IPN) is a known indicator of plaque vulnerability, and is thus considered a predictor of stroke. The morphology and location of the carotid plaque may be correlated with plaque vulnerability. Therefore, our study aimed to examine the associations of carotid plaque morphology and location with IPN. Methods A total of 141 patients with carotid atherosclerosis (mean age, 64.99 ± 10.96 years) who underwent carotid contrast-enhanced ultrasound (CEUS) between November 2021 and March 2022 were retrospectively analyzed. IPN was graded according to the presence and location of microbubbles within the plaque. The association of IPN grade with carotid plaque morphology and location was evaluated using ordered logistic regression. Results Of the 171 plaques, 89 (52%) were IPN Grade 0, 21 (12.2%) were Grade 1, and 61 (35.6%) were Grade 2. IPN grade significantly associated with both plaque morphology and location, with higher grades observed among Type III morphology and common carotid artery plaques. Significant negative association was further shown between IPN grade and serum high-density lipoprotein cholesterol (HDL-C) level. Plaque morphology and location, and HDL-C remained significantly associated with IPN grade after adjusting for confounding factors. Conclusion The location and morphology of carotid plaques were significantly associated with the IPN grade on CEUS, and therefore show potential as biomarkers for plaque vulnerability. Serum HDL-C was also identified as a protective factor against IPN, and may play a role in the management of carotid atherosclerosis. Our study provided a potential strategy for identification of vulnerable carotid plaques and elucidated the important imaging predictors of stroke.
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Cui E, Kersche G, Grubic N, Hétu MF, Pang SC, Sillesen H, Johri AM. Effect of pharmacologic anti-atherosclerotic therapy on carotid intraplaque neovascularization: A systematic review. J Clin Lipidol 2023; 17:315-326. [PMID: 37173161 DOI: 10.1016/j.jacl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/07/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
Intraplaque neovascularization (IPN), a key feature of vulnerable carotid plaque, is associated with adverse cardiovascular (CV) events. Statin therapy has been shown to diminish and stabilize atherosclerotic plaque, but its effect on IPN is uncertain. This review investigated the effects of common pharmacologic anti-atherosclerotic therapies on carotid IPN. Electronic databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception until July 13, 2022. Studies evaluating the effect of anti-atherosclerotic therapy on carotid IPN among adults with carotid atherosclerosis were included. Sixteen studies were eligible for inclusion. Contrast-enhanced ultrasound (CEUS) was the most common IPN assessment modality (n=8), followed by dynamic contrast-enhanced MRI (DCE-MRI) (n=4), excised plaque histology (n=3) and superb microvascular imaging (n=2). In fifteen studies, statins were the therapy of interest and one study assessed PCSK9 inhibitors. Among CEUS studies, baseline statin use was associated with a lower frequency of carotid IPN (median OR = 0.45). Prospective studies showed regression of IPN after 6-12 months of lipid-lowering therapy, with more regression observed in treated participants compared to untreated controls. Our findings suggest that lipid-lowering therapy with statins or PCSK9 inhibitors is associated with IPN regression. However, there was no correlation between change in IPN parameters and change in serum lipids and inflammatory markers in statin-treated participants, so it is unclear whether these factors are mediators in the observed IPN changes. Lastly, this review was limited by study heterogeneity and small sample sizes, so larger trials are needed to validate findings.
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Affiliation(s)
- Edward Cui
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Georgia Kersche
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Nicholas Grubic
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Marie-France Hétu
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Stephen C Pang
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada (Dr Pang)
| | - Henrik Sillesen
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Dr Sillesen); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Dr Sillesen)
| | - Amer M Johri
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri).
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Chen J, Zhao F, Lei C, Qi T, Xue X, Meng Y, Zhang W, Zhang H, Wang J, Zhu H, Cheng C, Wang Q, Bi C, Song B, Jin C, Niu Q, An F, Li B, Huo X, Zhao Y, Li B. Effect of evolocumab on the progression of intraplaque neovascularization of the carotid based on contrast-enhanced ultrasonography (EPIC study): A prospective single-arm, open-label study. Front Pharmacol 2023; 13:999224. [PMID: 36686711 PMCID: PMC9846542 DOI: 10.3389/fphar.2022.999224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Background and Purpose: The aim of this study was to explore the effect of half a year of evolocumab plus moderate-intensity statin treatment on carotid intraplaque neovascularization (IPN) and blood lipid levels. Methods: A total of 31 patients with 33 carotid plaques who received evolocumab plus statin treatment were included. Blood lipid levels, B-mode ultrasound and contrast-enhanced ultrasonography (CEUS) at baseline and after half a year of evolocumab plus statin therapy were collected. The area under the curve (AUC) reflected the total amount of acoustic developer entering the plaque or lumen within the 180 s measurement period. The enhanced intensity reflected the peak blood flow intensity during the monitoring period, and the contrast agent area reflected the area of vessels in the plaques. Results: Except for high-density lipoprotein cholesterol (HDL-c), all other lipid indices decreased. Compared with baseline, low-density lipoprotein cholesterol (LDL-c) decreased by approximately 57% (p < 0.001); total cholesterol (TC) decreased by approximately 34% (p < 0.001); small dense low-density lipoprotein (sd-LDL) decreased by approximately 52% (p < 0.001); and HDL-c increased by approximately 20% (p < 0.001). B-mode ultrasonography showed that the length and thickness of the plaque and the hypoechoic area ratio were reduced (p < 0.05). The plaque area, calcified area ratio, and lumen cross-sectional area changed little (p > 0.05). CEUS revealed that the area under the curve of plaque/lumen [AUC (P/L)] decreased from 0.27 ± 0.13 to 0.19 ± 0.11 (p < 0.001). The enhanced intensity ratio of plaque/lumen [intensity ratio (P/L)] decreased from 0.37 ± 0.16 to 0.31 ± 0.14 (p = 0.009). The contrast agent area in plaque/area of plaque decreased from 19.20 ± 13.23 to 12.66 ± 9.59 (p = 0.003). The neovascularization score decreased from 2.64 ± 0.54 to 2.06 ± 0.86 (p < 0.001). Subgroup analysis based on statin duration (<6 months and ≥6 months) showed that there was no significant difference in the AUC (P/L) or intensity ratio (P/L) at baseline or after half a year of evolocumab treatment. Conclusion: This study found that evolocumab combined with moderate-intensity statins significantly improved the blood lipid profile and reduced carotid IPN. Clinical Trial Registration: https://www.clinicaltrials.gov; identifier: NCT04423406.
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Affiliation(s)
- Ju Chen
- Department of Medical Ultrasonics, Zibo Central Hospital, Zibo, China
| | - Faming Zhao
- Department of Cardiology, Zibo Central Hospital, Zibo, China,Department of Infectious Disease, Zibo Infectious Disease Hospital, Zibo, China
| | - Chengbin Lei
- Laboratory Department, Zibo Central Hospital, Zibo, China
| | - Tianjun Qi
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Xin Xue
- Laboratory Department, Zibo Central Hospital, Zibo, China
| | - Yuan Meng
- Laboratory Department, Zibo Central Hospital, Zibo, China
| | - Wenzhong Zhang
- Department of Medical Ultrasonics, Zibo Central Hospital, Zibo, China
| | - Hui Zhang
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Jian Wang
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Haijun Zhu
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Cheng Cheng
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Qilei Wang
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Chenglong Bi
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Beibei Song
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Chengwei Jin
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Qiang Niu
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Fengshuang An
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Bin Li
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoguang Huo
- Department of Medical Ultrasonics, Zibo Central Hospital, Zibo, China,*Correspondence: Xiaoguang Huo, ; Yunhe Zhao, ; Bo Li,
| | - Yunhe Zhao
- Department of Cardiology, Zibo Central Hospital, Zibo, China,*Correspondence: Xiaoguang Huo, ; Yunhe Zhao, ; Bo Li,
| | - Bo Li
- Department of Cardiology, Zibo Central Hospital, Zibo, China,*Correspondence: Xiaoguang Huo, ; Yunhe Zhao, ; Bo Li,
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