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Ouyang F, Liu J, Wu Q, Chen J, Xu Z, Lv L, Wang B, Li J, Yu N, Zeng X. Relationship between the intravascular enhancement sign on three-dimensional T1-weighted turbo spin echo and intraluminal thrombus in middle cerebral artery atherosclerosis. Eur J Radiol 2024; 176:111495. [PMID: 38714134 DOI: 10.1016/j.ejrad.2024.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE To investigate the association between the intravascular enhancement sign (IVES) and intraluminal thrombus (ILT) detected by high-resolution magnetic resonance vessel wall imaging (HR-VWI) in patients with middle cerebral artery (MCA) atherosclerosis. METHOD The data of patients who underwent HR-VWI between May 2021 and May 2023, including clinical information, the number of IVES vessels, stenosis degree, ILT, plaque features on 3D T1-weighted turbo spin echo sequences, and signal intensity ratio (SIR) on 3D time-of-flight magnetic resonance angiography, were retrospectively analyzed. Correlation and logistic regression analyses were performed. RESULTS A total of 194 MCA plaques were identified in 132 patients (103 [53 %] on the left). Atherosclerosis with, relative to without, ILT was associated with a higher incidence of ischemic events, higher plaque enhancement and stenosis degrees, more vessels with IVES, and lower remodeling ratio, lumen area, wall area, total vessel area, and SIR. Multivariate logistic regression analysis showed significant and independent associations of the number of IVES vessels (OR = 1.089; 95 % CI [1.013-1.170]; P = 0.020) and SIR (OR = 0.007; 95 % CI [0.0004-0.124]; P < 0.001) with ILT. The number of vessels with the IVES (AUC = 0.81, 95 % CI [0.75-0.87]; P < 0.001) and SIR (AUC = 0.88, 95 % CI [0.82-0.94]; P < 0.001) sufficiently diagnosed ILT, and the AUC of the combination of the IVES and SIR was 0.89 (95 % CI [0.84-0.94]; P < 0.001). CONCLUSION The number of IVES vessels and SIR are independent risk factors for ILT. They may provide new monitoring targets for stroke prevention in patients with atherosclerotic stenosis.
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Affiliation(s)
- Feng Ouyang
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Jie Liu
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Qin Wu
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Jingting Chen
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Zihe Xu
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Lianjiang Lv
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Bo Wang
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Jian Li
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Nianzu Yu
- Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
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Wang J, Yu F, Zhang M, Lu J, Qian Z. A 3D framework for segmentation of carotid artery vessel wall and identification of plaque compositions in multi-sequence MR images. Comput Med Imaging Graph 2024; 116:102402. [PMID: 38810486 DOI: 10.1016/j.compmedimag.2024.102402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
Accurately assessing carotid artery wall thickening and identifying risky plaque components are critical for early diagnosis and risk management of carotid atherosclerosis. In this paper, we present a 3D framework for automated segmentation of the carotid artery vessel wall and identification of the compositions of carotid plaque in multi-sequence magnetic resonance (MR) images under the challenge of imperfect manual labeling. Manual labeling is commonly done in 2D slices of these multi-sequence MR images and often lacks perfect alignment across 2D slices and the multiple MR sequences, leading to labeling inaccuracies. To address such challenges, our framework is split into two parts: a segmentation subnetwork and a plaque component identification subnetwork. Initially, a 2D localization network pinpoints the carotid artery's position, extracting the region of interest (ROI) from the input images. Following that, a signed-distance-map-enabled 3D U-net (Çiçek etal, 2016)an adaptation of the nnU-net (Ronneberger and Fischer, 2015) segments the carotid artery vessel wall. This method allows for the concurrent segmentation of the vessel wall area using the signed distance map (SDM) loss (Xue et al., 2020) which regularizes the segmentation surfaces in 3D and reduces erroneous segmentation caused by imperfect manual labels. Subsequently, the ROI of the input images and the obtained vessel wall masks are extracted and combined to obtain the identification results of plaque components in the identification subnetwork. Tailored data augmentation operations are introduced into the framework to reduce the false positive rate of calcification and hemorrhage identification. We trained and tested our proposed method on a dataset consisting of 115 patients, and it achieves an accurate segmentation result of carotid artery wall (0.8459 Dice), which is superior to the best result in published studies (0.7885 Dice). Our approach yielded accuracies of 0.82, 0.73 and 0.88 for the identification of calcification, lipid-rich core and hemorrhage components. Our proposed framework can be potentially used in clinical and research settings to help radiologists perform cumbersome reading tasks and evaluate the risk of carotid plaques.
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Affiliation(s)
- Jian Wang
- Institute of Intelligent Diagnostics, Beijing United-Imaging Research Institute of Intelligent Imaging, Building 3-4F, 9 Yongteng N. Road, Beijing 100080, China.
| | - Fan Yu
- Department of Radiology and Nuclear medicine, Xuanwu Hospital, Capital Medical University, Changchun Street, No. 45, Beijing 100053, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, China.
| | - Mengze Zhang
- Institute of Intelligent Diagnostics, Beijing United-Imaging Research Institute of Intelligent Imaging, Building 3-4F, 9 Yongteng N. Road, Beijing 100080, China.
| | - Jie Lu
- Department of Radiology and Nuclear medicine, Xuanwu Hospital, Capital Medical University, Changchun Street, No. 45, Beijing 100053, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, China.
| | - Zhen Qian
- Institute of Intelligent Diagnostics, Beijing United-Imaging Research Institute of Intelligent Imaging, Building 3-4F, 9 Yongteng N. Road, Beijing 100080, China.
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Kassem M, Nies KPH, Boswijk E, van der Pol J, Aizaz M, Gijbels MJJ, Li D, Bucerius J, Mess WH, Wildberger JE, van Oostenbrugge RJ, Moonen RPM, Fan Z, Kooi ME. Quantification of carotid plaque composition with a multi-contrast atherosclerosis characterization (MATCH) MRI sequence. Front Cardiovasc Med 2023; 10:1227495. [PMID: 37680565 PMCID: PMC10481960 DOI: 10.3389/fcvm.2023.1227495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/18/2023] [Indexed: 09/09/2023] Open
Abstract
Background and purpose Carotid atherosclerotic plaques with a large lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and a thin or ruptured fibrous cap are associated with increased stroke risk. Multi-sequence MRI can be used to quantify carotid atherosclerotic plaque composition. Yet, its clinical implementation is hampered by long scan times and image misregistration. Multi-contrast atherosclerosis characterization (MATCH) overcomes these limitations. This study aims to compare the quantification of plaque composition with MATCH and multi-sequence MRI. Methods MATCH and multi-sequence MRI were used to image 54 carotid arteries of 27 symptomatic patients with ≥2 mm carotid plaque on a 3.0 T MRI scanner. The following sequence parameters for MATCH were used: repetition time/echo time (TR/TE), 10.1/4.35 ms; field of view, 160 mm × 160 mm × 2 mm; matrix size, 256 × 256; acquired in-plane resolution, 0.63 mm2× 0.63 mm2; number of slices, 18; and flip angles, 8°, 5°, and 10°. Multi-sequence MRI (black-blood pre- and post-contrast T1-weighted, time of flight, and magnetization prepared rapid acquisition gradient echo; acquired in-plane resolution: 0.63 mm2 × 0.63 mm2) was acquired according to consensus recommendations, and image quality was scored (5-point scale). The interobserver agreement in plaque composition quantification was assessed by the intraclass correlation coefficient (ICC). The sensitivity and specificity of MATCH in identifying plaque composition were calculated using multi-sequence MRI as a reference standard. Results A significantly lower image quality of MATCH compared to that of multi-sequence MRI was observed (p < 0.05). The scan time for MATCH was shorter (7 vs. 40 min). Interobserver agreement in quantifying plaque composition on MATCH images was good to excellent (ICC ≥ 0.77) except for the total volume of calcifications and fibrous tissue that showed moderate agreement (ICC ≥ 0.61). The sensitivity and specificity of detecting plaque components on MATCH were ≥89% and ≥91% for IPH, ≥81% and 85% for LRNC, and ≥71% and ≥32% for calcifications, respectively. Overall, good-to-excellent agreement (ICC ≥ 0.76) of quantifying plaque components on MATCH with multi-sequence MRI as the reference standard was observed except for calcifications (ICC = 0.37-0.38) and fibrous tissue (ICC = 0.59-0.70). Discussion and conclusion MATCH images can be used to quantify plaque components such as LRNC and IPH but not for calcifications. Although MATCH images showed a lower mean image quality score, short scan time and inherent co-registration are significant advantages.
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Affiliation(s)
- Mohamed Kassem
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Kelly P. H. Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ellen Boswijk
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Location VUmc, Amsterdam, Netherlands
| | - Jochem van der Pol
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mueez Aizaz
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marion J. J. Gijbels
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, Amsterdam, Netherlands
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Werner H. Mess
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joachim E. Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Robert J. van Oostenbrugge
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rik P. M. Moonen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Zhaoyang Fan
- Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - M. Eline Kooi
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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Nakahara T, Strauss HW, Narula J, Jinzaki M. Vulnerable Plaque Imaging. Semin Nucl Med 2023; 53:230-240. [PMID: 36333157 DOI: 10.1053/j.semnuclmed.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
Atherosclerotic plaques progress as a result of inflammation. Both invasive and noninvasive imaging techniques have been developed to identify and characterize plaque as vulnerable (more likely to rupture and cause a clinical event). Imaging techniques to identify vulnerable include identifying vessels with focal subendothelial collections of I) inflammatory cells; II) lipid/ fatty acid; III) local regions of hypoxia; IV) local expression of angiogenesis factors; V) local expression of protease; VI) intravascular foci of thrombus; hemorrhage (most often seen in the aftermath of a clinical event); VII) apoptosis and VIII) microcalcification. This review provides an overview of atherosclerotic plaque progression and tracers which can visualize specific molecules associated with vulnerability.
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Affiliation(s)
- Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - H William Strauss
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mahahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Phyo WSY, Shirakawa M, Yamada K, Kuwahara S, Yoshimura S. Characteristics of Calcification and Their Association with Carotid Plaque Vulnerability. World Neurosurg 2022; 167:e1017-e1024. [PMID: 36058484 DOI: 10.1016/j.wneu.2022.08.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Carotid plaque vulnerability is one of the important features for evaluating the risk of subsequent ischemic stroke. Although magnetic resonance imaging (MRI) is the gold standard modality for evaluating plaque vulnerability, some patients cannot undergo MRI because of physical or economic issues. Computed tomography (CT) is more readily available. The purpose of this study was to establish a new category of calcification on CT and to assess its usefulness for detecting vulnerable plaque. MATERIALS AND METHODS We retrospectively evaluated consecutive patients who underwent plaque imaging using CT and MRI before carotid revascularization at our institute. Calcifications were classified into 4 types according to the new calcium classification. The patients were divided into 2 groups, the double layer sign (DLS)-positive group and the DLS-negative group. Signal intensity ratio (SIR) of carotid plaque was measured on MRI for evaluating plaque vulnerability and compared between type of calcification and SIR. RESULTS Among the 132 patients evaluated, 50 patients (62.5%) in DLS positive group and 16 patients (30.8%) in DLS negative group had calcification with vulnerable plaque (SIR > 1.47) (P < 0.01). Substantial interobserver agreement of type of calcification was observed (kappa, 0.79; P < 0.01). Multivariate analysis showed that DLS (odds ratio 3.03; 95% confidence interval 1.35-6.8; P < 0.01) and male sex (odds ratio 3.15; 95% confidence interval 1.02-9.68; P = 0.04) were independent predictors of vulnerable plaque. CONCLUSIONS DLS in our new classification of calcification on CT reliably detects vulnerable plaque and could thus be used in patients who cannot undergo MRI.
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Affiliation(s)
- Wint Shwe Yee Phyo
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shuntaro Kuwahara
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
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6
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Du H, Yang W, Chen X. Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease. Front Neurol 2022; 12:789035. [PMID: 35140673 PMCID: PMC8818681 DOI: 10.3389/fneur.2021.789035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial artery calcification (IAC) was regarded as a proxy for intracranial atherosclerosis (ICAS). IAC could be easily detected on routine computer tomography (CT), which was neglected by clinicians in the previous years. The evolution of advanced imaging technologies, especially vessel wall scanning using high resolution-magnetic resonance imaging (HR-MRI), has aroused the interest of researchers to further explore the characteristics and clinical impacts of IAC. Recent histological evidence acquired from the human cerebral artery specimens demonstrated that IAC could mainly involve two layers: the intima and the media. Accumulating evidence from histological and clinical imaging studies verified that intimal calcification is more associated with ICAS, while medial calcification, especially the internal elastic lamina, contributes to arterial stiffness rather than ICAS. Considering the highly improved abilities of novel imaging technologies in differentiating intimal and medial calcification within the large intracranial arteries, this review aimed to describe the histological and imaging features of two types of IAC, as well as the risk factors, the hemodynamic influences, and other clinical impacts of IAC occurring in intimal or media layers.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Xiangyan Chen
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7
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Yuan C, Miller Z, Zhao XQ. Magnetic Resonance Imaging: Cardiovascular Applications for Clinical Trials. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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8
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Huo R, Xu H, Yang D, Qiao H, Li J, Han H, Liu Y, Wang T, Yuan H, Zhao X. Associations Between Carotid Plaque Characteristics and Improvement of Cerebral Blood Perfusion in Patients With Moderate to Severe Carotid Stenosis Undergoing Carotid Endarterectomy. J Magn Reson Imaging 2020; 53:613-625. [PMID: 33037860 DOI: 10.1002/jmri.27365] [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] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The relationship between plaque characteristics and their predictive value for perioperative cerebral blood flow (CBF) are unknown. PURPOSE To investigate the relationship between carotid plaque characteristics and perioperative CBF utilizing MRI. STUDY TYPE Prospective. POPULATION In all, 131 patients with carotid moderate-to-severe stenosis referred for carotid endarterectomy (CEA). FIELD STRENGTH/SEQUENCE 3T, black-blood T1 - and T2 -weighted, 3D time-of-flight, and simultaneous noncontrast angiography intraplaque hemorrhage. ASSESSMENT The relative CBF (rCBF = CBFindex-hemisphere /CBFcontralateral-hemisphere ) and the CBF difference ratio (DRCBF = [CBFpost-CEA - CBFpre-CEA ]/CBFpre-CEA ) in the middle cerebral artery territory were measured. The pre- and post-CEA CTP data were used as the assessment standard for CBF change. Carotid lipid-rich necrotic core (LRNC), intraplaque hemorrhage, calcification, fibrous cap rupture, maximum wall thickness, normalized wall index (NWI), and stenosis were determined. STATISTICAL TESTS Pearson or Spearman correlation, Mann-Whitney U-test, and linear regression. RESULTS Patients with LRNC had higher rCBFpre-CEA than those without (1.0 ± 0.1 vs. 0.9 ± 0.1, P < 0.05). NWI was weakly correlated with rCBFpre-CEA (r = -0.213, P < 0.05) and DRCBF (r = 0.185, P < 0.05) and marginally correlated with rCBFpost-CEA (r = 0.166, P = 0.057). LRNC was weakly correlated with rCBFpre-CEA (r = 0.179, P < 0.05). NWI was associated with rCBFpre-CEA (β = -0.035; 95% confidence interval [CI] [-0.064, -0.006]; P < 0.05), rCBFpost-CEA (β = 0.042; 95% CI [0.002, 0.081]; P < 0.05) and DRCBF (β = 0.105; 95% CI [0.026, 0.185]; P < 0.05). After adjusting for confounding factors, associations of NWI with rCBFpost-CEA (β = 0.059; 95% CI [0.016, 0.103]; P < 0.05) and DRCBF (β = 0.110; 95% CI [0.021, 0.199]; P < 0.05) remained statistically significant, while the association between NWI and rCBFpre-CEA was no longer significant (β = -0.026; 95% CI [-0.058, 0.006]; P = 0.112).The associations of LRNC with rCBFpre-CEA (β = 0.057; 95% CI [-0.0006, 0.114]; P = 0.052) and DRCBF (β = -0.157; 95% CI [-0.314, 0.001]; P = 0.051) were close to statistical significance. After adjusting for confounding factors, these associations were statistically significant (of LRNC vs. rCBFpre-CEA : β = 0.060; 95% CI [0.003, 0.118]; P < 0.05; LRNC vs. DRCBF : β = -0.205; 95% CI [-0.375, -0.036]; P < 0.05). DATA CONCLUSION Carotid plaque burden and components, particularly LRNC, might be effective indicators for CBF change following CEA. Level of Evidence 1 Technical Efficacy Stage 5.
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Affiliation(s)
- Ran Huo
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Dandan Yang
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China.,Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jin Li
- Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Ying Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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9
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Zhu G, Hom J, Li Y, Jiang B, Rodriguez F, Fleischmann D, Saloner D, Porcu M, Zhang Y, Saba L, Wintermark M. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020; 10:1048-1067. [PMID: 32968660 DOI: 10.21037/cdt.2020.03.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Carotid artery plaque is a measure of atherosclerosis and is associated with future risk of atherosclerotic cardiovascular disease (ASCVD), which encompasses coronary, cerebrovascular, and peripheral arterial diseases. With advanced imaging techniques, computerized tomography (CT) and magnetic resonance imaging (MRI) have shown their potential superiority to routine ultrasound to detect features of carotid plaque vulnerability, such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC), and calcification. The correlation between imaging features and histological changes of carotid plaques has been investigated. Imaging of carotid features has been used to predict the risk of cardiovascular events. Other techniques such as nuclear imaging and intra-vascular ultrasound (IVUS) have also been proposed to better understand the vulnerable carotid plaque features. In this article, we review the studies of imaging specific carotid plaque components and their correlation with risk scores.
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Affiliation(s)
- Guangming Zhu
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ying Li
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA.,Clinical Medical Research Center, Luye Pharma Group Ltd., Beijing 100000, China
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Dominik Fleischmann
- Department of Radiology, Cardiovascular Imaging Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Saloner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Michele Porcu
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Yanrong Zhang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
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10
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Song YJ, Kwak HS, Chung GH, Jo S. Quantification of Carotid Intraplaque Hemorrhage: Comparison between Manual Segmentation and Semi-Automatic Segmentation on Magnetization-Prepared Rapid Acquisition with Gradient-Echo Sequences. Diagnostics (Basel) 2019; 9:diagnostics9040184. [PMID: 31718016 PMCID: PMC6963393 DOI: 10.3390/diagnostics9040184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose: Carotid intraplaque hemorrhage (IPH) increases risk of territorial cerebral ischemic events, but different sequences or criteria have been used to diagnose or quantify carotid IPH. The purpose of this study was to compare manual segmentation and semi-automatic segmentation for quantification of carotid IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequences. Methods: Forty patients with 16–79% carotid stenosis and IPH on MPRAGE sequences were reviewed by two trained radiologists with more than five years of specialized experience in carotid plaque characterization with carotid plaque MRI. Initially, the radiologists manually viewed the IPH based on the MPRAGE sequence. IPH volume was then measured by three different semi-automatic methods, with high signal intensity 150%, 175%, and 200%, respectively, above that of adjacent muscle on the MPRAGE sequence. Agreement on measurements between manual segmentation and semi-automatic segmentation was assessed using the intraclass correlation coefficient (ICC). Results: There was near-perfect agreement between manual segmentation and the 150% and 175% criteria for semi-automatic segmentation in quantification of IPH volume. The ICC of each semi-automatic segmentation were as follows: 150% criteria: 0.861, 175% criteria: 0.809, 200% criteria: 0.491. The ICC value of manual vs. 150% criteria and manual vs. 175% criteria were significantly better than the manual vs. 200% criteria (p < 0.001). Conclusions: The ICC of 150% and 175% criteria for semi-automatic segmentation are more reliable for quantification of IPH volume. Semi-automatic classification tools may be beneficial in large-scale multicenter studies by reducing image analysis time and avoiding bias between human reviewers.
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Affiliation(s)
- Young Ju Song
- Department of Radiology of Chonbuk National University Hospital, Jeon-ju 54907, Korea;
| | - Hyo Sung Kwak
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeon-ju 54907, Korea;
- Correspondence: ; Tel.: +82-63-250-2582; Fax: +82-63-272-0481
| | - Gyung Ho Chung
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeon-ju 54907, Korea;
| | - Seongil Jo
- Department of Statistics (Institute of Applied Statistics), Chonbuk National University, Jeon-ju 54907, Korea;
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11
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Reproducibility of 3.0T High-Resolution Magnetic Resonance Imaging for the Identification and Quantification of Middle Cerebral Arterial Atherosclerotic Plaques. J Stroke Cerebrovasc Dis 2019; 28:1824-1831. [PMID: 31078388 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/24/2019] [Accepted: 04/14/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the reproducibility of 3.0T high-resolution magnetic resonance imaging for the identification and quantification of atherosclerotic plaques in the middle cerebral artery. METHODS Sixty-nine consecutive patients with ischemic stroke or asymptomatic stenosis (>30%) of the middle cerebral artery underwent 3.0T high-resolution magnetic resonance imaging examinations. Two independent investigators reviewed all images with 1 investigator re-evaluating all images 4 weeks later. Wall characteristics of the middle cerebral artery, including plaque surface morphology, plaque location, plaque components, and burden were identified and measured. RESULTS Intraobserver and interobserver agreement were all substantial in identifying plaque surface irregularity (k = 0.741, 0.555-0.897; k = 0.685, 0.490-0.843; respectively) and intraplaque hemorrhage (k = 0.654, 0.446-0.838; k = 0.605, 0.369-0.792; respectively). Intraobserver agreement was substantial (k = 0.654) and interobserver agreement was moderate (k = 0.553) for the identification of plaque fibrous caps. The total intraobserver and interobserver reproducibility was almost excellent for the identification of plaque position. With regards to vessel area measurement at the site of maximal lumen narrowing, intraobserver and interobserver reproducibility was excellent (intraclass correlation coefficient was 0.886 and 0.885, respectively) and moderate for lumen area at the site of maximal lumen narrowing (intraclass correlation coefficient was 0.695 and 0.558, respectively). In addition, intraobserver and interobserver reproducibility was excellent for vessel area and lumen area measurements at the reference sites. CONCLUSIONS The reproducibility of 3.0T high-resolution magnetic resonance imaging for the identification and quantification of artery wall characteristics was overall acceptable. However, the reliability for lumen area measurement at the maximum narrowing site and identification of the fibrous cap needs to be improved.
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12
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Saba L, Saam T, Jäger HR, Yuan C, Hatsukami TS, Saloner D, Wasserman BA, Bonati LH, Wintermark M. Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol 2019; 18:559-572. [PMID: 30954372 DOI: 10.1016/s1474-4422(19)30035-3] [Citation(s) in RCA: 258] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/15/2023]
Abstract
Stroke represents a massive public health problem. Carotid atherosclerosis plays a fundamental part in the occurence of ischaemic stroke. European and US guidelines for prevention of stroke in patients with carotid plaques are based on quantification of the percentage reduction in luminal diameter due to the atherosclerotic process to select the best therapeutic approach. However, better strategies for prevention of stroke are needed because some subtypes of carotid plaques (eg, vulnerable plaques) can predict the occurrence of stroke independent of the degree of stenosis. Advances in imaging techniques have enabled routine characterisation and detection of the features of carotid plaque vulnerability. Intraplaque haemorrhage is accepted by neurologists and radiologists as one of the features of vulnerable plaques, but other characteristics-eg, plaque volume, neovascularisation, and inflammation-are promising as biomarkers of carotid plaque vulnerability. These biomarkers could change current management strategies based merely on the degree of stenosis.
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Affiliation(s)
- Luca Saba
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy.
| | - Tobias Saam
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany; Radiologisches Zentrum Rosenheim, Rosenheim, Germany
| | - H Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Bruce A Wasserman
- The Russell H Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
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13
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Liu J, Sun J, Balu N, Ferguson MS, Wang J, Kerwin WS, Hippe DS, Wang A, Hatsukami TS, Yuan C. Semiautomatic carotid intraplaque hemorrhage volume measurement using 3D carotid MRI. J Magn Reson Imaging 2019; 50:1055-1062. [PMID: 30861249 DOI: 10.1002/jmri.26698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Presence of intraplaque hemorrhage (IPH) is a known risk factor for stroke and plaque progression. Accurate and reproducible measurement of IPH volume are required for further risk stratification. PURPOSE To develop a semiautomatic method to measure carotid IPH volume. STUDY TYPE Retrospective. POPULATION Patients scheduled for carotid endarterectomy and patients with 16-79% asymptomatic carotid stenosis by ultrasound. FIELD STRENGTH 3T. SEQUENCE Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MRI. ASSESSMENT A semiautomated volumetric measurement of IPH using signal intensity thresholding of 3D SNAP volume was implemented. Fourteen carotid endarterectomy patients were enrolled to determine the signal intensity threshold of IPH using histology. Thirty-three patients with 16-79% asymptomatic stenosis were scanned twice within 1 month to evaluate reproducibility. The normalized SNAP intensity with the highest Youden index for predicting IPH on histology was used for thresholding. Scan-rescan reproducibility of IPH measurement was assessed using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). STATISTICAL TESTS Receiver operating characteristic curve, area under the curve, Cohen's kappa, intraclass correlation coefficient, coefficient of variance (CV), and paired t-test. RESULTS IPH detection by the algorithm had substantial agreement with manual review (kappa: 0.92; 95% confidence interval [CI]: 0.83, 1.00) and moderate agreement with histology (kappa: 0.55; 95% CI: 0.34, 0.68). IPH volume measurements by the algorithm were strongly correlated with histology (Spearman's rho = 0.76, P = 0.002). IPH measurements were also reproducible, with ICCs of 0.86 (95% CI: 0.57, 0.96), 0.77 (95% CI: 0.32, 0.94), and 0.99 (95% CI: 0.93, 1.00) for maximum/mean normalized intensity and IPH volume, respectively. The corresponding CVs were 10.6%, 5.2%, and 11.8%. DATA CONCLUSION IPH volume measurements on SNAP MRI are highly reproducible using semiautomatic measurement. Level of Evidence 2 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2019;50:1055-1062.
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Affiliation(s)
- Jin Liu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Marina S Ferguson
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jinnan Wang
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - William S Kerwin
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Amy Wang
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, Washington, USA.,Department of Radiology, University of Washington, Seattle, Washington, USA
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14
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Chen L, Liu Q, Shi Z, Tian X, Peng W, Lu J. Interstudy reproducibility of dark blood high-resolution MRI in evaluating basilar atherosclerotic plaque at 3 Tesla. ACTA ACUST UNITED AC 2018; 24:237-242. [PMID: 30091714 DOI: 10.5152/dir.2018.17373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the interscan, intraobserver, and interobserver reproducibility of basilar atherosclerotic plaque employing dark blood high-resolution magnetic resonance imaging (HR-MRI) at 3 Tesla. METHODS Sixteen patients (14 males and 2 females) with > 30% basilar stenosis as identified by conventional magnetic resonance angiography were prospectively recruited for scan and rescan examinations on a 3 Tesla MRI system using T2-weighted turbo spin-echo protocol. Two observers independently measured the areas of vessels and lumens. Wall area was derived by subtracting the lumen area from the vessel area. Areas of vessels, lumens and walls were compared for the evaluation of interscan variability of basilar plaque. To assess the intraobserver variability, one observer reevaluated all the images of the first scan after a 4-week interval. RESULTS Fourteen patients were included in the final analysis. No clinically significant difference was observed for interscan, intraobserver, and interobserver measurements. The intraclass correlations for vessel, lumen, and wall areas were excellent and ranged from 0.973 to 0.981 for the interscan measurements, 0.997 to 0.998 for the intraobserver measurements and 0.979 to 0.985 for the interobserver measurements. The coefficients of variation for quantitative basilar morphology measurements were 4.31%-10.35% for the interscan measurements, 1.41%-4.62% for the intraobserver measurements and 3.79%-8.46% for the interobserver measurements. Compared with the interscan and interobserver measurements, narrow intervals of the scatterplots were observed for the intraobserver measurements by Bland-Altman plots. CONCLUSION Basilar atherosclerotic plaque imaging demonstrates excellent reproducibility at 3 Tesla. The study proves that dark blood HR-MRI may serve as a reliable tool for clinical studies focused on the progression and treatment response of basilar atherosclerosis.
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Affiliation(s)
- Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Zhang Shi
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Xia Tian
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
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15
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Zhou C, Yuan C, Li R, Wang W, Li C, Zhao X. Association Between Incomplete Circle of Willis and Carotid Vulnerable Atherosclerotic Plaques. Arterioscler Thromb Vasc Biol 2018; 38:2744-2749. [PMID: 30354232 DOI: 10.1161/atvbaha.118.311797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Carotid high-risk plaque, characterized by intraplaque hemorrhage, fibrous cap rupture, and large lipid-rich necrotic core, is associated with cerebrovascular events. This study sought to investigate the relationship between high-risk carotid plaque and an incomplete circle of Willis (COW).
Approach and Results—
Patients were recruited from a multicenter study, Chinese Atherosclerosis Risk Evaluation (CARE-II) and underwent 3-dimensional time-of-flight magnetic resonance angiography for intracranial arteries and 2-dimensional multicontrast magnetic resonance vessel wall imaging for carotid arteries on a 3.0T magnetic resonance scanner. The integrity of the COW in anterior and posterior portions was evaluated. Characteristics of carotid plaques were assessed. Correlation between incomplete COW and carotid plaque features was determined. Of 482 eligible patients, patients with carotid intraplaque hemorrhage showed significantly higher prevalence of an incomplete anterior COW (52.7% versus 38.5%;
P
=0.022) compared with those without. An incomplete anterior COW was associated with intraplaque hemorrhage before (odds ratio, 1.781; 95% CI, 1.083–2.931;
P
=0.023) and after adjusted for clinical risk factors (odds ratio, 1.945; 95% CI, 1.139–3.321;
P
=0.015). The unilateral carotid artery stenosis showed no correlation with incomplete anterior COW and posterior COW (all
P
>0.025). No significant associations were found between other plaque features and any type of incomplete COW (all
P
>0.025).
Conclusions—
An incomplete COW is independently associated with intraplaque hemorrhage of carotid atherosclerotic plaques.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02017756.
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Affiliation(s)
- Changwu Zhou
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
- Department of Radiology, University of Washington, Seattle (C.Y.)
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
| | - Wei Wang
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China (C.L.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
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16
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Ota H, Tamura H, Itabashi R, Yazawa Y, Nakamura Y, Hisamatsu K, Takamatsu M, Endo H, Niizuma K, Enomoto Y, Nagasaka T, Kajita K, Watanabe M, Yoshimura S, Yuan C. Quantitative characterization of carotid plaque components using MR apparent diffusion coefficients and longitudinal relaxation rates at 3T: A comparison with histology. J Magn Reson Imaging 2018; 48:1657-1667. [DOI: 10.1002/jmri.26216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/22/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology; Tohoku University Hospital; Miyagi Japan
| | - Hajime Tamura
- Division of Medical Physics; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Ryo Itabashi
- Department of Stroke Neurology; Kohnan Hospital; Miyagi Japan
| | - Yukako Yazawa
- Department of Stroke Neurology; Kohnan Hospital; Miyagi Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine; Tohoku Medical and Pharmaceutical University, Miyagi, Japan; Miyagi Japan
| | - Kenji Hisamatsu
- Pathology Division; Gifu University Hospital; Gifu Japan
- Department of Tumor Pathology; Gifu University Graduate School of Medicine; Gifu Japan
| | - Manabu Takamatsu
- Department of Pathology; The Cancer Institute Hospital, Japanese Foundation for Cancer Research; Tokyo Japan
| | - Hidenori Endo
- Department of Neurosurgery; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Yukiko Enomoto
- Department of Neurosurgery; Gifu University Graduate School of Medicine; Gifu Japan
| | - Tatsuo Nagasaka
- Department of Radiological Technology; Tohoku University Hospital; Miyagi Japan
| | - Kimihiro Kajita
- Department of Radiology service; Gifu University Hospital; Gifu Japan
| | - Mika Watanabe
- Department of Pathology; Tohoku University Hospital; Miyagi Japan
| | | | - Chun Yuan
- Department of Radiology; University of Washington; Seattle Washington USA
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17
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Qi H, Sun J, Qiao H, Zhao X, Guo R, Balu N, Yuan C, Chen H. Simultaneous T 1 and T 2 mapping of the carotid plaque (SIMPLE) with T 2 and inversion recovery prepared 3D radial imaging. Magn Reson Med 2018; 80:2598-2608. [PMID: 29802629 DOI: 10.1002/mrm.27361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To propose a technique that can produce different T1 and T2 contrasts in a single scan for simultaneous T1 and T2 mapping of the carotid plaque (SIMPLE). METHODS An interleaved 3D golden angle radial trajectory was used in conjunction with T2 preparation with variable duration (TEprep ) and inversion recovery pulses. Sliding window reconstruction was adopted to reconstruct images at different inversion delay time and TEprep for joint T1 and T2 fitting. In the fitting procedure, a rapid B1 correction method was presented. The accuracy of SIMPLE was investigated in phantom experiments. In vivo scans were performed on 5 healthy volunteers with 2 scans each, and on 5 patients with carotid atherosclerosis. RESULTS The phantom T1 and T2 estimations of SIMPLE agreed well with the standard methods with the percentage difference smaller than 7.1%. In vivo T1 and T2 for normal carotid vessel wall were 1213 ± 48.3 ms and 51.1 ± 1.7 ms, with good interscan repeatability. Alternations of T1 and T2 in plaque regions were in agreement with the conventional multicontrast imaging findings. CONCLUSION The proposed SIMPLE allows simultaneous T1 and T2 mapping of the carotid artery in less than 10 minutes, serving as a quantitative tool with good accuracy and reproducibility for plaque characterization.
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Affiliation(s)
- Haikun Qi
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Rui Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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18
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Change in Carotid Plaque Components. JACC Cardiovasc Imaging 2018; 11:184-192. [DOI: 10.1016/j.jcmg.2016.12.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022]
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19
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Carotid Artery Plaque Vulnerability Assessment Using Noninvasive Ultrasound Elastography: Validation With MRI. AJR Am J Roentgenol 2017. [PMID: 28639927 DOI: 10.2214/ajr.16.17176] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Vulnerable and nonvulnerable carotid artery plaques have different tissue morphology and composition that may affect plaque biomechanics. The objective of this study is to evaluate plaque vulnerability with the use of ultrasound noninvasive vascular elastography (NIVE). MATERIALS AND METHODS Thirty-one patients (mean [± SD] age, 69 ± 7 years) with stenosis of the internal carotid artery of 50% or greater were enrolled in this cross-sectional study. Elastography parameters quantifying axial strain, shear strain, and translation motion were used to characterize carotid artery plaques as nonvulnerable, neovascularized, and vulnerable. Maximum axial strain, cumulated axial strain, mean shear strain, cumulated shear strain, cumulated axial translation, and cumulated lateral translations were measured. Cumulated measurements were summed over a cardiac cycle. The ratio of cumulated axial strain to cumulated axial translation was also evaluated. The reference method used to characterize plaques was high-resolution MRI. RESULTS According to MRI, seven plaques were vulnerable, 12 were nonvulnerable without neovascularity, and 12 were nonvulnerable with neovascularity (a precursor of vulnerability). The two parameters cumulated axial translation and the ratio of cumulated axial strain to cumulated axial translation could discriminate between nonvulnerable plaques and vulnerable plaques or determine the presence of neovascularity in nonvulnerable plaques (which was also possible with the mean shear strain parameter). All parameters differed between the non-vulnerable plaque group and the group that combined vulnerable plaques and plaques with neovascularity. The most discriminating parameter for the detection of vulnerable neovascularized plaques was the ratio of cumulated axial strain to cumulated axial translation (expressed as percentage per millimeter) (mean ratio, 39.30%/mm ± 12.80%/mm for nonvulnerable plaques without neovascularity vs 63.79%/mm ± 17.59%/mm for vulnerable plaques and nonvulnerable plaques with neovascularity, p = 0.002), giving an AUC value of 0.886. CONCLUSION The imaging parameters cumulated axial translation and the ratio of cumulated axial strain to cumulated axial translation, as computed using NIVE, were able to discriminate vulnerable carotid artery plaques characterized by MRI from nonvulnerable carotid artery plaques. Consideration of neovascularized plaques improved the performance of NIVE. NIVE may be a valuable alternative to MRI for carotid artery plaque assessment.
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20
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Skagen K, Skjelland M, Zamani M, Russell D. Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment. Croat Med J 2017; 57:311-20. [PMID: 27586546 PMCID: PMC5048225 DOI: 10.3325/cmj.2016.57.311] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cardiovascular disease is estimated to be the leading cause of death, globally causing 14 million deaths each year. Stroke remains a massive public health problem and there is an increasing need for better strategies for the prevention and treatment of this disease. At least 20% of ischemic strokes are thromboembolic in nature, caused by a thromboembolism from an atherosclerotic plaque at the carotid bifurcation or the internal carotid artery. Current clinical guidelines for both primary and secondary prevention of stroke in patients with carotid stenosis caused by atherosclerotic plaques remain reliant on general patient characteristics (traditional risk factors for stroke) and static measures of the degree of artery stenosis. Patients with similar traditional risk factors, however, have been found to have different risk of stroke, and it has in recent years become increasingly clear that the degree of artery stenosis alone is not the best estimation of stroke risk. There is a need for new methods for the assessment of stroke risk to improve risk prediction for the individual patient. This review aims to give an overview of new methods available for the identification of carotid plaque instability and the assessment of stroke risk.
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Affiliation(s)
- Karolina Skagen
- Karolina Skagen, Oslo University Hospital, Rikshospitalet, Nevrologisk poliklinikk, Postbox 4950 Nydalen, 0424 Oslo, Norway,
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21
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Liem MI, Kennedy F, Bonati LH, van der Lugt A, Coolen BF, Nederveen AJ, Jager HR, Brown MM, Nederkoorn PJ. Investigations of Carotid Stenosis to Identify Vulnerable Atherosclerotic Plaque and Determine Individual Stroke Risk. Circ J 2017; 81:1246-1253. [DOI: 10.1253/circj.cj-16-1284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Fiona Kennedy
- UCL Stroke Research Centre, Institute of Neurology, University College London
| | | | | | | | | | - Hans R. Jager
- UCL Stroke Research Centre, Institute of Neurology, University College London
| | - Martin M. Brown
- UCL Stroke Research Centre, Institute of Neurology, University College London
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22
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A comparison study between 3D T2-weighted SPACE and conventional 2D T2-weighted turbo spin echo in assessment of carotid plaque. Int J Cardiovasc Imaging 2016; 33:395-400. [DOI: 10.1007/s10554-016-1017-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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23
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Liu J, Balu N, Hippe DS, Ferguson MS, Martinez-Malo V, DeMarco JK, Zhu DC, Ota H, Sun J, Xu D, Kerwin WS, Hatsukami TS, Yuan C. Semi-automatic carotid intraplaque hemorrhage detection and quantification on Magnetization-Prepared Rapid Acquisition Gradient-Echo (MP-RAGE) with optimized threshold selection. J Cardiovasc Magn Reson 2016; 18:41. [PMID: 27430263 PMCID: PMC4950626 DOI: 10.1186/s12968-016-0260-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraplaque hemorrhage (IPH) is associated with atherosclerosis progression and subsequent cardiovascular events. We sought to develop a semi-automatic method with an optimized threshold for carotid IPH detection and quantification on MP-RAGE images using matched histology as the gold standard. METHODS Fourteen patients scheduled for carotid endarterectomy underwent 3D MP-RAGE cardiovascular magnetic resonance (CMR) preoperatively. Presence and area of IPH were recorded using histology. Presence and area of IPH were also recorded on CMR based on intensity thresholding using three references for intensity normalization: the sternocleidomastoid muscle (SCM), the adjacent muscle and the automatically generated local median value. The optimized intensity thresholds were obtained by maximizing the Youden's index for IPH detection. Using leave-one-out cross validation, the sensitivity and specificity for IPH detection based on our proposed semi-automatic method and the agreement with histology on IPH area quantification were evaluated. RESULTS The optimized intensity thresholds for IPH detection were 1.0 times the SCM intensity, 1.6 times the adjacent muscle intensity and 2.2 times the median intensity. Using the semi-automatic method with the optimized intensity threshold, the following IPH detection and quantification performance was obtained: sensitivities up to 59, 68 and 80 %; specificities up to 85, 74 and 79 %; Pearson's correlation coefficients (IPH area measurement) up to 0.76, 0.93 and 0.90, respectively, using SCM, the adjacent muscle and the local median value for intensity normalization, after heavily calcified and small IPH were excluded. CONCLUSIONS A semi-automatic method with good performance on IPH detection and quantification can be obtained in MP-RAGE CMR, using an optimized intensity threshold comparing to the adjacent muscle. The automatically generated reference of local median value provides comparable performance and may be particularly useful for developing automatic classifiers. Use of the SCM intensity as reference is not recommended without coil sensitivity correction when surface coils are used.
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Affiliation(s)
- Jin Liu
- />University of Washington, Seattle, WA USA
| | | | | | | | | | - J. Kevin DeMarco
- />Walter Reed National Military Medical Center, Bethesda, MD USA
| | - David C. Zhu
- />Michigan State University, East Lansing, MI USA
| | | | - Jie Sun
- />University of Washington, Seattle, WA USA
| | | | | | | | - Chun Yuan
- />University of Washington, Seattle, WA USA
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24
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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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Teng Z, Feng J, Zhang Y, Sutcliffe MPF, Huang Y, Brown AJ, Jing Z, Lu Q, Gillard JH. A uni-extension study on the ultimate material strength and extreme extensibility of atherosclerotic tissue in human carotid plaques. J Biomech 2015; 48:3859-67. [PMID: 26472304 PMCID: PMC4655866 DOI: 10.1016/j.jbiomech.2015.09.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/16/2015] [Accepted: 09/24/2015] [Indexed: 12/26/2022]
Abstract
Atherosclerotic plaque rupture occurs when mechanical loading exceeds its material strength. Mechanical analysis has been shown to be complementary to the morphology and composition for assessing vulnerability. However, strength and stretch thresholds for mechanics-based assessment are currently lacking. This study aims to quantify the ultimate material strength and extreme extensibility of atherosclerotic components from human carotid plaques. Tissue strips of fibrous cap, media, lipid core and intraplaque hemorrhage/thrombus were obtained from 21 carotid endarterectomy samples of symptomatic patients. Uni-extension test with tissue strips was performed until they broke or slid. The Cauchy stress and stretch ratio at the peak loading of strips broken about 2 mm away from the clamp were used to characterize their ultimate strength and extensibility. Results obtained indicated that ultimate strength of fibrous cap and media were 158.3 [72.1, 259.3] kPa (Median [Inter quartile range]) and 247.6 [169.0, 419.9] kPa, respectively; those of lipid and intraplaque hemorrhage/thrombus were 68.8 [48.5, 86.6] kPa and 83.0 [52.1, 124.9] kPa, respectively. The extensibility of each tissue type were: fibrous cap – 1.18 [1.10, 1.27]; media – 1.21 [1.17, 1.32]; lipid – 1.25 [1.11, 1.30] and intraplaque hemorrhage/thrombus – 1.20 [1.17, 1.44]. Overall, the strength of fibrous cap and media were comparable and so were lipid and intraplaque hemorrhage/thrombus. Both fibrous cap and media were significantly stronger than either lipid or intraplaque hemorrhage/thrombus. All atherosclerotic components had similar extensibility. Moreover, fibrous cap strength in the proximal region (closer to the heart) was lower than that of the distal. These results are helpful in understanding the material behavior of atherosclerotic plaques.
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Affiliation(s)
- Zhongzhao Teng
- Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Yongxue Zhang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | | | - Yuan Huang
- Department of Radiology, University of Cambridge, UK
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, UK
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
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26
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Choi YJ, Jung SC, Lee DH. Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries. J Stroke 2015; 17:238-55. [PMID: 26437991 PMCID: PMC4635720 DOI: 10.5853/jos.2015.17.3.238] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 08/19/2015] [Accepted: 08/31/2015] [Indexed: 12/05/2022] Open
Abstract
Vessel wall imaging can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries beyond the simple luminal changes that can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke and the neurological adverse effects of atherosclerosis. Various techniques for vessel wall imaging have been developed and introduced to differentiate and analyze atherosclerotic plaques in the cervical carotid artery. High-resolution magnetic resonance imaging (HR-MRI) is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome can also be diagnosed and differentiated by using HR-MRI. Here, we review the radiologic features of intracranial artery disease and cervical carotid artery atherosclerosis on HR-MRI and various other vessel wall imaging techniques (e.g., ultrasound, computed tomography, magnetic resonance, and positron emission tomography-computed tomography).
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Affiliation(s)
- Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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In vivo semi-automatic segmentation of multicontrast cardiovascular magnetic resonance for prospective cohort studies on plaque tissue composition: initial experience. Int J Cardiovasc Imaging 2015; 32:73-81. [PMID: 26169389 DOI: 10.1007/s10554-015-0704-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
Automatic in vivo segmentation of multicontrast (multisequence) carotid magnetic resonance for plaque composition has been proposed as a substitute for manual review to save time and reduce inter-reader variability in large-scale or multicenter studies. Using serial images from a prospective longitudinal study, we sought to compare a semi-automatic approach versus expert human reading in analyzing carotid atherosclerosis progression. Baseline and 6-month follow-up multicontrast carotid images from 59 asymptomatic subjects with 16-79 % carotid stenosis were reviewed by both trained radiologists with 2-4 years of specialized experience in carotid plaque characterization with MRI and a previously reported automatic atherosclerotic plaque segmentation algorithm, referred to as morphology-enhanced probabilistic plaque segmentation (MEPPS). Agreement on measurements from individual time points, as well as on compositional changes, was assessed using the intraclass correlation coefficient (ICC). There was good agreement between manual and MEPPS reviews on individual time points for calcification (CA) (area: ICC; 0.85-0.91; volume: ICC; 0.92-0.95) and lipid-rich necrotic core (LRNC) (area: ICC; 0.78-0.82; volume: ICC; 0.84-0.86). For compositional changes, agreement was good for CA volume change (ICC; 0.78) and moderate for LRNC volume change (ICC; 0.49). Factors associated with LRNC progression as detected by MEPPS review included intraplaque hemorrhage (positive association) and reduction in low-density lipoprotein cholesterol (negative association), which were consistent with previous findings from manual review. Automatic classifier for plaque composition produced results similar to expert manual review in a prospective serial MRI study of carotid atherosclerosis progression. Such automatic classification tools may be beneficial in large-scale multicenter studies by reducing image analysis time and avoiding bias between human reviewers.
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28
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Gao S, van 't Klooster R, van Wijk DF, Nederveen AJ, Lelieveldt BPF, van der Geest RJ. Repeatability of in vivo quantification of atherosclerotic carotid artery plaque components by supervised multispectral classification. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2015; 28:535-45. [PMID: 26162931 PMCID: PMC4651977 DOI: 10.1007/s10334-015-0495-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/24/2015] [Accepted: 06/29/2015] [Indexed: 12/17/2022]
Abstract
Objective
To evaluate the agreement and scan–rescan repeatability of automated and manual plaque segmentation for the quantification of in vivo carotid artery plaque components from multi-contrast MRI. Materials and methods Twenty-three patients with 30–70 % stenosis underwent two 3T MR carotid vessel wall exams within a 1 month interval. T1w, T2w, PDw and TOF images were acquired around the region of maximum vessel narrowing. Manual delineation of the vessel wall and plaque components (lipid, calcification, loose matrix) by an experienced observer provided the reference standard for training and evaluation of an automated plaque classifier. Areas of different plaque components and fibrous tissue were quantified and compared between segmentation methods and scan sessions. Results In total, 304 slices from 23 patients were included in the segmentation experiment, in which 144 aligned slice pairs were available for repeatability analysis. The correlation between manual and automated segmented areas was 0.35 for lipid, 0.66 for calcification, 0.50 for loose matrix and 0.82 for fibrous tissue. For the comparison between scan sessions, the coefficient of repeatability of area measurement obtained by automated segmentation was lower than by manual delineation for lipid (9.9 vs. 17.1 mm2), loose matrix (13.8 vs. 21.2 mm2) and fibrous tissue (24.6 vs. 35.0 mm2), and was similar for calcification (20.0 vs. 17.6 mm2). Conclusion Application of an automated classifier for segmentation of carotid vessel wall plaque components from in vivo MRI results in improved scan–rescan repeatability compared to manual analysis.
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Affiliation(s)
- Shan Gao
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Ronald van 't Klooster
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Diederik F van Wijk
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Boudewijn P F Lelieveldt
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rob J van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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29
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Isabel C, Lecler A, Turc G, Naggara O, Schmitt E, Belkacem S, Oppenheim C, Touzé E. Relationship between watershed infarcts and recent intra plaque haemorrhage in carotid atherosclerotic plaque. PLoS One 2014; 9:e108712. [PMID: 25272160 PMCID: PMC4182714 DOI: 10.1371/journal.pone.0108712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/28/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Watershed infarcts (WSI) are thought to result from hemodynamic mechanism, but studies have suggested that microemboli from unstable carotid plaques may distribute preferentially in watershed areas, i.e., between two cerebral arterial territories. Intraplaque haemorrhage (IPH) is an emerging marker of plaque instability and microembolic activity. We assessed the association between WSI and IPH in patients with recently symptomatic moderate carotid stenosis. Methods and Results We selected 65 patients with symptomatic moderate (median NASCET degree of stenosis = 31%) carotid stenosis and brain infarct on Diffusion-Weighted Imaging (DWI) on Magnetic Resonance Imaging (MRI) from a multicentre prospective study. Fourteen (22%) had WSI (cortical, n = 8; internal, n = 4; cortical and internal, n = 2). Patients with WSI were more likely to have IPH than those without WSI although the difference was not significant (50% vs. 31%, OR = 2.19; 95% CI, 0.66–7.29; P = 0.20). After adjustment for degree of stenosis, age and gender, the results remained unchanged. Conclusion About one in fifth of brain infarcts occurring in patients with moderate carotid stenosis were distributed in watershed areas. Albeit not significant, an association between IPH - more generally plaque component - and WSI, still remains possible.
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Affiliation(s)
- Clothilde Isabel
- Université Paris Descartes, Service de Neurologie, Inserm U894, Paris, France
| | - Augustin Lecler
- Université Paris Descartes, Service de Neuroradiologie, Inserm U894, Paris, France
| | - Guillaume Turc
- Université Paris Descartes, Service de Neurologie, Inserm U894, Paris, France
| | - Olivier Naggara
- Université Paris Descartes, Service de Neuroradiologie, Inserm U894, Paris, France
| | | | - Samia Belkacem
- Service de neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Catherine Oppenheim
- Université Paris Descartes, Service de Neuroradiologie, Inserm U894, Paris, France
| | - Emmanuel Touzé
- Université Paris Descartes, Service de Neurologie, Inserm U894, Paris, France
- * E-mail:
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30
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Sun J, Zhao XQ, Balu N, Hippe DS, Hatsukami TS, Isquith DA, Yamada K, Neradilek MB, Cantón G, Xue Y, Fleg JL, Desvigne-Nickens P, Klimas MT, Padley RJ, Vassileva MT, Wyman BT, Yuan C. Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study. Int J Cardiovasc Imaging 2014; 31:95-103. [PMID: 25216871 DOI: 10.1007/s10554-014-0532-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98-0.99) and compositional (ICC range 0.88-0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5-4.9 % for morphology, 36-44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican St Brotman 127, Seattle, WA, 98109, USA,
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31
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Fan Z, Yu W, Xie Y, Dong L, Yang L, Wang Z, Conte AH, Bi X, An J, Zhang T, Laub G, Shah PK, Zhang Z, Li D. Multi-contrast atherosclerosis characterization (MATCH) of carotid plaque with a single 5-min scan: technical development and clinical feasibility. J Cardiovasc Magn Reson 2014; 16:53. [PMID: 25184808 PMCID: PMC4222690 DOI: 10.1186/s12968-014-0053-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/08/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multi-contrast weighted imaging is a commonly used cardiovascular magnetic resonance (CMR) protocol for characterization of carotid plaque composition. However, this approach is limited in several aspects including low slice resolution, long scan time, image mis-registration, and complex image interpretation. In this work, a 3D CMR technique, named Multi-contrast Atherosclerosis Characterization (MATCH), was developed to mitigate the above limitations. METHODS MATCH employs a 3D spoiled segmented fast low angle shot readout to acquire data with three different contrast weightings in an interleaved fashion. The inherently co-registered image sets, hyper T1-weighting, gray blood, and T2-weighting, are used to detect intra-plaque hemorrhage (IPH), calcification (CA), lipid-rich necrotic core (LRNC), and loose-matrix (LM). The MATCH sequence was optimized by computer simulations and testing on four healthy volunteers and then evaluated in a pilot study of six patients with carotid plaque, using the conventional multi-contrast protocol as a reference. RESULTS On MATCH images, the major plaque components were easy to identify. Spatial co-registration between the three image sets with MATCH was particularly helpful for the reviewer to discern co-existent components in an image and appreciate their spatial relation. Based on Cohen's kappa tests, moderate to excellent agreement in the image-based or artery-based component detection between the two protocols was obtained for LRNC, IPH, CA, and LM, respectively. Compared with the conventional multi-contrast protocol, the MATCH protocol yield significantly higher signal contrast ratio for IPH (3.1±1.3 vs. 0.4±0.3, p<0.001) and CA (1.6±1.5 vs. 0.7±0.6, p=0.012) with respect to the vessel wall. CONCLUSIONS To the best of our knowledge, the proposed MATCH sequence is the first 3D CMR technique that acquires spatially co-registered multi-contrast image sets in a single scan for characterization of carotid plaque composition. Our pilot clinical study suggests that the MATCH-based protocol may outperform the conventional multi-contrast protocol in several respects. With further technical improvements and large-scale clinical validation, MATCH has the potential to become a CMR method for assessing the risk of plaque disruption in a clinical workup.
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Affiliation(s)
- Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Wei Yu
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Li Dong
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lixin Yang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhanhong Wang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA
| | - Jing An
- MR Collaborations NE Asia, Siemens Healthcare, Beijing, China
| | - Tianjing Zhang
- MR Collaborations NE Asia, Siemens Healthcare, Beijing, China
| | - Gerhard Laub
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA
| | - Prediman Krishan Shah
- Oppenheimer Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Atherosclerosis Prevention and Management Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zhaoqi Zhang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
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Watanabe Y, Nagayama M, Sakata A, Okumura A, Amoh Y, Ishimori T, Nakashita S, Dodo Y. Evaluation of Fibrous Cap Rupture of Atherosclerotic Carotid Plaque with Thin-Slice Source Images of Time-of-Flight MR Angiography. Ann Vasc Dis 2014; 7:127-33. [PMID: 24995056 DOI: 10.3400/avd.oa.13-00101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/08/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the ability of source image of time-of-flight magnetic resonance angiography (TOF-MRA) in the detection of fibrous cap rupture of atherosclerotic carotid plaques. MATERIALS AND METHODS From the database of radiological information in our hospital, 35 patients who underwent carotid MR imaging and subsequent carotid endoarterectomy within 2 weeks were included in this retrospective study. MR imaging included thin-slice time-of-flight MR angiography, black-blood T1- and T2-weighted imaging. Sensitivity, specificity and accuracy were calculated for the detection of fibrous cap rupture with source image of TOF-MRA. The Cohen k coefficient was also calculated to quantify the degree of concordance of source image of TOF-MRA with histopathological data. RESULTS Sensitivity, specificity and accuracy in the detection of fibrous cap rupture were 90% (95%CI: 81-98), 69% (95%CI: 56-82) and 79% (95%CI: 71-87) with a k value of 0.59. The false positives (n = 15) were caused by partial-volume averaging between fibrous cap and lumen at the shoulder of carotid plaque. The false negatives (n = 5) were underestimated as partial thinning of fibrous cap. CONCLUSION Source image of TOF-MRA can be useful in the detection of fibrous cap rupture with high sensitivity, but further technical improvement should be necessary to overcome shortcomings causing image degradation.
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Affiliation(s)
- Yuji Watanabe
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masako Nagayama
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akihiko Sakata
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Okumura
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshiki Amoh
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takayoshi Ishimori
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Satoru Nakashita
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshihiro Dodo
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Patel V, Dahl JJ, Bradway DP, Doherty JR, Lee SY, Smith SW. Acoustic radiation force impulse imaging (ARFI) on an IVUS circular array. ULTRASONIC IMAGING 2014; 36:98-111. [PMID: 24554291 PMCID: PMC4176895 DOI: 10.1177/0161734613511595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Our long-term goal is the detection and characterization of vulnerable plaque in the coronary arteries of the heart using intravascular ultrasound (IVUS) catheters. Vulnerable plaque, characterized by a thin fibrous cap and a soft, lipid-rich necrotic core is a precursor to heart attack and stroke. Early detection of such plaques may potentially alter the course of treatment of the patient to prevent ischemic events. We have previously described the characterization of carotid plaques using external linear arrays operating at 9 MHz. In addition, we previously modified circular array IVUS catheters by short-circuiting several neighboring elements to produce fixed beamwidths for intravascular hyperthermia applications. In this paper, we modified Volcano Visions 8.2 French, 9 MHz catheters and Volcano Platinum 3.5 French, 20 MHz catheters by short-circuiting portions of the array for acoustic radiation force impulse imaging (ARFI) applications. The catheters had an effective transmit aperture size of 2 mm and 1.5 mm, respectively. The catheters were connected to a Verasonics scanner and driven with pushing pulses of 180 V p-p to acquire ARFI data from a soft gel phantom with a Young's modulus of 2.9 kPa. The dynamic response of the tissue-mimicking material demonstrates a typical ARFI motion of 1 to 2 microns as the gel phantom displaces away and recovers back to its normal position. The hardware modifications applied to our IVUS catheters mimic potential beamforming modifications that could be implemented on IVUS scanners. Our results demonstrate that the generation of radiation force from IVUS catheters and the development of intravascular ARFI may be feasible.
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Affiliation(s)
- Vivek Patel
- 1Department of Biomedical Engineering, Duke University, Durham, NC, USA
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Mihai G, Varghese J, Lu B, Zhu H, Simonetti OP, Rajagopalan S. Reproducibility of thoracic and abdominal aortic wall measurements with three-dimensional, variable flip angle (SPACE) MRI. J Magn Reson Imaging 2013; 41:202-12. [DOI: 10.1002/jmri.24545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/15/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Georgeta Mihai
- Department of Radiology; The Ohio State University; Columbus Ohio USA
| | - Juliet Varghese
- The Dorothy M. Davis Heart and Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University; Columbus Ohio USA
| | - Bo Lu
- College of Public Health; The Ohio State University; Columbus Ohio USA
| | - Hong Zhu
- Department of Clinical Sciences Division of Biostatistics; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Orlando P. Simonetti
- Department of Radiology; The Ohio State University; Columbus Ohio USA
- The Dorothy M. Davis Heart and Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University; Columbus Ohio USA
| | - Sanjay Rajagopalan
- The Dorothy M. Davis Heart and Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University; Columbus Ohio USA
- Department of Medicine Division of Cardiology; The University of Maryland; Baltimore Maryland USA
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35
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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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36
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Yang WQ, Huang B, Liu XT, Liu HJ, Li PJ, Zhu WZ. Reproducibility of high-resolution MRI for the middle cerebral artery plaque at 3T. Eur J Radiol 2013; 83:e49-55. [PMID: 24189388 DOI: 10.1016/j.ejrad.2013.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/08/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the reproducibility of HR-MRI for the identification of MCA atherosclerotic plaque components and quantification of stenosis. MATERIALS AND METHODS Seventy-three consecutive subjects who initially had ischemic stroke or asymptomatic MCA stenosis (>50%) were enrolled in the study. All subjects were scanned using 3.0T MRI. Two independent readers reviewed all images and one reader reevaluated all images four weeks later. The tissue components of plaques were analyzed qualitatively and the vessels were quantitative measured. RESULTS HR-MRI displayed the artery wall and lumen clearly. The intra-observer reproducibility was excellent for the identification of plaques (kappa [κ]=0.96; 95% CI: 0.83-1.04) and contrast enhancement (κ=0.89; 0.78-0.95); it was substantial for intra-plaque hemorrhage (κ=0.79; 0.57-0.96) and the fibrous cap (κ=0.65; 0.42-0.86). The inter-observer reproducibility was excellent for plaques (κ=0.92; 0.73-1.06), substantial for contrast enhancement (κ=0.80; 0.65-0.93), intra-plaque hemorrhage (κ=0.68; 0.47-0.92) and moderate for the fibrous cap (κ=0.58; 0.44-0.79). Both intra-observer and inter-observer reproducibility were excellent for quantitative vessel, lumen and wall measurements with intraclass correlation coefficients ranging from 0.91 to 0.97 and 0.87 to 0.96, respectively. However, vessel and wall areas and the intervals defined by the Bland-Altman plots were wide in comparison to the mean. CONCLUSIONS The identification of MCA atherosclerotic plaque components and the quantification of vessel and lumen measurements are reproducible. The reproducibility is overall acceptable. HR-MRI may provide a useful tool for clinical risk evaluation in MCA atherosclerosis.
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Affiliation(s)
- Wan-Qun Yang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080, China
| | - Biao Huang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080, China.
| | - Xin-Tong Liu
- Department of Neurology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080, China
| | - Hong-Jun Liu
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080, China
| | - Pei-Jun Li
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, Guangdong 510080, China
| | - Wen-Zhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430030, China.
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37
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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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38
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High-resolution magnetic resonance imaging of carotid atherosclerosis identifies vulnerable carotid plaques. J Vasc Surg 2013; 57:1046-1051.e2. [PMID: 23375613 DOI: 10.1016/j.jvs.2012.10.088] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/05/2012] [Accepted: 10/14/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Carotid magnetic resonance imaging (MRI) may be a useful tool in characterizing carotid plaque vulnerability, but large studies are still lacking. The purpose of this study was to assess carotid MRI features of vulnerable plaque in a large study and the changes in carotid plaque morphology with respect to time since the neurological event. METHODS We included 161 patients with carotid plaque more than 3 mm thick. All patients underwent carotid MRI to obtain 3-T high-resolution magnetic resonance sequences. Large lipid core, intraplaque hemorrhage (IPH), fibrous cap rupture (FCR), and gadolinium enhancement (GE) were assessed and classified as present or absent. Prevalences of these features were then compared between symptomatic and asymptomatic patients and time since stroke. RESULTS Seven patients were excluded because of poor image quality. Of the remaining 154 patients, 52 were symptomatic and 102 were asymptomatic. The prevalences of IPH (39 vs 16%; P = .002), FCR (30 vs 9%; P = .001), and GE (75 vs 55%; P = .015) were significantly higher in symptomatic than asymptomatic patients. After multivariate analysis, the prevalences of IPH (odds ratio, 2.6; P = .023) and FCR (odds ratio, 2.8; P = .038) were still significantly higher. The prevalence of IPH was significantly higher in symptomatic patients with plaque regardless of the time since the neurological event. For FCR, the difference between symptomatic and asymptomatic patients was significant only during the first 15 days after the neurological event. CONCLUSIONS Carotid MRI can identify plaque features that are associated with symptomatic presentation and may be indicative of plaque vulnerability. These features may ultimately be used in the management of extracranial carotid stenosis.
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39
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High-Risk Plaque for Carotid Artery Stenting Evaluated With 3-Dimensional T1-Weighted Gradient Echo Sequence. Stroke 2013; 44:105-10. [DOI: 10.1161/strokeaha.112.663138] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Machet A, Fonseca A, Oppenheim C, Touzé E, Meder JF, Mas JL, Naggara O. Does Anticoagulation Promote Mural Hematoma Growth or Delayed Occlusion in Spontaneous Cervical Artery Dissections. Cerebrovasc Dis 2013; 35:175-81. [DOI: 10.1159/000346592] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/18/2012] [Indexed: 11/19/2022] Open
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41
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Doherty JR, Dumont DM, Trahey GE, Palmeri ML. Acoustic radiation force impulse imaging of vulnerable plaques: a finite element method parametric analysis. J Biomech 2012; 46:83-90. [PMID: 23122224 DOI: 10.1016/j.jbiomech.2012.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/22/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
Abstract
Plaque rupture is the most common cause of complications such as stroke and coronary heart failure. Recent histopathological evidence suggests that several plaque features, including a large lipid core and a thin fibrous cap, are associated with plaques most at risk for rupture. Acoustic Radiation Force Impulse (ARFI) imaging, a recently developed ultrasound-based elasticity imaging technique, shows promise for imaging these features noninvasively. Clinically, this could be used to distinguish vulnerable plaques, for which surgical intervention may be required, from those less prone to rupture. In this study, a parametric analysis using Finite Element Method (FEM) models was performed to simulate ARFI imaging of five different carotid artery plaques across a wide range of material properties. It was demonstrated that ARFI imaging could resolve the softer lipid pool from the surrounding, stiffer media and fibrous cap and was most dependent upon the stiffness of the lipid pool component. Stress concentrations due to an ARFI excitation were located in the media and fibrous cap components. In all cases, the maximum Von Mises stress was<1.2 kPa. In comparing these results with others investigating plaque rupture, it is concluded that while the mechanisms may be different, the Von Mises stresses imposed by ARFI imaging are orders of magnitude lower than the stresses associated with blood pressure.
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Affiliation(s)
- Joshua R Doherty
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
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42
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Millon A, Boussel L, Brevet M, Mathevet JL, Canet-Soulas E, Mory C, Scoazec JY, Douek P. Clinical and histological significance of gadolinium enhancement in carotid atherosclerotic plaque. Stroke 2012; 43:3023-8. [PMID: 22923447 DOI: 10.1161/strokeaha.112.662692] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although the ability of MRI to investigate carotid plaque composition is well established, the mechanism and the significance of plaque gadolinium (Gd) enhancement remain unknown. We evaluated clinical and histological significance of Gd enhancement of carotid plaque in patients undergoing endarterectomy for carotid stenosis. METHODS Sixty-nine patients scheduled for a carotid endarterectomy prospectively underwent a 3-T MRI. Carotid plaque enhancement was assessed on T1-weighted images performed before and 5 minutes after Gd injection. Enhancement was recorded according to its localization. Histological analysis was performed of the entire plaque and of the area with matched contrast enhancement on MR images. RESULTS Gd enhancement was observed in 59% patients. Three types of carotid plaques were identified depending on enhancement location (shoulder region, shoulder and fibrous cap, and central in the plaque). Fibrous cap rupture, intraplaque hemorrhage, and plaque Gd enhancement was significantly more frequent in symptomatic than in asymptomatic patients (P=0.043, P<0.0001, and P=0.034, respectively). After histological analysis, Gd enhancement was significantly associated with vulnerable plaque (American Heart Association VI, P=0.006), neovascularization (P<0.0001), macrophages (P=0.030), and loose fibrosis (P<0.0001). Prevalence of neovessels, macrophages, and loose fibrosis in the area of Gd enhancement was 97%, 87%, and 80%, respectively, and was different depending on the enhancement location in the plaque. Fibrous cap status and composition were different depending on the type of plaque. CONCLUSIONS Gd enhancement of carotid plaque is associated with vulnerable plaque phenotypes and related to an inflammatory process.
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Affiliation(s)
- Antoine Millon
- Department of Vascular Surgery, University Hospital of Lyon, Lyon University, Lyon, France.
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43
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Sakellarios AI, Stefanou K, Siogkas P, Tsakanikas VD, Bourantas CV, Athanasiou L, Exarchos TP, Fotiou E, Naka KK, Papafaklis MI, Patterson AJ, Young VEL, Gillard JH, Michalis LK, Fotiadis DI. Novel methodology for 3D reconstruction of carotid arteries and plaque characterization based upon magnetic resonance imaging carotid angiography data. Magn Reson Imaging 2012; 30:1068-82. [PMID: 22617149 DOI: 10.1016/j.mri.2012.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 12/20/2011] [Accepted: 03/08/2012] [Indexed: 01/24/2023]
Abstract
In this study, we present a novel methodology that allows reliable segmentation of the magnetic resonance images (MRIs) for accurate fully automated three-dimensional (3D) reconstruction of the carotid arteries and semiautomated characterization of plaque type. Our approach uses active contours to detect the luminal borders in the time-of-flight images and the outer vessel wall borders in the T(1)-weighted images. The methodology incorporates the connecting components theory for the automated identification of the bifurcation region and a knowledge-based algorithm for the accurate characterization of the plaque components. The proposed segmentation method was validated in randomly selected MRI frames analyzed offline by two expert observers. The interobserver variability of the method for the lumen and outer vessel wall was -1.60%±6.70% and 0.56%±6.28%, respectively, while the Williams Index for all metrics was close to unity. The methodology implemented to identify the composition of the plaque was also validated in 591 images acquired from 24 patients. The obtained Cohen's k was 0.68 (0.60-0.76) for lipid plaques, while the time needed to process an MRI sequence for 3D reconstruction was only 30 s. The obtained results indicate that the proposed methodology allows reliable and automated detection of the luminal and vessel wall borders and fast and accurate characterization of plaque type in carotid MRI sequences. These features render the currently presented methodology a useful tool in the clinical and research arena.
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Affiliation(s)
- Antonis I Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
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44
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van 't Klooster R, Naggara O, Marsico R, Reiber JHC, Meder JF, van der Geest RJ, Touzé E, Oppenheim C. Automated versus manual in vivo segmentation of carotid plaque MRI. AJNR Am J Neuroradiol 2012; 33:1621-7. [PMID: 22442043 DOI: 10.3174/ajnr.a3028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Automatically identifying carotid plaque composition using MR imaging remains a challenging task in vivo. The purpose of our study was to compare the detection and quantification of carotid artery atherosclerotic plaque components based on in vivo MR imaging data using manual and automated segmentation. MATERIALS AND METHODS Sixty patients from a multicenter study were split into a training group (20 patients) and a study group (40 patients). Each MR imaging study consisted of 4 high-resolution carotid wall sequences (T1, T2, PDw, TOF). Manual segmentation was performed by delineation of the vessel wall and different plaque components. Automated segmentation was performed in the study group by a supervised classifier trained on images from the training group of patients. RESULTS For the detection of plaque components, the agreement between the visual and automated analysis was moderate for calcifications (κ = 0.59, CI 95% [0.36-0.82]) and good for hemorrhage (0.65 [0.42-0.88]) and lipids (0.65 [0.03-1.27]). For quantification of plaque volumes, the intraclass correlation was high for hemorrhage (0.80 [0.54-0.92]) and fibrous tissue (0.80 [0.65-0.89]), good for lipids (0.65 [0.43-0.80]), and poor for calcifications. CONCLUSIONS In 40 patients with carotid stenosis, our results indicated that it was possible to automatically detect carotid plaque components with substantial or good agreement with visual identification, and that the volumes obtained manually and automatically were reasonably consistent for hemorrhage and lipids but not for calcium.
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Affiliation(s)
- R van 't Klooster
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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45
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Xu WH, Li ML, Gao S, Ni J, Yao M, Zhou LX, Peng B, Feng F, Jin ZY, Cui LY. Middle cerebral artery intraplaque hemorrhage: Prevalence and Clinical Relevance. Ann Neurol 2012; 71:195-8. [PMID: 22367991 DOI: 10.1002/ana.22626] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wei-Hai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Turc G, Oppenheim C, Naggara O, Eker OF, Calvet D, Lacour JC, Crozier S, Guegan-Massardier E, Hénon H, Neau JP, Toussaint JF, Mas JL, Méder JF, Touzé E. Relationships Between Recent Intraplaque Hemorrhage and Stroke Risk Factors in Patients With Carotid Stenosis. Arterioscler Thromb Vasc Biol 2012; 32:492-9. [DOI: 10.1161/atvbaha.111.239335] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Intraplaque hemorrhage (IPH) is an emerging marker of plaque instability. However, little is known about the relationships between IPH and traditional risk factors and whether these relationships differ between symptomatic and asymptomatic disease.
Methods and Results—
Two hundred thirty-four patients with symptomatic (n=114) or asymptomatic (n=120) carotid stenosis underwent high-resolution plaque magnetic resonance imaging. Seventy-five patients had recent IPH (symptomatic, 33%; asymptomatic, 31%). In symptomatic stenosis, recent IPH was independently associated with degree of stenosis (odds ratio [OR]=4.21, 1.61–10.98 for North American Symptomatic Carotid Endarterectomy Trial >35%; OR=2.92, 1.18–7.24 for European Carotid Surgery Trial >60%), qualifying event (OR=4.13; 1.11–15.32 for stroke or hemispheric transient ischemic attack ≥1 hour versus transient ischemic attack <1 hour or ocular symptoms), time from ischemic event (OR=6.65, 1.56–28.35 for ≤2 weeks; OR=2.24, 0.87–5.81 for 2–12 weeks versus >12 weeks;
P
for trend=0.03). In asymptomatic stenosis, IPH was only associated with stenosis severity >70% by ECST (OR=6.65; 1.95–22.73) but not by the NASCET method.
Conclusion—
Our findings support the potential link between recent IPH and risk of ipsilateral stroke in symptomatic disease but also imply that prognostic studies should adjust for known stroke risk factors in multivariate analyses. In asymptomatic stenosis, the potential predictive value of recent IPH is less likely to be confounded by stroke risk factors.
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Affiliation(s)
- Guillaume Turc
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Catherine Oppenheim
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Olivier Naggara
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Omer F. Eker
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - David Calvet
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Christophe Lacour
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Sophie Crozier
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Evelyne Guegan-Massardier
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Hilde Hénon
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Philippe Neau
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-François Toussaint
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Louis Mas
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-François Méder
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Emmanuel Touzé
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
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Zannad F, De Backer G, Graham I, Lorenz M, Mancia G, Morrow DA, Reiner Z, Koenig W, Dallongeville J, Macfadyen RJ, Ruilope LM, Wilhelmsen L. Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques. Fundam Clin Pharmacol 2012; 26:163-74. [PMID: 22220636 DOI: 10.1111/j.1472-8206.2011.01023.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.
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Affiliation(s)
- Faiez Zannad
- Centre for Clinical Investigation, Institut Lorrain du Coeur et des Vaisseaux, CHU Brabois, 54500 Vandoeuvre, France.
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Furer V, Fayad ZA, Farkouh ME, Rosenbaum D, Greenberg JD. Noninvasive atherosclerosis imaging modalities and their application to investigating cardiovascular drug effects in rheumatoid arthritis. Drug Dev Res 2011. [DOI: 10.1002/ddr.20482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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van den Bouwhuijsen QJA, Vernooij MW, Hofman A, Krestin GP, van der Lugt A, Witteman JCM. Determinants of magnetic resonance imaging detected carotid plaque components: the Rotterdam Study. Eur Heart J 2011; 33:221-9. [PMID: 21821844 DOI: 10.1093/eurheartj/ehr227] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Components of carotid atherosclerotic plaque such as intraplaque haemorrhage and lipid core are important determinants of plaque progression and destabilization. The association between plaque components and risk factors for cardiovascular disease is not well studied. METHODS AND RESULTS Participants from the population-based Rotterdam Study with carotid wall thickening on ultrasound (n = 1006) underwent high-resolution magnetic resonance imaging for carotid plaque characterization. Maximum wall thickening, the degree of stenosis, and the presence of intraplaque haemorrhage, lipid core, and calcification were assessed in both carotid arteries and their associations with cardiovascular risk factors were investigated. Intraplaque haemorrhage and lipid core were present in almost 25% of plaques, respectively, and occurred simultaneously in 9% of plaques. In men, intraplaque haemorrhage and lipid core were more prevalent compared with women (28.8 vs. 18.3 and 28.9 vs. 21.7%, respectively). Intraplaque haemorrhage occurred more frequently at older age [odds ratio (OR) per 10 years 1.8, 95% confidence interval 1.6-2.1], in men (OR 2.2, 1.7-2.9), in persons with hypertension (multivariate adjusted OR 1.4, 1.1-1.8), and in current smokers (multivariate adjusted OR 1.6, 1.2-2.3). Men (OR 1.5, 1.2-1.9) and subjects with hypercholesterolaemia (multivariate adjusted OR 1.4, 1.1-1.7) more often exhibited a lipid core. CONCLUSION In subjects from the general population with carotid wall thickening, intraplaque haemorrhage and lipid core-both considered indicators of unstable plaque-are highly frequent and more prevalent in men compared with women. Furthermore, different risk factors are associated with these plaque components: hypertension and current smoking were risk factors for the presence of intraplaque haemorrhage, and hypercholesterolaemia was the only risk factor for lipid core presence.
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Gao H, Long Q, Kumar Das S, Halls J, Graves M, Gillard JH, Li ZY. Study of carotid arterial plaque stress for symptomatic and asymptomatic patients. J Biomech 2011; 44:2551-7. [PMID: 21824619 DOI: 10.1016/j.jbiomech.2011.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 07/06/2011] [Accepted: 07/08/2011] [Indexed: 11/16/2022]
Abstract
Stroke is one of the leading causes of death in the world, resulting mostly from the sudden ruptures of atherosclerosis carotid plaques. Until now, the exact plaque rupture mechanism has not been fully understood, and also the plaque rupture risk stratification. The advanced multi-spectral magnetic resonance imaging (MRI) has allowed the plaque components to be visualized in-vivo and reconstructed by computational modeling. In the study, plaque stress analysis using fully coupled fluid structure interaction was applied to 20 patients (12 symptomatic and 8 asymptomatic) reconstructed from in-vivo MRI, followed by a detailed biomechanics analysis, and morphological feature study. The locally extreme stress conditions can be found in the fibrous cap region, 85% at the plaque shoulder based on the present study cases. Local maximum stress values predicted in the plaque region were found to be significantly higher in symptomatic patients than that in asymptomatic patients (200 ± 43 kPa vs. 127 ± 37 kPa, p=0.001). Plaque stress level, defined by excluding 5% highest stress nodes in the fibrous cap region based on the accumulative histogram of stress experienced on the computational nodes in the fibrous cap, was also significantly higher in symptomatic patients than that in asymptomatic patients (154 ± 32 kPa vs. 111 ± 23 kPa, p<0.05). Although there was no significant difference in lipid core size between the two patient groups, symptomatic group normally had a larger lipid core and a significantly thinner fibrous cap based on the reconstructed plaques using 3D interpolation from stacks of 2D contours. Plaques with a higher stenosis were more likely to have extreme stress conditions upstream of plaque throat. The combined analyses of plaque MR image and plaque stress will advance our understanding of plaque rupture, and provide a useful tool on assessing plaque rupture risk.
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Affiliation(s)
- Hao Gao
- Centre for excellence in Signal and Image Processing, Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow G11XW, UK
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