1
|
Huang Y, Sun X, Ding X, Tan S, Yu Z, Shi X, Li X, Ge H. Pathological Intraplaque Hemorrhage as the Gold Standard to Assess the Efficacy of Ultrasound in Predicting Vulnerable Carotid Plaque Rupture. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38962941 DOI: 10.1002/jum.16518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/27/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To assess the clinical utility of ultrasound in predicting the risk of carotid vulnerable plaque rupture using pathological intraplaque hemorrhage as the gold standard. METHODS A total of 118 patients who underwent endarterectomy due to symptomatic carotid artery stenosis were enrolled. Conventional ultrasound assessed the plaque thickness, area stenosis rate, echo, and surface morphology. Neovascularization were assessed by contrast-enhanced ultrasound (CEUS) and tracing intraplaque nonenhanced areas. According to neovascularization grade (0-4), plaques were classified as low-, intermediate-, and high risk. Fresh intraplaque hemorrhage within the pathology was adopted as the gold standard for diagnosing plaque rupture risk. Thus, we divided patients into ruptured risk and nonruptured risk groups to assess the value of crucial factors for plaque rupture risk using ultrasound. RESULTS Of the 118 patients, hypertension accounted for 71.2%, hyperlipidemia 68.6%, diabetes 52.5%, and statin history 64.4%. In the rupture risk group, diabetes, smoking, and stenosis rate were significantly higher than the nonrupture risk group (P < .001); plaque thickness ≥4 mm (P > .05); and mainly hypoechoic with irregular surface morphology (P < .001), nonenhanced areas in the plaques (P < .001), and neovascularization >grade 2 (P < .001). Compared with the low-risk group, plaque rupture risk was 7.219 times higher in the medium-risk group and 18.333 times higher in the high-risk group. The kappa value of the interobserver consistency of crucial ultrasound parameters was >0.75, and the intraclass correlation coefficient was 0.919 (P < .01). CONCLUSIONS Both conventional ultrasound and CEUS have significant clinical importance in the prediction of rupture risk in vulnerable carotid plaques, thereby enabling stroke risk stratification and the assessment of plaque rupture risk.
Collapse
Affiliation(s)
- Yaping Huang
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Xinping Sun
- Department of Ultrasound, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Xu Ding
- Department of Vascular Surgery, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Shuping Tan
- Department of Vascular Surgery, Beijing Hospital, Beijing, China
| | - Zexing Yu
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xue Shi
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin Li
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huiyu Ge
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Li W, Liu Y, Liu J, Guo Q, Li J, Wang A, Zheng H. Remnant cholesterol is associated with unstable carotid plaque in a neurologically healthy population. Stroke Vasc Neurol 2024:svn-2023-002888. [PMID: 38754970 DOI: 10.1136/svn-2023-002888] [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: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Remnant cholesterol (RC) is considered to be one of the most significant and important risk factors for atherosclerotic cardiovascular disease (ASCVD). Nonetheless, the association between RC and unstable carotid plaque remains unclear. Our primary objective is to ascertain whether RC exhibits an independent and significant association with unstable carotid plaque in a neurologically healthy population. METHODS In the cross-sectional study, we enrolled neurologically healthy participants who visited our centre for health checkups between 2021 and 2022. All eligible participants underwent a standardised questionnaire, physical examinations and laboratory testing. The carotid plaque was evaluated with a standard carotid ultrasound and an advanced ultrasound imaging technique called superb microvascular imaging. The correlation between lipids and unstable carotid plaque was primarily assessed utilising univariate and multivariate logistic regression. RESULTS The study totally enrolled 1100 participants who had an average age of 57.00 years (IQR: 49.00-63.00), with 67.55% being men. Among the participants, 321 (29.18%) had unstable carotid plaque. In the multivariate logistic regression analysis, higher RC had an independent association with an elevated incidence of unstable carotid plaque compared with the lowest concentrations of RC (OR=1.673, 95% CI 1.113 to 2.515, p=0.0134), but not other lipids. In addition, apolipoprotein A1 was negatively related to unstable carotid plaque (OR=0.549, 95% CI 0.364 to 0.830, p=0.0045). CONCLUSIONS Elevated concentrations of RC are independently and excellently correlated with unstable carotid plaque within a neurologically healthy population.
Collapse
Affiliation(s)
- Wenbo Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Health Management Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qirui Guo
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huaguang Zheng
- Health Management Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Zamani M, Skagen K, Lindberg B, Bjerkeli V, Aukrust P, Halvorsen B, Skjelland M. Relationship between fibroblast growth factor in plasma and carotid plaque neovascularization: a pilot study. Front Immunol 2024; 15:1385377. [PMID: 38711510 PMCID: PMC11070475 DOI: 10.3389/fimmu.2024.1385377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Background Unstable atherosclerotic carotid plaques with intraplaque neovascularization (IPN) carry a substantial risk for ischemic stroke. Conventional ultrasound methods fall short in detecting IPN, where superb microvascular imaging (SMI) has emerged as a promising tool for both visualizing and quantification. High levels of fibroblast growth factor 23 (FGF-23) have, in observational studies, been suggested as related to cardiovascular morbidity and mortality. The association of FGF-23 to atherosclerotic carotid plaque instability remains relatively unexplored. Methods A cohort of twenty-nine patients with ≥50% atherosclerotic carotid stenosis underwent conventional carotid ultrasound, SMI, and blood tests, including measurement of FGF-23 in plasma. Nineteen patients were characterized as symptomatic and ten as asymptomatic. Results Our major findings were: i) Higher FGF-23 levels were strongly correlated with increased SMI-assessed IPN. ii) Neo-vessel count recorded by quantitative SMI was positively correlated to increased FGF-23 levels, but not with basic FGF levels. (iii) In contrast, traditional risk factors for plaque instability exhibited no noteworthy associations with SMI-assessed IPN or with FGF-23 levels. Conclusion This pilot study suggest the potential of FGF-23 as a valuable marker for neovascularization and atherosclerotic carotid plaque instability as a risk factor for ischemic stroke. Further research involving larger cohorts and prospective data is necessary to understand FGF-23's role in this context comprehensively.
Collapse
Affiliation(s)
- Mahtab Zamani
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Beate Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine (RIIM), Oslo University Hospital, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine (RIIM), Oslo University Hospital, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine (RIIM), Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Li M, Guo R. Study on the Consistency of Angiogenesis in Carotid Plaque Evaluated by Contrast-Enhanced Ultrasound and Superb Microvascular Imaging and Its Correlation With Stroke Occurrence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:771-779. [PMID: 38205964 DOI: 10.1002/jum.16409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES This study aimed to investigate the value of contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI) in evaluating angiogenesis in carotid artery plaques and prognosis in stroke patients. METHODS Sixty-one patients with carotid atherosclerotic plaques were selected. All patients received conventional ultrasound, CEUS, and SMI examination, including 32 patients with cerebral infarction and 29 patients without cerebral infarction. The results of CEUS and SMI neovascularization of patients were graded 0, 1, and 2 points according to the image characteristics. The consistency between SMI results and CEUS results was evaluated, and the differences in neovascularization in carotid plaques between patients with cerebral infarction and those without cerebral infarction were compared. RESULTS SMI showed that the neovascularization score in plaque was 0 point in 13 cases, 1 point in 24 cases, and 2 points in 24 cases. There were no significant differences in age, sex, plaque size, or echo between the two groups. There was no significant difference between the SMI and CEUS results, P > .05. The CEUS neovascularization grade of patients with cerebral infarction had a higher score, which was significantly different from that of patients without cerebral infarction, P < .05. The SMI neovascularization grade of patients with cerebral infarction had a higher score, which was significantly different from that of patients without cerebral infarction, P < .05. CONCLUSION SMI can show neovascularization in plaques, with a significantly higher grade of neovascularization in those of patients with cerebral infarction than in those without cerebral infarction.
Collapse
Affiliation(s)
- Mingqiu Li
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Hou C, Li S, Zhang L, Zhang W, He W. The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics. Insights Imaging 2024; 15:78. [PMID: 38499954 PMCID: PMC10948691 DOI: 10.1186/s13244-024-01650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE This study aimed to examine the clinical and multimodal ultrasonic characteristics differences between carotid web (CW) and CW with plaque as well as the potential risk factors for stroke caused by CW. METHODS We retrospectively enrolled patients diagnosed with CW by CTA or high-resolution MRI (HRMRI) and simultaneously underwent contrast enhanced ultrasound (CEUS) and superb microvascular imaging examinations from January 2015 to October 2022. The CW angle was measured using computer-aided software. The variations between CW and CW with plaque were evaluated, and univariable and multivariable logistic regressions were utilized to identify possible risk predictors for stroke caused by CW. RESULTS Two hundred ninety-nine patients with an average age of 60.85 (± 8.77) years were included. Sex, age, history of smoking, alcohol, hypertension, diabetes mellitus, homocysteine level, and treatment, as well as web length and thickness, luminal stenosis, location wall, number, CW angle, and CEUS enhancement, were quite different among CW and CW with plaque patients (p < 0.05). The logistic regression analysis showed that web length was an independent predictor of luminal stenosis in CW patients. For patients with CW and plaque, plaque and web thickness, as well as plaque enhancement, were associated with stenosis. Furthermore, luminal stenosis and plaque length were risk factors for symptoms. CONCLUSION The multimodal ultrasonic and clinical manifestations of CW and CW with plaque are quite different. Web length is an independent risk factor for carotid artery stenosis in CW patients, whereas luminal stenosis and plaque length were risk factors for symptoms in CW with plaque patients. CRITICAL RELEVANCE STATEMENT Exploring the similarities and differences between the carotid web and the carotid web with plaque, based on the stereo-geometric spatial position relationship and hemodynamic changes, may provide further insights into the underlying mechanisms of stroke occurrence caused by the carotid web. KEY POINTS 1. Multimodal ultrasonic and clinical manifestations of carotid web and carotid web with plaque are substantially different. 2. A thin triangular endoluminal defect is identified as a typical feature of the web on superb microvascular imaging, and two kinds of typical ultrasonic features of CW with plaque are also identified. 3. Web length is an independent risk factor for carotid stenosis in carotid web patients, whereas luminal stenosis and plaque length are risk factors for symptoms in patients with CW and plaque.
Collapse
Affiliation(s)
- Chao Hou
- Department of Ultrasound, Lanzhou University Second Hospital, No.82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, No. 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, China
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119, South Forth Ring Road West, Fengtai District, Beijing, 100070, China
| | - Shuo Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119, South Forth Ring Road West, Fengtai District, Beijing, 100070, China
| | - Lei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119, South Forth Ring Road West, Fengtai District, Beijing, 100070, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119, South Forth Ring Road West, Fengtai District, Beijing, 100070, China.
| | - Wen He
- Department of Ultrasound, Lanzhou University Second Hospital, No.82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China.
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119, South Forth Ring Road West, Fengtai District, Beijing, 100070, China.
| |
Collapse
|
6
|
Lai Z, Wang C, Liu X, Sun H, Guo Z, Shao J, Li K, Chen J, Wang J, Lei X, Shu K, Feng Y, Kong D, Sun W, Liu B. Characterization of the proteome of stable and unstable carotid atherosclerotic plaques using data-independent acquisition mass spectrometry. J Transl Med 2024; 22:247. [PMID: 38454421 PMCID: PMC10921703 DOI: 10.1186/s12967-023-04723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/13/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Currently, noninvasive imaging techniques and circulating biomarkers are still insufficient to accurately assess carotid plaque stability, and an in-depth understanding of the molecular mechanisms that contribute to plaque instability is still lacking. METHODS We established a clinical study cohort containing 182 patients with carotid artery stenosis. After screening, 39 stable and 49 unstable plaques were included in the discovery group, and quantitative proteomics analysis based on data independent acquisition was performed for these plaque samples. Additionally, 35 plaques were included in the validation group to validate the proteomics results by immunohistochemistry analysis. RESULTS A total of 397 differentially expressed proteins were identified in stable and unstable plaques. These proteins are primarily involved in ferroptosis and lipid metabolism-related functions and pathways. Plaque validation results showed that ferroptosis- and lipid metabolism-related proteins had different expression trends in stable plaques versus unstable fibrous cap regions and lipid core regions. Ferroptosis- and lipid metabolism-related mechanisms in plaque stability were discussed. CONCLUSIONS Our results may provide a valuable strategy for revealing the mechanisms affecting plaque stability and will facilitate the discovery of specific biomarkers to broaden the therapeutic scope.
Collapse
Affiliation(s)
- Zhichao Lai
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Chaonan Wang
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China
- Department of Hemangiomas & Vascular Malformations, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- Proteomics Research Center, Core Facility of Instruments, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking, Union Medical College, Dongdansantiao 9St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Haidan Sun
- Proteomics Research Center, Core Facility of Instruments, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking, Union Medical College, Dongdansantiao 9St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhengguang Guo
- Proteomics Research Center, Core Facility of Instruments, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking, Union Medical College, Dongdansantiao 9St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jiang Shao
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Kang Li
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Junye Chen
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Department of Pathophysiology, Peking Union Medical College, Beijing, China
| | - Jiaxian Wang
- Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Xiangling Lei
- Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Keqiang Shu
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yuyao Feng
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Deqiang Kong
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Wei Sun
- Proteomics Research Center, Core Facility of Instruments, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking, Union Medical College, Dongdansantiao 9St, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Bao Liu
- Department of Vascular Surgery, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan 1St, Dongcheng District, Beijing, 100730, People's Republic of China.
| |
Collapse
|
7
|
Cannella R, Pilato G, Mazzola M, Bartolotta TV. New microvascular ultrasound techniques: abdominal applications. LA RADIOLOGIA MEDICA 2023; 128:1023-1034. [PMID: 37495910 PMCID: PMC10473992 DOI: 10.1007/s11547-023-01679-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
Microvascular ultrasound (MVUS) is a new ultrasound technique that allows the detection of slow-velocity flow, providing the visualization of the blood flow in small vessels without the need of intravenous contrast agent administration. This technology has been integrated in the most recent ultrasound equipment and applied for the assessment of vascularization. Compared to conventional color Doppler and power Doppler imaging, MVUS provides higher capability to detect intralesional flow. A growing number of studies explored the potential applications in hepatobiliary, genitourinary, and vascular pathologies. Different flow patterns can be observed in hepatic and renal focal lesions providing information on tumor vascularity and improving the differential diagnosis. This article aims to provide a detailed review on the current evidences and applications of MVUS in abdominal imaging.
Collapse
Affiliation(s)
- Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Giulia Pilato
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Mariasole Mazzola
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| |
Collapse
|
8
|
Wang LJ, Zhai PQ, Xue LL, Shi CY, Zhang Q, Zhang H. Machine learning-based identification of symptomatic carotid atherosclerotic plaques with dual-energy computed tomography angiography. J Stroke Cerebrovasc Dis 2023; 32:107209. [PMID: 37290153 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107209] [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: 01/28/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE This study aimed to develop and validate a machine learning model incorporating both dual-energy computed tomography (DECT) angiography quantitative parameters and clinically relevant risk factors for the identification of symptomatic carotid plaques to prevent acute cerebrovascular events. METHODS The data of 180 patients with carotid atherosclerosis plaques were analysed from January 2017 to December 2021; 110 patients (64.03±9.58 years old, 20 women, 90 men) were allocated to the symptomatic group, and 70 patients (64.70±9.89 years old, 50 women, 20 men) were allocated to the asymptomatic group. Overall, five machine learning models using the XGBoost algorithm, based on different CT and clinical features, were developed in the training cohort. The performances of all five models were assessed in the testing cohort using receiver operating characteristic curves, accuracy, recall rate, and F1 score. RESULTS The shapley additive explanation (SHAP) value ranking showed fat fraction (FF) as the highest among all CT and clinical features and normalised iodine density (NID) as the 10th. The model based on the top 10 features from the SHAP measurement showed optimal performance (area under the curve [AUC] .885, accuracy .833, recall rate .933, F1 score .861), compared with the other four models based on conventional CT features (AUC .588, accuracy .593, recall rate .767, F1 score .676), DECT features (AUC .685, accuracy .648, recall rate .667, F1 score .678), conventional CT and DECT features (AUC .819, accuracy .740, recall rate .867, F1 score .788), and all CT and clinical features (AUC .878, accuracy .833, recall rate .867, F1 score .852). CONCLUSION FF and NID can serve as useful imaging markers of symptomatic carotid plaques. This tree-based machine learning model incorporating both DECT and clinical features could potentially comprise a non-invasive method for identification of symptomatic carotid plaques to guide clinical treatment strategies.
Collapse
Affiliation(s)
- Ling-Jie Wang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Pei-Qing Zhai
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Li-Li Xue
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Cai-Yun Shi
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Qian Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| | - Hua Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, PR China.
| |
Collapse
|
9
|
Uchihara Y, Saito K, Motoyama R, Ishibashi-Ueda H, Yamaguchi E, Hatakeyama K, Tanaka A, Kataoka H, Iihara K, Sugie K, Koga M, Toyoda K, Nagatsuka K, Ihara M. Neovascularization From the Carotid Artery Lumen Into the Carotid Plaque Confirmed by Contrast-Enhanced Ultrasound and Histology. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1798-1803. [PMID: 37202244 DOI: 10.1016/j.ultrasmedbio.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study was aimed at assessing intraplaque neovessels, focusing on neovascularization from the vascular luminal side using contrast-enhanced ultrasound (CEUS) and determining that this contrast effect indicates that the neovessel is connected to the vessel lumen histopathologically. Whether plaque vulnerability can be assessed more accurately was also investigated. METHODS We enrolled consecutive patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and pre-operative CEUS with perflubutane of the carotid arteries. We graded the contrast effect semi-quantitatively from the vascular luminal and adventitial sides. We compared the contrast effect with the pathological findings, especially the neovascularization of the CEA specimens. RESULTS In total, 68 carotid arterial atheromatous plaques (47 symptomatic) were analyzed. Symptomatic plaques were significantly correlated with stronger contrast effects from the luminal side than from the adventitial side (p = 0.0095). Microbubbles from the luminal side appeared to flow mainly into the plaque shoulder. The contrast effect value for the plaque shoulder and neovessel density were significantly correlated (ρ = 0.35, p = 0.031). Neovessel density was significantly higher in symptomatic than in asymptomatic plaques (56.2 ± 43.7/mm2 and 18.1 ± 15.2/mm2, respectively, p < 0.0001). Serial histological sections of CEA specimens in a symptomatic plaque with a strong contrast effect from the luminal side revealed multiple neovessels fenestrated to the vessel lumen with endothelial cells, consistent with the CEUS findings. CONCLUSION Contrast-enhanced ultrasound can be used to evaluate neovessels originating from the luminal side, histopathologically confirmed in serial sections. Symptomatic vulnerable plaque is correlated more significantly with intraplaque neovascularization from the luminal side than with neovascularization from the adventitia.
Collapse
Affiliation(s)
- Yuto Uchihara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Nara Medical University, Nara, Japan.
| | - Kozue Saito
- Department of Neurology, Nara Medical University, Nara, Japan; Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rie Motoyama
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | | | - Eriko Yamaguchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akito Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Nara Medical University, Nara, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuyuki Nagatsuka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| |
Collapse
|
10
|
Ren L, Han Y, Long M, Yan L, Wang Q, Fei X, Luo Y. Association with carotid plaque parameters detected on contrast-enhanced ultrasound and coronary artery plaque progression in non-culprit lesions: A retrospective study. Int J Cardiol 2023; 377:115-122. [PMID: 36682688 DOI: 10.1016/j.ijcard.2023.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
AIM To investigate the correlation between carotid plaque parameters detected on contrast-enhanced ultrasound(CEUS) and the plaque progression in non-culprit coronary lesions (NCCLs) after percutaneous coronary intervention (PCI). METHODS In this retrospective cross-sectional study, we analyzed 173 patients who underwent PCI. Patients were stratified into two groups (progression and non-progression groups) by comparing the coronary angiography (CAG) results at baseline and follow-up. The correlation between carotid plaque parameters and plaque progression in NCCLs was analyzed by multivariate logistic regression analysis. A logistic regression model was established to predict NCCLs progression. RESULTS Overall, 55 of 173 patients exhibited NCCLs progression (31.79%). Univariate comparisons showed that plaque thickness, plaque length, and IPN score were significantly higher in the progressive group than in the non-progressive group (P < 0.01). Multivariate logistic regression analysis revealed that carotid plaque length (OR = 3.418, 95% CI =1.101-10.610) and IPN score (OR = 7.395, 95% CI =3.154-17.342) were strongly associated with plaque progression in NCCLs. After adjusting for confounders, the history of previous PCI, plaque length, and IPN score were independent predictors of the NCCLs progression (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the logistic regression model in predicting the NCCLs progression were 62.50%, 90.53%, 81.12%, 76.92%, and 82.69%, respectively, and the area under the receiver operating characteristic (ROC) curve was 0.882 (95% CI: 0.826-0.939). CONCLUSIONS Carotid plaque length and IPN score were strongly correlated with plaque progression in NCCLs. Combining the history of previous PCI can reasonably predict the NCCLs progression.
Collapse
Affiliation(s)
- Ling Ren
- The Second Medical College of Lanzhou University, No. 222 Tianshui South Road, Chengguan District, Lanzhou, Gansu 730030, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yanyan Han
- Cardiology Department, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China; Medical School of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Mei Long
- Department of Cardiology, Zibo Central Hospital, No. 54 Gongqingtuanxi Road, Zhangdian District, Zibo, Shandong 255000, China
| | - Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Qi Wang
- Cardiology Department, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China; Medical School of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Xiang Fei
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
| | - Yukun Luo
- The Second Medical College of Lanzhou University, No. 222 Tianshui South Road, Chengguan District, Lanzhou, Gansu 730030, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
| |
Collapse
|
11
|
Wang B, Chen Y, Qiao Q, Dong L, Xiao C, Qi Z. Evaluation of carotid plaque vulnerability with different echoes by shear wave elastography and CEUS. J Stroke Cerebrovasc Dis 2023; 32:106941. [PMID: 36586243 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106941] [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: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Using shear wave elastography (SWE) and contrast enhanced ultrasound (CEUS)to examine carotid plaques with different echoes, and explore a reliable method to quantify characteristics associated with vulnerable carotid plaques. METHODS 2D ultrasound, SWE and CEUS were performed on 244 carotid plaques, and the echoes were evaluated according to the Gray-Weale classification scale and gray-scale median (GSM), and the mean Young's modulus (YM) of the plaque was measured and the intraplaque neovascularization was observed to investigate the relationship between carotid plaque types with different echo characteristics, GSM and the values of each parameter of YM and CEUS. The relationship between GSM and YM and CEUS values was investigated. RESULTS The differences between GSM values (F = 49.742, P < 0.001), with the maximum, mean, and minimum YM values of ultrasound elastography (P < 0.001), and with the number (P < 0.001) and density (P = 0.047) of neovascularization on CEUS were statistically significant for the different echogenic types of plaques, and the lower the echogenicity of the plaque, the lower the GSM values (r = 0.632, P < 0.001), the smaller the YM values (all r > 0, P < 0.001), and the higher the neovascularization number and density values (r < 0, P < 0.001); and there were also statistically significant differences between the above indicators in the vulnerable and stable plaque groups (all P < 0.05). CONCLUSION GSM, SWE, and CEUS techniques can quantitatively evaluate the vulnerability of different echo carotid plaques in a more comprehensive and objective manner, which may help clinical identification of vulnerable plaques, and provide important reference values for early diagnosis and treatment in clinical practice.
Collapse
Affiliation(s)
| | | | - Qi Qiao
- First hospital of Qinhuangdao, Hebei, China
| | - Lili Dong
- First hospital of Qinhuangdao, Hebei, China
| | | | - Zhengqin Qi
- First hospital of Qinhuangdao, Hebei, China.
| |
Collapse
|
12
|
Guo Y, Wang X, Wang L, Wei X, Duan Y, Yang X, Zhang M, Zhao B. The Value of Superb Microvascular Imaging and Contrast-enhanced Ultrasound for the Evaluation of Neovascularization in Carotid Artery Plaques. Acad Radiol 2023; 30:403-411. [PMID: 36123231 DOI: 10.1016/j.acra.2022.08.001] [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: 06/26/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the consistency between superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) for the detection of neovascularization in carotid plaques of different thicknesses and to evaluate the applied value of these two methods for detecting neovascularization in carotid plaques in the clinic. METHODS A total of 45 patients with carotid artery plaques who were diagnosed in our hospital involving 76 hypoechoic plaques with a thickness ≥2.0 mm were selected. According to thickness, the plaques were divided into three groups: 2.0-2.5 mm, 2.5-3.0 mm and ≥3.0 mm. Each group underwent both SMI and CEUS, and two experienced sonographers (A and B) analyzed the ultrasound images to evaluate the neovascularization of carotid plaques. The amount of the neovascular signal was assessed using a semi-quantitative grading scale (vascularity grade: grade 0-3). SMI and CEUS were graded respectively according to the visual methods as follows: grade 0: no blood flow signal/enhancement within plaques; grade 1: a few blood flow signals/enhancement within plaques; grade 2: medium blood flow signals/enhancement within plaques; and grade 3: extensive blood flow signals/enhancement within plaques. Kappa consistency test was used to analyze the consistency of the grade of neovascularization in plaques between SMI with CEUS. Gamma rank correlation analysis was used to examine the correlation between neovascularization grade by SMI and CEUS in plaque and plaque thickness. RESULTS Of these patients, 14 had unilateral plaques and 31 had bilateral plaques. The two sonographers were highly consistent in terms of applying SMI and CEUS methods for diagnosing neovascularization in carotid plaques (Kappa values were 0.736 and 0.680>0). Consistency was found between SMI and CEUS by sonographers (sonographer A: Kappa=0.823; sonographer B: Kappa=0.842) in evaluating the neovascular grade in the carotid plaques. SMI and CEUS grades were positively correlated with plaque thickness (sonographer A: γ = 0.735 and 0.772; sonographer B: γ = 0.805 and 0.798). CONCLUSION Neovascularization in carotid plaques was successfully detected by SMI in a manner that concurred well with CEUS results. Our data indicate that both CEUS and SMI have high diagnostic value for assessing the neovascularization of plaques.
Collapse
Affiliation(s)
- Yanqin Guo
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinghua Wang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lu Wang
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Xiaoli Wei
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yinling Duan
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaohuan Yang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Min Zhang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China.
| |
Collapse
|
13
|
Chen J, Liu D, Wang J, Song W, Ma F. Clinical application of super sensitive microflow ultrasound on the detection of intraplaque neovascularization in patients with atheromatous carotid artery plaque. Clin Hemorheol Microcirc 2022; 82:283-293. [PMID: 35912734 DOI: 10.3233/ch-221510] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a routine technique for detecting intraplaque neovascularization (IPN). However, the invasiveness and complexity of CEUS severely limit its clinical application. This article aims to investigate the application value of AngioPLUS (AP) technique in assessing IPN formation in patients with atheromatous (AS) carotid artery plaque. METHODS Patients diagnosed with carotid artery atherosclerosis combined plaque formation were recruited and their demographic characteristics including serum fasting blood glucose (FBG), triglyceride (TG), and low-density lipoprotein (LDL) were collected. AP was used to scoring intraplaque microvascular flow (IMVF), measuring the thickness and length of the plaque and determining the number of IPN of the plaque. RESULTS IMVF score evaluated by AP was positively correlated with plaque length, thickness, IPN number, serum TG, LDL and FBG levels in patients with carotid atherosclerosis with plaque. The evaluation results of CEUS score and IMVF classification detected by AP of plaques were consistent in patients with carotid atherosclerosis. CONCLUSION IMVF scoring by AP is a promising approach to assess IPN and plaque status in patients with atheromatous carotid artery plaque.
Collapse
Affiliation(s)
- Jin Chen
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Dandan Liu
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Jing Wang
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Wanji Song
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Fang Ma
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| |
Collapse
|
14
|
Bi Q, Zhou X, Lu Y, Fu W, Wang Y, Wang F, Wang J. Polymorphisms of the apolipoprotein E gene affect response to atorvastatin therapy in acute ischemic stroke. Front Cardiovasc Med 2022; 9:1024014. [PMID: 36426228 PMCID: PMC9678920 DOI: 10.3389/fcvm.2022.1024014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/20/2022] [Indexed: 10/13/2023] Open
Abstract
Background Polymorphisms of the apolipoprotein E (APOE) gene are related to the efficacy of statin therapy. The biological functions of the APOE subtypes determine the metabolism of blood plasma lipids and the progression of atherosclerosis. This study aimed to explore the impact of APOE gene polymorphisms on the effect of atorvastatin on lipid regulation and plaque stabilization. Methods The study was a prospective cohort study that consecutively included patients with acute ischemic stroke (AIS) in the Department of Neurology, Shanghai Tenth People's Hospital, from December 2018 to December 2019. The patients were divided into E2, E3, and E4 groups according to their APOE genotype. Atorvastatin (20 mg) was administrated to all patients. Changes in blood lipid levels over 3 months and plaque size and stability over 12 months were analyzed. Results We enrolled 253 consecutive patients with AIS, of whom, 136 had carotid atherosclerotic plaques. Two patients with genotype E2/E4 were excluded. There were 30 patients in the E2 group (12.0%), 191 patients in the E3 group (76.0%), and 30 patients in the E4 group (12.0%). The lowest percentage reduction in low-density lipoprotein cholesterol (LDL-C) was observed in the E4 group (41.2%), while the highest percentage reduction was observed in the E2 group (17.6%). The plaques in the E2 group showed slower progression, while those in the E4 group showed more rapid progression. Conclusion APOE gene polymorphisms affect the biological functions of atorvastatin. Compared to the ε3 or ε4 allele, the ε2 allele exerted a greater lipid-lowering effect on LDL-C levels, enhanced the ability of atorvastatin to stabilize carotid artery plaques, and slowed carotid artery plaque progression.
Collapse
Affiliation(s)
- QianQian Bi
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - XiaoYu Zhou
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - YanQin Lu
- Department of Infectious Diseases, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wang Fu
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - YongPeng Wang
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng Wang
- Department of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jue Wang
- Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
15
|
Aziz MU, Eisenbrey JR, Deganello A, Zahid M, Sharbidre K, Sidhu P, Robbin ML. Microvascular Flow Imaging: A State-of-the-Art Review of Clinical Use and Promise. Radiology 2022; 305:250-264. [PMID: 36165794 PMCID: PMC9619200 DOI: 10.1148/radiol.213303] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Abstract
Vascular imaging with color and power Doppler is a useful tool in the assessment of various disease processes. Assessment of blood flow, from infarction and ischemia to hyperemia, in organs, neoplasms, and vessels, is used in nearly every US investigation. Recent developments in this area are sensitive to small-vessel low velocity flow without use of intravenous contrast agents, known as microvascular flow imaging (MVFI). MVFI is more sensitive in detection of small vessels than color, power, and spectral Doppler, reducing the need for follow-up contrast-enhanced US (CEUS), CT, and MRI, except when arterial and venous wash-in and washout characteristics would be helpful in diagnosis. Varying clinical applications of MVFI are reviewed in adult and pediatric populations, including its technical underpinnings. MVFI shows promise in assessment of several conditions including benign and malignant lesions in the liver and kidney, acute pathologic abnormalities in the gallbladder and testes, and superficial lymph nodes. Future potential of MVFI in different conditions (eg, endovascular repair) is discussed. Finally, clinical cases in which MVFI correlated and potentially obviated additional CEUS, CT, or MRI are shown.
Collapse
Affiliation(s)
- Muhammad Usman Aziz
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - John R. Eisenbrey
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Annamaria Deganello
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Mohd Zahid
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Kedar Sharbidre
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Paul Sidhu
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Michelle L. Robbin
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| |
Collapse
|
16
|
He L, Cai Y, Feng Y, Wang W, Feng T, Shen E, Yang S. Utility of vector flow mapping technology in quantitative assessment of carotid wall shear stress in hypertensive patients: A preliminary study. Front Cardiovasc Med 2022; 9:967763. [PMID: 36386366 PMCID: PMC9649775 DOI: 10.3389/fcvm.2022.967763] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/11/2022] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Blood flowing in the arterial lumen acts on the surface of the vessel wall to form wall shear stress (WSS). To date, there has been limited research on the utility of non-invasive technology in the accurate quantification of carotid WSS in patients with hypertension (HP). OBJECTIVE The present study aimed to explore the usage of vascular vector flow mapping (VFM) in the quantitative assessment of carotid WSS in hypertensive patients at an early stage and to validate its clinical utility. METHODS A total of 50 individuals confirmed without carotid plaques were grouped into a HP group (n = 25) and a control (CON) group (n = 25) according to blood pressure. An ALOKA LISENDO 880 Color Doppler Ultrasound with a L441 3-15 MHZ probe was used to obtain a longitudinal section scan to determine the regions of interests (ROIs) of the common carotid artery. VFM-based WSS measurements were obtained by selecting the ROI with optimal image quality from three full cardiac cycles. WSS-derived measurements, including WSSmax, WSSmin, and WSSmean, were analyzed and compared between the HP and CON groups. In addition, the correlations between WSS-derived measurements and the carotid artery intima-media thickness (IMT) were also analyzed. RESULTS There were significant statistical differences in WSSmax and WSSmean between patients in the HP and CON groups. Specifically, the HP group had significantly decreased WSSmax and WSSmean compared to the CON group (WSSmax: 1.781 ± 0.305 Pa vs. 2.286 ± 0.257 Pa; WSSmean: 1.276 ± 0.333 Pa vs. 1.599 ± 0.293 Pa, both p < 0.001). However, there was no statistical difference in WSSmin between the groups (0.79 ± 0.36 vs. 0.99 ± 0.42, p = 0.080). Additionally, Spearman's correlation analysis indicated that the WSS-derived parameters were negatively correlated with the IMT (p < 0.001). CONCLUSION Vascular VFM technology shows promising results in the quantitative assessment of difference in hemodynamics of the vascular flow field between patients with HP and normal controls. Difference in WSS may serve as a potential predictor for the development of arteriosclerosis risks.
Collapse
Affiliation(s)
- Lan He
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, China
| | - Yundan Cai
- Department of Ultrasound Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Yuhong Feng
- FUJIFILM Healthcare (Guangzhou), Co., Ltd., Guangzhou, China
| | - Wenwen Wang
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - E. Shen
- Department of Ultrasound Medicine, Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Shaoling Yang
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, China
| |
Collapse
|
17
|
Aghabaglou F, Ainechi A, Abramson H, Curry E, Kaovasia TP, Kamal S, Acord M, Mahapatra S, Pustavoitau A, Smith B, Azadi J, Son JK, Suk I, Theodore N, Tyler BM, Manbachi A. Ultrasound monitoring of microcirculation: An original study from the laboratory bench to the clinic. Microcirculation 2022; 29:e12770. [PMID: 35611457 PMCID: PMC9786257 DOI: 10.1111/micc.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/08/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Monitoring microcirculation and visualizing microvasculature are critical for providing diagnosis to medical professionals and guiding clinical interventions. Ultrasound provides a medium for monitoring and visualization; however, there are challenges due to the complex microscale geometry of the vasculature and difficulties associated with quantifying perfusion. Here, we studied established and state-of-the-art ultrasonic modalities (using six probes) to compare their detection of slow flow in small microvasculature. METHODS Five ultrasonic modalities were studied: grayscale, color Doppler, power Doppler, superb microvascular imaging (SMI), and microflow imaging (MFI), using six linear probes across two ultrasound scanners. Image readability was blindly scored by radiologists and quantified for evaluation. Vasculature visualization was investigated both in vitro (resolution and flow characterization) and in vivo (fingertip microvasculature detection). RESULTS Superb Microvascular Imaging (SMI) and Micro Flow Imaging (MFI) modalities provided superior images when compared with conventional ultrasound imaging modalities both in vitro and in vivo. The choice of probe played a significant difference in detectability. The slowest flow detected (in the lab) was 0.1885 ml/s and small microvasculature of the fingertip were visualized. CONCLUSIONS Our data demonstrated that SMI and MFI used with vascular probes operating at higher frequencies provided resolutions acceptable for microvasculature visualization, paving the path for future development of ultrasound devices for microcirculation monitoring.
Collapse
Affiliation(s)
- Fariba Aghabaglou
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Ana Ainechi
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Haley Abramson
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Eli Curry
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Tarana Parvez Kaovasia
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Serene Kamal
- HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Electrical and Computer EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Molly Acord
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Smruti Mahapatra
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Aliaksei Pustavoitau
- Department of Anesthesiology and Critical Care, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Beth Smith
- Department of Radiology and Radiological Science, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Javad Azadi
- Department of Radiology and Radiological Science, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jennifer K. Son
- Department of Radiology and Radiological Science, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Ian Suk
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Nicholas Theodore
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Betty M. Tyler
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Amir Manbachi
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Electrical and Computer EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Mechanical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| |
Collapse
|
18
|
He H, Zhang X, Du L, Ye M, Lu Y, Xue J, Wu J, Shuai X. Molecular imaging nanoprobes for theranostic applications. Adv Drug Deliv Rev 2022; 186:114320. [PMID: 35526664 DOI: 10.1016/j.addr.2022.114320] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 12/13/2022]
Abstract
As a non-invasive imaging monitoring method, molecular imaging can provide the location and expression level of disease signature biomolecules in vivo, leading to early diagnosis of relevant diseases, improved treatment strategies, and accurate assessment of treating efficacy. In recent years, a variety of nanosized imaging probes have been developed and intensively investigated in fundamental/translational research and clinical practice. Meanwhile, as an interdisciplinary discipline, this field combines many subjects of chemistry, medicine, biology, radiology, and material science, etc. The successful molecular imaging not only requires advanced imaging equipment, but also the synthesis of efficient imaging probes. However, limited summary has been reported for recent advances of nanoprobes. In this paper, we summarized the recent progress of three common and main types of nanosized molecular imaging probes, including ultrasound (US) imaging nanoprobes, magnetic resonance imaging (MRI) nanoprobes, and computed tomography (CT) imaging nanoprobes. The applications of molecular imaging nanoprobes were discussed in details. Finally, we provided an outlook on the development of next generation molecular imaging nanoprobes.
Collapse
Affiliation(s)
- Haozhe He
- Nanomedicine Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China; Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
| | - Xindan Zhang
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Lihua Du
- PCFM Lab of Ministry of Education, School of Materials Science and Engineering, Sun Yat-Sen University, Guangzhou 510260, China
| | - Minwen Ye
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Yonglai Lu
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Jiajia Xue
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China.
| | - Jun Wu
- PCFM Lab of Ministry of Education, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China.
| | - Xintao Shuai
- Nanomedicine Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China; PCFM Lab of Ministry of Education, School of Materials Science and Engineering, Sun Yat-Sen University, Guangzhou 510260, China.
| |
Collapse
|
19
|
Wang B, Dong L, Qi Z. Carotid plaque vulnerability assessed by contrast-enhanced ultrasound and clinical risk factors. J Stroke Cerebrovasc Dis 2022; 31:106598. [PMID: 35780717 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106598] [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: 04/02/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022] Open
Abstract
AIM To evaluate the vulnerability of carotid plaque by contrast-enhanced ultrasound, to study the clinical risk factors of the plaque, and to analyze the relationship between plaque vulnerability and clinical indicators. MATERIALS AND METHODS 244 patients with carotid plaque were selected for contrast-enhanced ultrasound examination, biochemical and other indicators were detected, and the stability of plaque was evaluated by semi-quantitative visual grading of intraplaque neovascularization (IPN), and correlation between plaque and each indicator was analyzed. RESULTS Different grades of neovascularization in plaque had statistical differences with BMI, arm circumference, WHR, WBC, CRP, tHcy, TBIL, DBIL, SUA, LP (a) and DD (P<0.05). Correlation analysis showed that TBIL, DBIL were negatively correlated with the grading, while others were positively correlated. CONCLUSION The expression levels of SUA, tHcy, TC, TG, LDL-C, LP (a), DD, WBC and CRP are closely related to contrast-enhanced ultrasound grading, which further indicated the vulnerability of plaque and provides theoretical basis for clinical treatment.
Collapse
Affiliation(s)
| | - Lili Dong
- First Hospital of Qinhuangdao, Hebei, China
| | - Zhengqin Qi
- First Hospital of Qinhuangdao, Hebei, China.
| |
Collapse
|
20
|
Wang Y, Feng Y, Yang X, Wang W, Wang Y. Diagnosis of Atherosclerotic Plaques Using Vascular Endothelial Growth Factor Receptor-2 Targeting Antibody Nano-microbubble as Ultrasound Contrast Agent. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6524592. [PMID: 35572831 PMCID: PMC9098277 DOI: 10.1155/2022/6524592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023]
Abstract
The atherosclerotic plaque is characterized by narrowing of blood vessels and reduced blood flow leading to the insufficient blood supply to the brain. The hemodynamic changes caused by arterial stenosis increase the shearing force of the fibrous cap on the surface of the plaque, thereby reducing the stability of the plaque. Unstable plaques are more likely to promote angiogenesis and increase the risk of patients with cerebrovascular diseases. A timely understanding of the formation and stability of the arterial plaque can guide in taking targeted measures for reducing the risk of acute stroke in patients. It has been confirmed that nano-microbubbles can enter these plaques through the gaps in the patient's vascular endothelial cells, thereby enhancing the acquisition of ultrasound information for plaque visualization. Therefore, we aim to investigate the diagnostic value of targeted nano-microbubbles for atherosclerotic plaques. This study constructed vascular endothelial growth factor receptor-2 (VEGFR-2) targeting antibody nano-microbubbles and compared its diagnostic value with that of blank nano-microbubbles for atherosclerotic plaques. Studies have found that VEGFR-2 targeting antibody nano-microbubbles can accurately detect the position of plaques. Its detection rate, sensitivity, and specificity for plaques are higher than those of blank nano-microbubbles. Similarly, the peak intensity and average transit time of VEGFR-2 targeting antibody nano-microbubbles were greater than those of blank nano-microbubbles. Therefore, we believe that the combination of VEGFR-2 antibody and nano-microbubbles can enhance the acquisition of ultrasound information on atherosclerotic plaque neovascularization, thereby improving the early diagnosis of unstable plaque.
Collapse
Affiliation(s)
- Yi Wang
- Department of Ultrasonography, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei, China
| | - Yujin Feng
- Department of Ultrasonography, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei, China
| | - Xiaoyun Yang
- Department of Ultrasonography, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei, China
| | - Wengang Wang
- Department of Ultrasonography, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei, China
| | - Yueheng Wang
- Department of Ultrasonography, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei, China
| |
Collapse
|
21
|
Adoption of Two-Dimensional Ultrasound Gastrointestinal Filling Contrast on Artificial Intelligence Algorithm in Clinical Diagnosis of Gastric Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7385344. [PMID: 35535230 PMCID: PMC9078808 DOI: 10.1155/2022/7385344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
This research was aimed to explore the value of gastrointestinal filling contrast-enhanced ultrasound (CEUS) and computed tomography (CT-)-enhanced scanning based on artificial intelligence (AI) algorithm in the evaluation of gastric cancer staging. 102 patients with gastric cancer were selected as the research objects. All of them underwent CEUS of gastrointestinal filling and 64-slice spiral CT before surgery. In addition, an improved mean shift algorithm was proposed based on differential optical flow and deep convolutional neural network (D-CNN), which was applied in image processing. The predicted positive rate (PPR), sensitivity, specificity, and accuracy of gastric cancer in different stages by CEUS and CT were calculated using pathological diagnosis results as the gold standard. 17 patients with T1 stage, 41 patients with T2-T3 stage, and 35 patients with T4 stage were detected by CEUS. 13 patients with T1 stage, 34 patients with T2-T3 stage, and 30 patients with T4 stage were detected by CT enhanced examination. The PPRs of CEUS for T1, T2-T3, and T4 stages of gastric cancer were higher than those of CT enhanced (P < 0.05). The PPR of CEUS for N0 staging of gastric cancer was higher than that of CT enhanced (P < 0.05), and it for N3 staging of gastric cancer was lower than that of CT enhanced (P < 0.05). From the analysis of M staging of gastric cancer, the PPRs of CEUS for M0 and M1 staging of gastric cancer were not statistically different from the PPRs of CT enhanced (P > 0.05). The sensitivity (95.6%), specificity (81.82%), and accuracy (94.12%) of CEUS in assessing resectability were significantly higher than those of CT enhancement (89.01%, 63.67%, and 86.27%, respectively), and the differences were statistically significant (P < 0.05). In summary, CEUS gastrointestinal filling based on the D-CNN algorithm could better improve the display rate of the tissue lesions around the stomach. It also helped to judge the lesion progress, the depth of infiltration, and lymph node metastasis of the lesion. In addition, it had excellent performance in evaluating the resectability of gastric cancer before surgery and had clinical promotion value.
Collapse
|
22
|
Li Y, Zheng S, Zhang J, Wang F, He W. Multimodal ultrasound parameters aided carotid plaque risk stratification in patients with asymptomatic carotid stenosis. Acta Radiol 2022; 63:278-286. [PMID: 33525913 DOI: 10.1177/0284185121989189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice. PURPOSE To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis. MATERIAL AND METHODS A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves. RESULTS From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26-7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77-5.89, P<0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47-11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77-0.92) and the Hosmer-Lemeshow test P value was 0.822. CONCLUSIONS In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.
Collapse
Affiliation(s)
- Yi Li
- Capital Medical University, Beijing, PR China
- Department of Ultrasound, Beijing Tiantan Hospital, Beijing, PR China
| | - Shuai Zheng
- Capital Medical University, Beijing, PR China
- Department of Ultrasound, Beijing Tiantan Hospital, Beijing, PR China
| | - Jinghan Zhang
- Capital Medical University, Beijing, PR China
- Department of Ultrasound, Beijing Tiantan Hospital, Beijing, PR China
| | - Fumin Wang
- Capital Medical University, Beijing, PR China
- Department of Ultrasound, Beijing Tiantan Hospital, Beijing, PR China
| | - Wen He
- Capital Medical University, Beijing, PR China
- Department of Ultrasound, Beijing Tiantan Hospital, Beijing, PR China
| |
Collapse
|
23
|
Bhattacharjee S, Jain RD, Bathala L, Hk A, Sharma VK. Pictorial Essay of Cervical Duplex Ultrasonography. POCUS JOURNAL 2022; 7:245-252. [PMID: 36896382 PMCID: PMC9983729 DOI: 10.24908/pocus.v7i2.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives: Cervical duplex ultrasonography (CDU) is a simple, non-invasive, portable technique, that provides valuable high-quality visual information about the integrity of the carotid and vertebral vessels, plaque morphology and flow hemodynamics. CDU is useful in the assessment and follow up of patients with cerebrovascular disease as well as other conditions like inflammatory vasculitis, carotid artery dissection and carotid body tumours. CDU is inexpensive and invaluable in smaller centres. Methods: CDU was performed in all patients in both longitudinal and transverse planes in the out-patient clinic. Brightness mode (B-mode) and Doppler waveforms were obtained. Relevant findings were presented. Results: CDU provides real time visualisation of plaque characteristics and follow up, hemodynamic characteristics in Takayasu arteritis, visualisation of dissection. Conclusion: With availability of MR/CT angiography, CDU can be an adjuvant in follow up, triage and early bed-side diagnosis of the vascular diseases. We present our experience with CDU in the out-patient clinics in this pictorial essay.
Collapse
Affiliation(s)
| | | | | | | | - Vijay K Sharma
- Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital Singapore
| |
Collapse
|
24
|
Tanaka T, Yahagi K, Wada O, Ninomiya K, Horiuchi Y, Asami M, Yuzawa H, Komiyama K, Tanaka J, Aoki J, Suzuki A, Ishizaki K, Tanabe K. Possible Neoangiogenesis in Achilles Tendon Xanthoma with Familial Hypercholesterolemia: A Novel Approach to Achilles Tendon Xanthoma. Intern Med 2021; 60:3921-3926. [PMID: 34121008 PMCID: PMC8758461 DOI: 10.2169/internalmedicine.7326-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Achilles tendon xanthoma (ATX) is one of the typical features of familial hypercholesterolemia (FH). The morphological evaluation of ATX by X-ray radiography is widely recognized; however, the utility of other imaging modalities remains unclear. We herein report two cases of FH in which Doppler ultrasound imaging demonstrated a microvascular flow in ATX that only rarely could be observed in normal Achilles tendons. Neoangiogenesis accompanies chronic inflammation and it may play an important role in the deposition of cholesterol crystals leading to ATX. In addition to the morphological evaluation of ATX, the assessment of neoangiogenesis may therefore be essential for the evaluation of ATX.
Collapse
Affiliation(s)
- Tetsu Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | | | - Osamu Wada
- Division of Physiological Laboratory, Mitsui Memorial Hospital, Japan
| | - Kai Ninomiya
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | | | - Hitomi Yuzawa
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | - Jun Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| | - Akitake Suzuki
- Division of Rheumatology, Mitsui Memorial Hospital, Japan
| | - Kazuho Ishizaki
- Division of Physiological Laboratory, Mitsui Memorial Hospital, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Japan
| |
Collapse
|
25
|
Song Y, Xing H, Zhang Z, Felix LO. Detection of Carotid Atherosclerotic Intraplaque Neovascularization Using Superb Microvascular Imaging: A Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2629-2638. [PMID: 33587302 DOI: 10.1002/jum.15652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/31/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Although superb microvascular imaging (SMI) (Toshiba/Canon, Tokyo, Japan) has enabled routine characterization of intraplaque neovascularization (IPN) features in patients with carotid stenosis, no reports have been published on the multicenter and large sample size research in this aspect. The efficacy of SMI in detecting carotid IPN has not been concluded. This study aimed to assess the efficacy of SMI comparing with contrast-enhanced carotid ultrasonography (CEUS) in the detection of carotid IPN or pathologic evaluations of IPN correlated with a history of stroke or transient ischemic attack (TIA). METHODS Web of Science, Cochrane Library, PubMed, Embase, and Scopus were searched up to August 2020 to identify peer-reviewed human studies on the diagnostic accuracy of SMI in detecting IPN. For the selected study, the correlation coefficient R and Kappa index between SMI and CEUS in detecting IPN were calculated. The correlation coefficient R between SMI in identifying IPN and pathologic evaluations of IPN and the odds ratio of IPN detected by SMI and history of stroke or TIA were also extracted. The subgroup analysis was performed to indicate the source of heterogeneity. RESULTS Our search identified 11 reports enrolling a total of 605 carotid stenosis patients. Carotid IPN detected by SMI was significantly correlated with which detected by CEUS (R, 0.89; 95% CI, 0.80-0.94; P = .00, and Kappa index, 0.73; 95% CI, 0.67-0.80; P = .00). Notably, a significant correlation was observed in SMI in detecting IPN and pathologic evaluations of IPN (R, 0.52; 95% CI, 0.40-0.62; P = .00). The odds ratio of IPN detected by SMI and history of stroke or TIA was pooled summary with statistical significance (OR, 3.33; 95% CI, 1.78-6.23; P = .00). In subgroup analysis, lower heterogeneity was associated with the degree of carotid stenosis, patients from which country, and types of equipment. CONCLUSIONS SMI and CEUS display an excellent agreement in detecting carotid IPN. IPN detected by SMI shows high consistency with pathologic evaluations of IPN. Individuals with carotid IPN are more likely to develop stroke or TIA than those without carotid IPN.
Collapse
Affiliation(s)
- Yi Song
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Hang Xing
- Division of Cardiothoracic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Zhiqi Zhang
- Division of Cardiothoracic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Lewis Oscar Felix
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, 02903, USA
| |
Collapse
|
26
|
Oura K, Yamaguchi Oura M, Itabashi R, Maeda T. Vascular Imaging Techniques to Diagnose and Monitor Patients with Takayasu Arteritis: A Review of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11111993. [PMID: 34829340 PMCID: PMC8620366 DOI: 10.3390/diagnostics11111993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022] Open
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis that causes stenosis, occlusion, and sometimes the aneurysm of the aorta and its major branches. TA often occurs in young women, and because the symptoms are not obvious in the early stages of the disease, diagnosis is difficult and often delayed. In approximately 10% to 20% of patients, TA is reportedly complicated by ischemic stroke or transient ischemic attack. It is important to diagnose TA early and provide appropriate treatment to prevent complications from stroke. Diagnostic imaging techniques to visualize arterial stenosis are widely used in clinical practice. Even if no signs of cerebrovascular events are present at the time of the most recent evaluation of patients with TA, follow-up vascular imaging is important to monitor disease progression and changes in the cerebrovascular risk. However, the optimal imaging technique for monitoring of TA has not been established. Therefore, the purpose of this review is to describe newly available evidence on the usefulness of conventional imaging modalities (digital subtraction angiography, computed tomography angiography, magnetic resonance imaging/angiography, duplex ultrasound, and positron emission tomography) and novel imaging modalities (optical coherence tomography, infrared thermography, contrast-enhanced ultrasonography, and superb microvascular imaging) in the diagnosis and monitoring of TA.
Collapse
|
27
|
Correlation between serum uric acid levels and carotid plaque neovascularisation assessed by contrast-enhanced ultrasound. Clin Radiol 2021; 76:942.e1-942.e6. [PMID: 34482988 DOI: 10.1016/j.crad.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022]
Abstract
AIM To investigate the potential impact of serum uric acid (SUA) levels on the grade of intraplaque neovascularisation (IPN) at contrast-enhanced ultrasound (CEUS). MATERIAL AND METHODS The study screened 212 patients with carotid atherosclerotic plaques using conventional ultrasound, and the patients then underwent CEUS. Based on the distribution of contrast medium microbubbles in the plaque, patients were split into three groups: 60 patients regarded as grade 0-1 (group A), 81 patients as grade 2 (group B), and 71 patients as grade 3 (group C), and SUA levels were measured on the second day after CEUS. RESULTS The frequencies of stroke were statistically different between the three groups (p<0.05). In grades 0, 1, 2, and 3, SUA levels ranged from 236.92 ± 72.75, 276.46 ± 67.31, 283.93 ± 53.85, and 384.49 ± 79.80 μmol/l, respectively. Spearman's analysis showed that the visual grade of IPN at CEUS correlated linearly with the SUA level (r=0.551, p<0.01). The difference in SUA levels between different sexes was statistically significant (p<0.05), and the differences in plaque echogenicity and diastolic blood pressure (DBP) between the three groups were also statistically significant (all p<0.05). CONCLUSIONS SUA levels correlate positively with the visual grade of IPN at CEUS, which may promote plaque vulnerability. The present results may further help to optimise therapy for vulnerable plaque and improve stroke risk stratification strategies.
Collapse
|
28
|
Zhang Y, Cao J, Zhou J, Zhang C, Li Q, Chen S, Feinstein S, Grayburn PA, Huang P. Plaque Elasticity and Intraplaque Neovascularisation on Carotid Artery Ultrasound: A Comparative Histological Study. Eur J Vasc Endovasc Surg 2021; 62:358-366. [PMID: 34266763 DOI: 10.1016/j.ejvs.2021.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/12/2021] [Accepted: 05/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Plaque elasticity and intraplaque neovascularisation are strongly suggestive of vulnerable plaque. This study aimed to investigate the relationship between intraplaque neovascularisation and plaque elasticity, and to compare the ultrasound findings with histopathological changes. METHODS Patients enrolled in this study presented with symptomatic carotid stenosis (> 70%) and later underwent both pre-operative ultrasonography and endarterectomy. Contrast enhanced ultrasound (CEUS) and shear wave elastography (SWE) were used to measure the neovascularisation and elasticity of the plaque, respectively. After removal, plaques were histologically assessed to determine the microvessel density (MVD), matrix metalloproteinase (MMP)-9 expression, and type I/type III collagen ratio using immunohistochemistry staining and morphometry. A correlation analysis was used to establish the relationship among the aforementioned quantitative parameters. Inter- and intra-observer consistency evaluations were performed using the intraclass correlation coefficient and Bland-Altman plots. RESULTS Ninety-four symptomatic patients with 98 plaques were included. The area under the curve (AUC) of the carotid plaque detected using CEUS correlated with its shear wave velocity (SWV) (r = -.714; p < .001), MVD (r = .842; p < .001), collagen type I/III ratio (r = -.833; p < .001), and MMP-9 (r = .738; p < .001). SWE was positively correlated with the type I/III collagen ratio (r = .805; p < .001). The overall interexaminer consistency of the SWE was acceptable (r = .638; p < .001). The interobserver correlation coefficient of the AUC, time to peak (TP), mean transit time (MTT), and SWV were .719, .756, .733, and .686, respectively. The intra-observer variability values of the AUC, TP, MTT, and SWV were .826, .845, .633, and .748, respectively. CONCLUSION SWE and CEUS can comprehensively evaluate the vulnerability of the carotid plaque by assessing the elasticity of the plaque and neovascularisation within it. The negative correlation between the intraplaque neovascularisation and elasticity, further validated by histological findings, suggests that the more abundant the neovascularisation, the less elasticity.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jing Cao
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jingyi Zhou
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Chao Zhang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Qunying Li
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Shuyuan Chen
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Steven Feinstein
- Echocardiography Section of Cardiology, Rush University Medical Centre, Chicago, IL, USA
| | - Paul A Grayburn
- Department of Internal Medicine, Division of Cardiology, Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.
| |
Collapse
|
29
|
Li H, Xu X, Luo B, Zhang Y. The Predictive Value of Carotid Ultrasonography With Cardiovascular Risk Factors-A "SPIDER" Promoting Atherosclerosis. Front Cardiovasc Med 2021; 8:706490. [PMID: 34447790 PMCID: PMC8382941 DOI: 10.3389/fcvm.2021.706490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022] Open
Abstract
Insufficient recommendations do not support the clinical use of carotid ultrasonography for further risk stratification in moderate-to-high risk patients with cardiovascular disease (CVD). A literature review was performed to assess six aspects of the research progress and limitations of carotid ultrasonography and carotid atherosclerosis-related risk factors: (1) structures of the carotid intima and media; (2) plaques; (3) inflammation; (4) dynamics of carotid blood flow; (5) early detection and intervention; and (6) risk factors for CVD. Although carotid intima-media thickness and carotid plaques are well-acknowledged independent predictors of CVD risk, normative and cut-off values are difficult to define due to the heterogeneous measurements reported in previous studies. Plaque properties, including location, number, density, and size, become more important risk predictors for cardiovascular disease, but a better approach for clinical use needs to be further established. Three-dimensional ultrasound and contrast-enhanced ultrasound are promising for promoting risk stratification with more details on plaque morphology. Moreover, inflammatory diseases and biomarkers should be evaluated for a full assessment of the inflammatory burden for atherosclerosis. Carotid flow velocity is not only an indicator for stenosis but also a potential risk predictor. Carotid atherosclerosis should be detected and treated early, and additional clinical trials are needed to determine the efficacy of these measures in reducing CVD risk. Cardiovascular risk factors tend to affect carotid plaques, and early treat-to-target therapy might yield clinical benefits. Based on the aforementioned six aspects, we consider that these six important factors act like a “SPIDER” spinning the web of atherosclerosis; a timely comprehensive assessment and intervention may halt the progression to CVD. Carotid ultrasound results should be combined with other atherosclerotic factors, and a comprehensive risk assessment may help to guide cardiovascular prevention decisions.
Collapse
Affiliation(s)
- Hongwei Li
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuling Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| |
Collapse
|
30
|
Cai S, Wang H, Zhang X, Zhang L, Zhu Q, Sun Q, Li J, Jiang Y. Superb Microvascular Imaging Technology Can Improve the Diagnostic Efficiency of the BI-RADS System. Front Oncol 2021; 11:634752. [PMID: 34249681 PMCID: PMC8263934 DOI: 10.3389/fonc.2021.634752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 06/08/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To explore whether superb microvascular imaging (SMI)SMI can improve the diagnostic efficiency by evaluating the vascular index (VI) and vascular architecture (VA) in breast lesions. METHODS This is a retrospective study of data collected prospectively for research use. Taking 225 consecutive cases of breast lesions from November 2016 to December 2017 as a training set, the VI values and VA types of benign and malignant lesions were calculated based on the pathological results. Taking 238 consecutive cases of breast lesions from January 2018 to October 2018 as the verification set, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated to compare the diagnostic efficacy. RESULTS The training set included 225 breast lesions and the validation set 238 breast lesions. The VI value in the malignant group (10.3 ± 8.0) was significantly higher than that in the benign group (4.3 ± 5.0)(P<0.001). A VI value of 4.05 was used as the diagnostic threshold for differentiating benign from malignant lesions, with a sensitivity of 80.5%, a specificity of 61.9%, an accuracy of 71.1%, a PPV of 62.9%, a NPV of 76.9%, and an area under the curve of 0.758 (0.696-0.819). There was a significant difference in the types of benign and malignant VA (P < 0.001), and the PPV of the root hair-like and crab claw-like VAs were 93.9% and 100.0%, respectively. The diagnostic sensitivity, specificity, accuracy, PPV, NPV and area under the AUC curve were 58.0%, 98.2%, 97.0%, 70.3% and 0.781, respectively (95%CI: 0.719-0.844). SMI combined with conventional ultrasound improved the diagnostic specificity (70.0% vs. 90.0%), accuracy (87.4% vs. 96.6%), and PPV (82.5% vs. 93.2%) without decreasing the diagnostic sensitivity (99.3%), yielded higher diagnostic performance with the area under the ROC curve was 0.941 (95%CI: 0904-0.979) compared with conventional US alone (P < 0.001). CONCLUSION A VI value 4.05 is a cut-off value with good diagnostic efficacy. The residual root-like and crab claw-like VAs are the characteristic VAs of malignant lesions. Conventional ultrasound combined with the VI and VA can improve the diagnostic specificity, accuracy and PPV without reducing the diagnostic sensitivity.
Collapse
Affiliation(s)
- Siman Cai
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongyan Wang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoyan Zhang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qingli Zhu
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuxin Jiang
- Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| |
Collapse
|
31
|
Xia S, Qiu W, Cai A, Kong B, Xu L, Wu Z, Li L. The association of lipoprotein(a) and intraplaque neovascularization in patients with carotid stenosis: a retrospective study. BMC Cardiovasc Disord 2021; 21:285. [PMID: 34107870 PMCID: PMC8190836 DOI: 10.1186/s12872-021-02038-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Lipoprotein(a) is genetically determined and increasingly recognized as a major risk factor for arteriosclerotic cardiovascular disease. We examined whether plasma lipoprotein(a) concentrations were associated with intraplaque neovascularization (IPN) grade in patients with carotid stenosis and in terms of increasing plaque susceptibility to haemorrhage and rupture. Methods We included 85 patients diagnosed with carotid stenosis as confirmed using carotid ultrasound who were treated at Guangdong General Hospital. Baseline data, including demographics, comorbid conditions and carotid ultrasonography, were recorded. The IPN grade was determined using contrast-enhanced ultrasound through the movement of the microbubbles. Univariate and multivariate binary logistic regression analyses were used to evaluate the association between lipoprotein(a) and IPN grade, with stepwise adjustment for covariates including age, sex, comorbid conditions and statin therapy (model 1), total cholesterol, triglyceride, low-density lipoprotein cholesterol calculated by Friedwald's formula, high-density lipoprotein cholesterol, apolipoprotein A and apolipoprotein B (model 2), maximum plaque thickness and total carotid maximum plaque thickness, degree of carotid stenosis and internal carotid artery (ICA) occlusion (model 3). Results Lipoprotein(a) was a significant predictor of higher IPN grade in binary logistic regression before adjusting for other risk factors (odds ratio [OR] 1.238, 95% confidence interval [CI] (1.020, 1.503), P = 0.031). After adjusting for other risk factors, lipoprotein(a) still remained statistically significant in predicting IPN grade in all model. (Model 1: OR 1.333, 95% CI 1.074, 1.655, P = 0.009; Model 2: OR 1.321, 95% CI 1.059, 1.648, P = 0.014; Model 3: OR 1.305, 95% CI 1.045, 1.628, P = 0.019). Lp(a) ≥ 300 mg/L is also significantly related to IPN compare to < 300 mg/L (OR 2.828, 95% CI 1.055, 7.580, P = 0.039) as well as in model 1, while in model 2 and model 3 there are not significant difference. Conclusions Plasma lipoprotein(a) concentrations were found to be independently associated with higher IPN grade in patients with carotid stenosis. Lowering plasma lipoprotein(a) levels may result in plaque stabilization by avoiding IPN formation.
Collapse
Affiliation(s)
- Shuang Xia
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 of Zhongshan 2nd Road, Guangzhou, 510100, Guangdong, China
| | - Weida Qiu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 of Zhongshan 2nd Road, Guangzhou, 510100, Guangdong, China
| | - Bo Kong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 of Zhongshan 2nd Road, Guangzhou, 510100, Guangdong, China
| | - Lan Xu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 of Zhongshan 2nd Road, Guangzhou, 510100, Guangdong, China
| | - Zejia Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 of Zhongshan 2nd Road, Guangzhou, 510100, Guangdong, China
| | - Liwen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 of Zhongshan 2nd Road, Guangzhou, 510100, Guangdong, China.
| |
Collapse
|
32
|
Chiba T, Fujiwara S, Oura K, Oikawa K, Chida K, Kobayashi M, Yoshida K, Kubo Y, Maeda T, Itabashi R, Ogasawara K. Superb Microvascular Imaging Ultrasound for Cervical Carotid Artery Stenosis for Prediction of the Development of Microembolic Signals on Transcranial Doppler during Carotid Exposure in Endarterectomy. Cerebrovasc Dis Extra 2021; 11:61-68. [PMID: 34034253 PMCID: PMC8215948 DOI: 10.1159/000516426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction During exposure of the carotid arteries, embolism from the surgical site is recognized as a primary cause of neurological deficits or new cerebral ischemic lesions following carotid endarterectomy (CEA), and associations have been reported between histological neovascularization in the carotid plaque and both plaque vulnerability and the development of artery-to-artery embolism. Superb microvascular imaging (SMI) enables accurate visualization of neovessels in the carotid plaque without the use of intravenous contrast. This study aimed to determine whether preoperative SMI ultrasound for cervical carotid artery stenosis predicts the development of microembolic signals (MES) on transcranial Doppler (TCD) during exposure of the carotid arteries in CEA. Methods Preoperative cervical carotid artery SMI ultrasound followed by CEA under TCD monitoring of MES in the ipsilateral middle cerebral artery was conducted in 70 patients previously diagnosed with internal carotid artery stenosis (defined as ≥70%). First, observers visually identified intraplaque microvascular flow (IMVF) signals as moving enhancements located near the surface of the carotid plaque within the plaque on SMI ultrasonograms. Next, regions of interest (ROI) were manually placed at the identified IMVF signals (or at arbitrary places within the plaque when no IMVF signals were identified within the carotid plaque) and the carotid lumen, and time-intensity curves of the IMVF signal and lumen ROI were generated. Ten heartbeat cycles of both time-intensity curves were segmented into each heartbeat cycle based on gated electrocardiogram findings and averaged with respect to the IMVF signal and lumen ROI. The difference between the maximum and minimum intensities (ID) was calculated based on the averaged IMVF signal (ID<sub>IMVF</sub>) and lumen (ID<sub>l</sub>) curves. Finally, the ratio of ID<sub>IMVF</sub> to ID<sub>l</sub> was calculated. Results MES during exposure of the carotid arteries were detected in 17 patients (24%). The incidence of identification of IMVF signals was significantly greater in patients with MES (94%) than in those without (57%; p = 0.0067). The ID<sub>IMVF</sub>/ID<sub>l</sub> ratio was significantly greater in patients with MES (0.108 ± 0.120) than in those without (0.017 ± 0.042; p < 0.0001). The specificity and positive predictive value for the ID<sub>IMVF</sub>/ID<sub>l</sub> ratio for prediction of the development of MES were significantly higher than those for the identification of IMVF signals. Logistic regression analysis revealed that only the ID<sub>IMVF</sub>/ID<sub>l</sub> ratio was significantly associated with the development of MES (95% CI 101.1–3,628.9; p = 0.0048). Conclusion Preoperative cervical carotid artery SMI ultrasound predicts the development of MES on TCD during exposure of the carotid arteries in CEA.
Collapse
Affiliation(s)
- Takayuki Chiba
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kazumasa Oura
- Department of Neurology and Gerontology, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kohki Oikawa
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kokei Chida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Tetsuya Maeda
- Department of Neurology and Gerontology, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Ryo Itabashi
- Department of Neurology and Gerontology, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| |
Collapse
|
33
|
Iannuzzi A, Rubba P, Gentile M, Mallardo V, Calcaterra I, Bresciani A, Covetti G, Cuomo G, Merone P, Di Lorenzo A, Alfieri R, Aliberti E, Giallauria F, Di Minno MND, Iannuzzo G. Carotid Atherosclerosis, Ultrasound and Lipoproteins. Biomedicines 2021; 9:biomedicines9050521. [PMID: 34066616 PMCID: PMC8148516 DOI: 10.3390/biomedicines9050521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022] Open
Abstract
Carotid artery plaques are considered a measure of atherosclerosis and are associated with an increased risk of atherosclerotic cardiovascular disease, particularly ischemic strokes. Monitoring of patients with an elevated risk of stroke is critical in developing better prevention strategies. Non-invasive imaging allows us to directly see atherosclerosis in vessels and many features that are related to plaque vulnerability. A large body of evidence has demonstrated a strong correlation between some lipid parameters and carotid atherosclerosis. In this article, we review the relationship between lipids and atherosclerosis with a focus on carotid ultrasound, the most common method to estimate atherosclerotic load.
Collapse
Affiliation(s)
- Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
- Correspondence:
| | - Paolo Rubba
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Marco Gentile
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Vania Mallardo
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Ilenia Calcaterra
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Alessandro Bresciani
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
| | - Giuseppe Covetti
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Pasquale Merone
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Roberta Alfieri
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Emilio Aliberti
- North Tees University Hospital, Stockton-on Tees TS19 8PE, UK;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Matteo Nicola Dario Di Minno
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Gabriella Iannuzzo
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| |
Collapse
|
34
|
Sato W, Suto Y, Yamanaka T, Watanabe H. An advanced ultrasound application used to assess peripheral vascular diseases: superb microvascular imaging. J Echocardiogr 2021; 19:150-157. [PMID: 33856650 DOI: 10.1007/s12574-021-00527-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
Over the past several years, a novel ultrasound imaging modality termed superb microvascular imaging (SMI) has enabled visualization of microvessels. SMI ultrasound studies of peripheral artery diseases have significantly extended our knowledge of tissue microcirculation and the arterial microenvironments of atherosclerotic lesions. We here present an overview of current knowledge on the utility of SMI assessment of vascular diseases and highlight certain peripheral microcirculation disorders for which SMI is particularly valuable. The evidence indicates that SMI can detect intraplaque neovascularization and usefully assess carotid plaque vulnerability; vascularization of the carotid arterial wall detected by SMI is a potential marker of disease activity in patients with Takayasu arteritis; SMI reveals the foot microcirculation and yields a quantitative vascular index (in line with the angiosome concept); and, SMI may serve as an auxiliary diagnostic modality for hereditary hemorrhagic telangiectasia and Raynaud syndrome. In general, microcirculatory evaluation by SMI is an attractive field for future research on therapeutic strategies for peripheral vascular diseases.
Collapse
Affiliation(s)
- Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Yuta Suto
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Takayuki Yamanaka
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan.
| |
Collapse
|
35
|
Nas OF, Kandemirli SG, Erdemli Gursel B, Bilgin C, Korkmaz B, Yolgosteren A, Inecikli MF. Diagnostic utility of superb microvascular imaging in depiction of corkscrew collaterals in Buerger's disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:129-134. [PMID: 32557645 DOI: 10.1002/jcu.22880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/07/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To evaluate the corkscrew collaterals in Buerger's disease by superb microvascular imaging (SMI) and power Doppler ultrasonography (PDU). METHODS We evaluated with SMI and PDU 14 patients with Buerger's disease in whom corkscrew collaterals had been identified on digital subtraction angiography (DSA). Corkscrew collaterals were classified on DSA and PDU based on their size and morphology. RESULTS A total of 17 vascular regions of collateral vessel formation were assessed. Based on DSA classification, there were three cases of type I collaterals (arterial diameter of >2 mm with large helical pattern), seven cases of type III collaterals (arterial diameter of 1-1.5 mm with small helical pattern), and seven cases of type IV collaterals (arterial diameter of <1 mm with tiny helical pattern). On PDU, all type I collaterals on DSA appeared as "large snake" images, all type III collaterals on DSA appeared as "small snake" images, and all type IV collaterals on DSA appeared as dots. SMI imaging, both in color and monochrome mode, provided superior demonstration of the continuity of the vessel of large or small "snake" images. In cases appearing as dot pattern on PDU, color SMI was able to show continuity of the flow signal as a helical pattern. DISCUSSION SMI is a promising new Doppler imaging technique that is superior to conventional power Doppler imaging in depiction and identification of corkscrew collaterals in Buerger's disease.
Collapse
Affiliation(s)
- Omer Fatih Nas
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Sedat Giray Kandemirli
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | | | - Cem Bilgin
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Baris Korkmaz
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Atif Yolgosteren
- Faculty of Medicine, Department of Cardiovascular Surgery, Uludag University, Bursa, Turkey
| | | |
Collapse
|
36
|
Li Y, Zheng S, Zhang J, Wang F, Liu X, He W. Advance ultrasound techniques for the assessment of plaque vulnerability in symptomatic and asymptomatic carotid stenosis: a multimodal ultrasound study. Cardiovasc Diagn Ther 2021; 11:28-38. [PMID: 33708475 DOI: 10.21037/cdt-20-876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Advanced carotid ultrasound techniques may be useful in characterizing plaque vulnerability, but comprehensive studies are still lacking. The aim of this study was to identify factors associated with vulnerable plaques using advanced ultrasound techniques. Methods This is a prospective observational study of patients with >50% internal carotid stenosis (ICA). All patients underwent conventional ultrasound, superb microvascular imaging (SMI) and shear wave elastography (SWE) examinations. Plaque size, echogenicity, stiffness and intraplaque neovascularization (IPN) were assessed and compared between symptomatic and asymptomatic groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SWE and SMI of the vulnerable plaques. Results The final analysis included 123 patients (78.9% male; mean age, 66±8 years), 65 were enrolled in the symptomatic group, and 58 were enrolled in the asymptomatic group. The mean elasticity was 78.1±25.4 kPa for asymptomatic and 51.5±18.3 kPa for symptomatic plaques. Symptomatic plaques showed higher visual IPN grades on SMI than asymptomatic plaques (P<0.001). Multivariate regression analysis showed that plaque stiffness (PS) (OR 0.95, 95% CI, 0.919-0.974) and IPN level (OR 4.17, 95% CI, 2.008-8.664) were independently associated with symptomatic plaques. The combination of the two factors had a preferable accuracy to discriminate symptomatic plaques (AUC 0.89, 95% CI, 0.827-0.944). Conclusions Advanced carotid ultrasound techniques can identify plaque characteristics that are associated with ischemic events and may be potentially indicative of plaque vulnerability. These factors may ultimately be used in the clinical management of carotid stenosis.
Collapse
Affiliation(s)
- Yi Li
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Shuai Zheng
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Jinghan Zhang
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Fumin Wang
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Xinyao Liu
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Wen He
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| |
Collapse
|
37
|
Mantella LE, Liblik K, Johri AM. Vascular imaging of atherosclerosis: Strengths and weaknesses. Atherosclerosis 2021; 319:42-50. [PMID: 33476943 DOI: 10.1016/j.atherosclerosis.2020.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022]
Abstract
Atherosclerosis is an inflammatory disease that can lead to several complications such as ischemic heart disease, stroke, and peripheral vascular disease. Therefore, researchers and clinicians rely heavily on the use of imaging modalities to identify, and more recently, quantify the burden of atherosclerosis in the aorta, carotid arteries, coronary arteries, and peripheral vasculature. These imaging techniques vary in invasiveness, cost, resolution, radiation exposure, and presence of artifacts. Consequently, a detailed understanding of the risks and benefits of each technique is crucial prior to their introduction into routine cardiovascular screening. Additionally, recent research in the field of microvascular imaging has proven to be important in the field of atherosclerosis. Using techniques such as contrast-enhanced ultrasound and superb microvascular imaging, researchers have been able to detect blood vessels within a plaque lesion that may contribute to vulnerability and rupture. This paper will review the strengths and weaknesses of the various imaging techniques used to measure atherosclerotic burden. Furthermore, it will discuss the future of advanced imaging modalities as potential biomarkers for atherosclerosis.
Collapse
Affiliation(s)
- Laura E Mantella
- Department of Biomedical and Molecular Sciences, Queen's University, 18 Stuart Street, K7L 3N6, Kingston, ON, Canada
| | - Kiera Liblik
- Department of Medicine, Cardiovascular Imaging Network at Queen's University, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada
| | - Amer M Johri
- Department of Biomedical and Molecular Sciences, Queen's University, 18 Stuart Street, K7L 3N6, Kingston, ON, Canada; Department of Medicine, Cardiovascular Imaging Network at Queen's University, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada.
| |
Collapse
|
38
|
Zhou Y, Wang C. Superb microvascular imaging for detecting neovascularization of carotid plaque compared with contrast-enhanced ultrasound: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e21907. [PMID: 32871924 PMCID: PMC7458249 DOI: 10.1097/md.0000000000021907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Superb microvascular imaging (SMI) is a novel Doppler technique that depicts low velocity blood flow without the use of a contrast agent. Studies suggested that SMI may or may not detect neovascularization of carotid plaque with accuracy comparable to contrast-enhanced ultrasound. To gain clarity, a meta-analysis to systematically review and synthesize relevant data on the SMI for the detection of intraplaque neovascularization was undertaken. METHODS We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the June 31, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS This systematic review will investigate whether SMI is feasible on the detection of intraplaque neovascularization compared with contrast-enhanced ultrasound. CONCLUSION Its findings will provide helpful evidence for the feasibility of SMI on the detection of intraplaque neovascularization. SYSTEMATIC REVIEW REGISTRATION INPLASY202070097.
Collapse
|
39
|
Lyu Q, Tian X, Ding Y, Yan Y, Huang Y, Zhou P, Hui P. Evaluation of Carotid Plaque Rupture and Neovascularization by Contrast-Enhanced Ultrasound Imaging: an Exploratory Study Based on Histopathology. Transl Stroke Res 2020; 12:49-56. [PMID: 32601933 DOI: 10.1007/s12975-020-00825-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022]
Abstract
A significant portion of ischemic stroke is on account of emboli caused by fibrous cap rupture of vulnerable plaque with intraplaque neovascularization as a significant triggering factor to plaque vulnerability. Contrast-enhanced ultrasound (CEUS) could offer detailed information on plaque surface and intraplaque microvascular. This study aims to comprehensively assess the value of CEUS for the detection of plaque rupture and neovascularization in histologically verified plaques that had been removed from the patients who had undergone carotid endarterectomy (CEA). Fifty-one consecutive subjects (mean age, 67.0 ± 6.5 years; 43 [84.3%] men) scheduled for CEA were recruited. Standard ultrasound and CEUS were performed prior to surgery. Based on the direction of the contrast agents that diffuse within the plaques, plaques were divided as "inside-out" direction (contrast agents diffuse from the artery lumen towards the inside of the plaque) and non-inside-out direction. Plaque enhancement was assessed by using a semi-quantitative grading scale (grade 1: no enhancement; grade 2: moderate enhancement; grade 3: extensive enhancement). Plaques were evaluated for histopathologic characteristics according to Oxford Plaque Study (OPS) standard postoperative. Intraplaque neovascularization as manifested by the appearance of CD34-positive microvessels was characterized in terms of microvessel density (MVD), microvessel area (MVA), and microvessel shape (MVS). In 51 plaques, the sensitivity, specificity, positive, and negative predictive values of contrast agent inside-out direction diffusion for the detection of plaque fibrous cap rupture were 87.5%, 92.6%, 91.3%, and 89.3%, respectively. The incidence of cap rupture was significantly higher in contrast agent inside-out direction diffusion than non-inside-out direction diffusion (73.9% vs 25.0%, p < 0.001), and inside-out direction diffusion did exhibit higher frequency of vulnerable plaques (OPS grades 3-4) (95.7% vs 53.6%, p = 0.001). Multivariate logistic regression analysis revealed the contrast agent inside-out direction diffusion as an independent correlate to plaque rupture (OR 8.5, 95% CI 2.4-30.1, p = 0.001). With increasing plaque enhancement, plaque MVD (p < 0.001), plaque MVA (p = 0.012), and percentage of highly irregular-shaped microvessels increased (p < 0.001). Contrast agent inside-out direction diffusion could indicate plaque rupture. The increase in plaque enhancement paralleled increased, larger, and more irregular-shaped microvessels, which may suggest an increased risk of plaque vulnerability.
Collapse
Affiliation(s)
- Qi Lyu
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Xiaojie Tian
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Yafang Ding
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Yanhong Yan
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Yabo Huang
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Peng Zhou
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China.
| |
Collapse
|
40
|
Bogiatzi C, Azarpazhooh MR, Spence JD. Choosing the right therapy for a patient with asymptomatic carotid stenosis. Expert Rev Cardiovasc Ther 2020; 18:53-63. [PMID: 32043917 DOI: 10.1080/14779072.2020.1729127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Most patients with asymptomatic carotid stenosis (ACS) now have a lower risk with intensive medical therapy than with stenting (CAS) or endarterectomy (CEA); the annual risk of stroke or death with intensive medical therapy is ~ 0.5%, vs. a periprocedural risk with CAS of ~ 2.5-4.1% with CAS, and ~ 1.4-1.8% with CEA. The excess risk of CAS is greater in older patients.Areas covered: Discussed are the need for intensive medical therapy, the nature of intensive medical therapy, approaches to identifying the few patients with ACS who could benefit from CEA or CAS, and which patients would be better suited to CEA vs. CAS.Expert opinion: All patients with ACS are at high risk of cardiovascular events, soshould receive intensive medical therapy including lifestyle modification, intensive lipid-lowering, B vitamins to lower homocysteine (using methylcobalamin rather than cyanocobalamin), and appropriate antithrombotic therapy. High-risk patients who could benefit from intervention can be identified by clinical and imaging features including transcranial Doppler embolus detection, ulceration, intraplaque hemorrhage, reduced cerebrovascular reserve, plaque echolucency, silent infarction on brain imaging, and progression of stenosis. Most patients whose risk of stroke warrants intervention would be better treated with CEA than with CAS.
Collapse
Affiliation(s)
- Chrysi Bogiatzi
- Department of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - M Reza Azarpazhooh
- Department of Clinical Neurological Sciences (Neurology), Western University, London, Ontario, Canada
| | - J David Spence
- Departments of Clinical Neurological Sciences (Neurology) and Internal Medicine (Clinical Pharmacology), Robarts Research Institute, London, Ontario, Canada
| |
Collapse
|
41
|
Zamani M, Skagen K, Scott H, Russell D, Skjelland M. Advanced ultrasound methods in assessment of carotid plaque instability: a prospective multimodal study. BMC Neurol 2020; 20:39. [PMID: 31996153 PMCID: PMC6990506 DOI: 10.1186/s12883-020-1620-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 01/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background A significant proportion of ischemic strokes are caused by emboli from atherosclerotic, unstable carotid artery plaques. The selection of patients for endarterectomy in current clinical practice is primarily based on the degree of carotid artery stenosis and clinical symptoms. However, the content of the plaque is known to be more important for stroke risk. Intraplaque neovascularization (IPN) has recently emerged as a possible surrogate marker for plaque instability. Neo-microvessels from the adventitial vasa vasorum grow into the full thickness of the vessel wall in an adaptive response to hypoxia, causing subsequent intraplaque haemorrhage and plaque rupture. Conventional ultrasound cannot detect IPN. Contrast-enhanced ultrasound and Superb Microvascular Imaging (SMI), have, however, shown promise in IPN assessment. Recent research using Shear Wave Elastography (SWE) has also reported reduced tissue stiffness in the artery wall (reduced mean Young’s modulus) in unstable compared to stable plaques. The purpose of this study is to identify unstable carotid artery plaques at risk of rupture and future ischemic stroke risk using multimodal assessments. Methods Forty five symptomatic and 45 asymptomatic patients > 18 years, with > 50% carotid stenosis referred to Oslo University Hospital ultrasound lab will be included in this on-going project. Patients will undergo contrast enhanced ultrasound, SMI, carotid-MRI and PET-(18F-FDG). Contrast enhanced ultrasound will be analyzed semi-quantitatively (5-levels visual classification) and quantitatively by plotting time-intensity curve analyses to obtain plaque peak contrast enhancement intensity. Plaques removed at carotid endarterectomy will be assessed histologically and the number of microvessels, areas of inflammation, granulation, calcification, lipid and fibrosis will be measured. Discussion This multimodality study will primarily provide information on the clinical value of advanced ultrasound methods (SMI, SWE) for the detection of unstable carotid artery plaque in comparison with other methods including contrast-enhanced ultrasound, carotid-MRI and PET-(18F-FDG) using histology as the gold standard. Secondly, findings from the methods mentioned above will be related to cerebrovascular symptoms, blood tests (leukocytes, CRP, ESR, lipoproteins and inflammatory markers) and cardiovascular risk factors at inclusion and at 1-year follow-up. The overall aim is to optimize detection of plaque instability which can lead to better preventive decisions and reduced stroke rate.
Collapse
Affiliation(s)
- M Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway. .,Department of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - K Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H Scott
- Department of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pathology, Oslo University Hospital, Rikshospitalet, Norway
| | - D Russell
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
42
|
Zamani M, Skagen K, Russell D, Skjelland M. Response by Zamani et al to Letter Regarding Article, “Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media”. Stroke 2020; 51:e12. [DOI: 10.1161/strokeaha.119.027944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mahtab Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - David Russell
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| |
Collapse
|
43
|
Zhu X, Ding C. Letter by Zhu and Ding Regarding Article, "Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media". Stroke 2020; 51:e11. [PMID: 31813357 DOI: 10.1161/strokeaha.119.027872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xiaoxia Zhu
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, P.R. China
| | - Chandong Ding
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, P.R. China
| |
Collapse
|