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Wang Z, Zhang P. Novel imaging modalities for the identification of vulnerable plaques. Front Cardiovasc Med 2024; 11:1450252. [PMID: 39328242 PMCID: PMC11424440 DOI: 10.3389/fcvm.2024.1450252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/26/2024] [Indexed: 09/28/2024] Open
Abstract
Atherosclerosis is a slow, progressive disease that is closely associated with major adverse cardiovascular events. Early diagnosis and risk assessment of atherosclerosis can effectively improve the prognosis and reduce the occurrence of adverse cardiovascular events in the later stage. A variety of invasive and non-invasive imaging modalities are important tools for diagnosing lesions, monitoring the efficacy of treatments, and predicting associated risk events. This review mainly introduces the four commonly used non-invasive imaging modalities in clinical practice and intravascular imaging such as optical coherence tomography, intravascular ultrasound imaging, and near-infrared spectroscopy, compares the advantages and disadvantages in the diagnosis of vulnerable plaques, and briefly summarizes the new progressions of each.
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Mai V, Taneja A, Larjava H, Chehroudi B, MacDonald D, Luong C. Calcified carotid artery atheroma on standard dental radiographs: A public health opportunity for cardiovascular risk reduction. Am J Prev Cardiol 2024; 19:100714. [PMID: 39206343 PMCID: PMC11350465 DOI: 10.1016/j.ajpc.2024.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/14/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Objective Calcified carotid artery atheroma (CCAA) can be identified incidentally on standard dental panoramic radiographs (DPRs). We sought to (1) determine the prevalence of CCAA on DPRs in a general dental population and (2) establish the proportion of patients in whom this would represent a new statin-indicated condition. Methods We identified patients aged ≥30 with DPRs from 2019 to 2021 from the University of British Columbia Dental Clinic. Patient charts were reviewed for use of lipid-lowering therapies (LLT) and existing statin-indicated conditions. DPRs for each patient were evaluated for the presence and characteristics of CCAA. Results Of 921 patients with a DPR and documented medical history, 548 (59.5 %) were diagnostic for evaluation of CCAA. Although 116/548 (21.2 %) of these patients had evidence of CCAA, only 25.9 % (30/116) were already on LLT; another 20.7 % (24/116) of patients with CCAA had a pre-existing statin-indicated condition but were not on LLT. Therefore, in 53.4 % (62/116) of patients with CCAA-positive DPRs, this constituted a new diagnosis of atherosclerosis not yet treated with LLT, representing 6.7 % (62/921) of the clinic population and 11.3 % of individuals with DPRs of diagnostic quality (62/548). Dyslipidemia, hypertension, coronary artery disease, diabetes, atrial fibrillation, stroke/transient ischemic attack, older age, and male sex were all found to be significant predictors of CCAA. Conclusion CCAA is a common finding among patients with DPRs and in over half of cases, the presence of CCAA represents a new diagnosis of atherosclerosis. The high prevalence of new, untreated atherosclerosis in this population indicates an opportunity for risk factor modification and collaboration between dentists and physicians to optimize patient care.
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Affiliation(s)
- Vicky Mai
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
| | - Aneesha Taneja
- University of British Columbia, Division of Periodontics, Vancouver, BC, Canada
| | - Hannu Larjava
- University of British Columbia, Division of Periodontics, Vancouver, BC, Canada
| | - Babak Chehroudi
- University of British Columbia, Division of Periodontics, Vancouver, BC, Canada
| | - David MacDonald
- University of British Columbia, Division of Oral & Maxillofacial Radiology, Vancouver, BC, Canada
| | - Christina Luong
- University of British Columbia, Division of Cardiology, Vancouver, BC, Canada
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Zhuo J, Wang L, Li R, Li Z, Zhang J, Xu Y. Identification of symptomatic carotid artery plaque: a predictive model combining angiography with optical coherence tomography. Front Neurol 2024; 15:1445227. [PMID: 39281411 PMCID: PMC11392725 DOI: 10.3389/fneur.2024.1445227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/22/2024] [Indexed: 09/18/2024] Open
Abstract
Objective Symptomatic carotid artery disease is indicative of an elevated likelihood of experiencing a subsequent stroke, with the morphology of plaque and its specific features being closely linked to the risk of stroke occurrence. Our study based on the characteristics of carotid plaque assessed by optical coherence tomography (OCT), the plaque morphology evaluated by digital subtraction angiography (DSA) and clinical laboratory indicators were combined, develop a combined predictive model to identify symptomatic carotid plaque. Methods Patients diagnosed with carotid atherosclerotic stenosis who underwent whole-brain DSA and OCT examination at the Affiliated Hospital of Jining Medical University from January 2021 to November 2023 were evaluated. Clinical features, as well as DSA and OCT plaque characteristics, were analyzed for differences between symptomatic and asymptomatic cohorts. An analysis of logistic regression was carried out to identify factors associated with the presence of symptomatic carotid plaque. A multivariate binary logistic regression equation was established with the odds ratio (OR) serving as the risk assessment parameter. The receiver operating characteristic curve was utilized to assess the combined predictive model and independent influencing factors. Results A total of 52 patients were included in the study (symptomatic: 44.2%, asymptomatic: 55.8%). Symptomatic carotid stenosis was significantly linked to four main factors: low-density lipoprotein-cholesterol >3.36 mmol/L [OR, 6.400; 95% confidence interval (CI), 1.067-38.402; p = 0.042], irregular plaque (OR, 6.054; 95% CI, 1.016-36.083; p = 0.048), ruptured plaque (OR, 6.077; 95% CI, 1.046-35.298; p = 0.048), and thrombus (OR, 6.773; 95% CI, 1.194-38.433; p = 0.044). The combined predictive model generated using four indicators showed good discrimination (Area Under Curve, 0.924; 95% CI, 0.815-0. 979). The p value was <0.05 with 78.26% sensitivity and 93.10% specificity. Conclusion OCT is valuable in evaluating the plaque characteristics of carotid atherosclerotic stenosis. The combined predictive model comprising low-density lipoprotein-cholesterol >3.36 mmol/L, irregular plaque, ruptured plaque, and thrombus could help in the detection of symptomatic carotid plaque. Further research conducted on additional independent cohorts is necessary to confirm the clinical significance of the predictive model for symptomatic carotid plaque.
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Affiliation(s)
- Jun Zhuo
- Medical Engineering and Technology Research Center, School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
- Medical Science and Technology Innovation Center, Institute of Medical Engineering and Interdisciplinary Research, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lin Wang
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ruolin Li
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhiyuan Li
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Junhu Zhang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yunjian Xu
- Medical Engineering and Technology Research Center, School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
- Medical Science and Technology Innovation Center, Institute of Medical Engineering and Interdisciplinary Research, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Gao H, Zhao L, Cao X, Zhang G. Differential miR-195-5p and its potential role during the development of carotid artery stenosis. Vascular 2024:17085381241273320. [PMID: 39140317 DOI: 10.1177/17085381241273320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Carotid artery stenosis (CAS) is a leading cause of cerebral ischemic events (CIE). Timely detection and risk assessment can aid in managing CAS patients and improving their prognosis. The aim of the current study is to identify a new biomarker for CAS and to further investigate the impact of miR-195-5p on cellular processes in vascular smooth muscle cells (VSMCs). METHODS This study involved 112 CAS patients and 65 healthy individuals. Serum miR-195-5p levels were measured using RT-qPCR. The ROC curve was then plotted to evaluate the diagnostic potential of miR-195-5p for CAS. The Kaplan-Meier curve and Cox regression were employed to determine miR-195-5p's prognostic significance. In vitro, the effects of miR-195-5p mimic or inhibitor on VSMC proliferation and migration were assessed using CCK-8 and Transwell assays. RESULTS In CAS patients, serum miR-195-5p levels were elevated and correlated with the degree of CAS. The ROC curve had an AUC value of 0.897, with sensitivity of 71.4% and specificity of 95.4%. Higher levels of miR-195-5p indicated a higher risk of CIE occurrence and may serve as an independent predictor of CIE. The upregulation of miR-195-5p promoted VSMC proliferation and migration, while downregulation had the opposite effect. CONCLUSIONS miR-195-5p was demonstrated to have diagnostic and prognostic significance in CAS and may serve as a potential biomarker. It may contribute to the progression of CAS by promoting the proliferation and migration of VSMCs.
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Affiliation(s)
- Haining Gao
- Department of Neurology, Nanjing Qixia District Hospital, Nanjing, China
| | - Liansheng Zhao
- Department of Neurology, Nanjing Qixia District Hospital, Nanjing, China
| | - Xuemei Cao
- Department of Neurology, Nanjing Qixia District Hospital, Nanjing, China
| | - Guoxin Zhang
- Department of Neurology, Nanjing Qixia District Hospital, Nanjing, China
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Brunnander K, Henze A, Fox AJ, Johansson E. Assessments of arterial and venous phase radiodensity does not improve carotid near-occlusion diagnostics. Sci Rep 2024; 14:18616. [PMID: 39127795 PMCID: PMC11316748 DOI: 10.1038/s41598-024-68732-w] [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: 11/14/2023] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
The hypothesis of this study was that evaluation of radiodensity assessment beyond a carotid stenosis in arterial and/or venous phase can be used to separate near-occlusion and conventional ≥ 50% stenosis. We prospectively included participants with ≥ 50% carotid stenosis with inclusion preference for cases with extracranial internal carotid artery (ICA) asymmetry. All participants were examined with a research biphasic computed tomography angiography (CTA) protocol (arterial and venous phase). Reference diagnosis was set by interpretation on CTA and radiodensity difference between ipsilateral and contralateral ICA (c-corrected) or vertebral (v-corrected) was compared. We included 93 participants, 62 with near-occlusion and 31 with conventional ≥ 50% stenosis. Just beyond the stenosis, median c-corrected radiodensity was - 20 Hounsfield units (HU) among near-occlusions and - 1 HU among conventional ≥ 50% stenoses (p < 0.001) in the arterial phase. For the venous phase, these findings were + 17 HU and + 3 HU (p = 0.007). Similar group differences were seen for v-correction. No parameter had good diagnostic performance, area under the curve ≤ 0.82. With specificity set at ≥ 95%, detected near-occlusions were foremost those with large side-to-side differences in distal ICA-diameter. Carotid near-occlusions can have reduced radiodensity beyond the stenosis in arterial phases and increased radiodensity in venous phases compared to a reference artery-which was not clearly seen for conventional stenoses. However, these radiodensity findings are best seen in near-occlusion cases that are not diagnostically challenging, while they work poorly as additional diagnostic aids.
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Affiliation(s)
| | | | - Allan J Fox
- Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - Elias Johansson
- Clinical Science, Umeå University, Umeå, Sweden.
- Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden.
- Neuroscience and Physiology, Gothenburg University, Blå Stråket 7, 413 45, Gothenburg, Sweden.
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Smith J, Margalit D, Golledge J, Nastasi D, Nohria A, McDowell L. Carotid Artery Stenosis and Ischemic Stroke in Patients With Head and Neck Cancer Treated With Radiation Therapy: A Critical Review. Int J Radiat Oncol Biol Phys 2024; 119:1437-1454. [PMID: 38583496 DOI: 10.1016/j.ijrobp.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
The purpose of this review is to summarize the literature on carotid artery stenosis (CAS) and ischemic stroke (IS) in patients with head and neck cancer (HNC) treated with radiation therapy (RT) to guide assessment, screening, and management strategies. Patients treated with RT for HNC are at an elevated risk of developing CAS, with published meta-analyses demonstrating that CAS >50% occurs in approximately 25% of patients. Previous research suggests a 10-year cumulative incidence of stroke between 5.7% and 12.5%. Cardiovascular disease (CVD) risk prediction tools such as Qstroke, QRISK-2, and Framingham risk score perform poorly for predicting IS for patients with HNC who received RT. Duplex ultrasound is the most common imaging modality to assess CAS, but controversy remains as to the utility of screening asymptomatic individuals. Only 3 of the 5 major HNC survivorship guidelines acknowledge RT as a risk factor for CAS or IS, while only 1 makes a specific recommendation on screening for CAS (American Head and Neck Society). Within the general population, only 1 CVD guideline discusses RT as a risk factor for CAS (Society for Vascular Surgery). Clinicians involved in the care of patients with HNC treated with RT should be aware of the increased risk of CAS and IS and the challenges in risk prediction. Although there is a lack of evidence to make firm recommendations, HNC survivorship recommendations should ensure HNC survivors and primary care providers are informed of these risks and the importance of assessment and management of CVD risk factors. Future studies are required to refine risk prediction models in patients with HNC and to determine those most likely to benefit from targeted screening and initiation of early preventative strategies.
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Affiliation(s)
- Justin Smith
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia.
| | - Danielle Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia; The Australian Institute of Tropical Health and Medicine, Townsville, Australia
| | - Domenico Nastasi
- Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, Australia
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Adult Survivorship Program, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Lachlan McDowell
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
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Xiaoyong T, Yuping C, Wei H, Juan C, Feng Q, Zhuo L. Evaluafion of the efficacy of wall shear stress in carotid artery stenting. Heliyon 2024; 10:e31383. [PMID: 38828314 PMCID: PMC11140617 DOI: 10.1016/j.heliyon.2024.e31383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
Objective To characterize the value of carotid wall shear stress (WSS) following carotid artery stenting (CAS) in patients with carotid stenosis. Methods Twenty-eight patients with carotid stenosis treated with CAS between March 2021 to May 2022 in the eighth medical center of the PLA General Hospital were selected for our study. Carotid ultrasound was performed before the operation, one week post-operation, and six months post-operation. Carotid artery WSS was detected by blood flow vector imaging, and the changes in WSS before and after the operation were collected. Genetic testing of drugs was detected for patients with restenosis. Results Pre-operative WSS of the proximal, narrowest region, and distal carotid arteries in patients with ischemic carotid artery stenosis was 7.88 ± 3.18Pa, 14.36 ± 6.66Pa, and 1.55 ± 1.15Pa, respectively. Comparatively, pre-operative WSS of the proximal, narrowest region and distal carotid arteries in patients without ischemic symptoms was 5.02 ± 1.99Pa, 9.68 ± 4.23Pa, and 1.10 ± 0.68Pa, respectively, with a significant difference between the two groups (p < 0.001). Overall WSS of the proximal, narrowest region, and distal carotid arteries in patients before CAS was 6.68 ± 3.0Pa, 12.47 ± 5.98Pa, and 1.39 ± 0. 96Pa. WSS of the proximal, narrowest region, and distal carotid was 4.15 ± 1.42Pa, 6.71 ± 2.64Pa, and1.86 ± 1.13Pa one week after CAS, compared to 4.44 ± 1.91Pa, 7.90 ± 4.38Pa, and 2. 36 ± 1.09Pa six months after CAS. WSS of the proximal and narrowest region of the carotid artery was reduced after carotid stenting, and the difference was statistically significant (p < 0.001). There was no statistically significant difference in WSS between one week and six months after stenting (P > 0.05). Conclusion We employed early carotid WSS as a means of evaluating the efficacy of carotid artery stenting. Changes in carotid WSS are closely associated with carotid artery stenosis, providing valuable hemodynamic information for CAS treatment. This technique holds great application value in pre-operative evaluation and long-term follow-up.
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Affiliation(s)
- Tao Xiaoyong
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chen Yuping
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Huang Wei
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chen Juan
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Qiu Feng
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Li Zhuo
- Department of Ultrasonography, The Eighth Medical Center of PLA General Hospital, Beijing, China
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Ristow AVB, Massière B, Meirelles GV, Casella IB, Morales MM, Moreira RCR, Procópio RJ, Oliveira TF, de Araujo WJB, Joviliano EE, de Oliveira JCP. Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease. J Vasc Bras 2024; 23:e20230094. [PMID: 39099701 PMCID: PMC11296686 DOI: 10.1590/1677-5449.202300942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 08/06/2024] Open
Abstract
Extracranial cerebrovascular disease has been the subject of intense research throughout the world, and is of paramount importance for vascular surgeons. This guideline, written by the Brazilian Society of Angiology and Vascular Surgery (SBACV), supersedes the 2015 guideline. Non-atherosclerotic carotid artery diseases were not included in this document. The purpose of this guideline is to bring together the most robust evidence in this area in order to help specialists in the treatment decision-making process. The AGREE II methodology and the European Society of Cardiology system were used for recommendations and levels of evidence. The recommendations were graded from I to III, and levels of evidence were classified as A, B, or C. This guideline is divided into 11 chapters dealing with the various aspects of extracranial cerebrovascular disease: diagnosis, treatments and complications, based on up-to-date knowledge and the recommendations proposed by SBACV.
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Affiliation(s)
- Arno von Buettner Ristow
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-RIO, Disciplina de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-RJ, Rio de Janeiro, RJ, Brasil.
| | - Bernardo Massière
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-RIO, Disciplina de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-RJ, Rio de Janeiro, RJ, Brasil.
| | - Guilherme Vieira Meirelles
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade Estadual de Campinas – UNICAMP, Hospital das Clínicas, Disciplina de Cirurgia do Trauma, Campinas, SP, Brasil.
| | - Ivan Benaduce Casella
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, São Paulo, SP, Brasil.
| | - Marcia Maria Morales
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Associação Portuguesa de Beneficência de São José do Rio Preto, Serviço de Cirurgia Vascular, São José do Rio Preto, SP, Brasil.
| | - Ricardo Cesar Rocha Moreira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-PR, Curitiba, PR, Brasil.
- Pontifícia Universidade Católica do Paraná – PUC-PR, Hospital Cajurú, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | - Ricardo Jayme Procópio
- Universidade Federal de Minas Gerais – UFMG, Hospital das Clínicas, Setor de Cirurgia Endovascular, Belo Horizonte, MG, Brasil.
- Universidade Federal de Minas Gerais – UFMG, Faculdade de Medicina, Belo Horizonte, MG, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-MG, Belo Horizonte, MG, Brasil.
| | - Tércio Ferreira Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SE, Aracajú, SE, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Walter Jr. Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-PR, Curitiba, PR, Brasil.
- Universidade Federal do Paraná – UFPR, Hospital das Clínicas – HC, Curitiba, PR, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Júlio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
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Kadyan V, Vaddi A, Nagpal A, Molina MR, Lurie AG, Tadinada A. Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification. J Clin Med 2024; 13:3189. [PMID: 38892900 PMCID: PMC11173268 DOI: 10.3390/jcm13113189] [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: 04/16/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The objective of this study was to develop a practical staging method for reporting external carotid artery calcifications (ECACs) using cone-beam computed tomography (CBCT) imaging, specifically to standardize reporting for oral and maxillofacial radiologists. Methods: This retrospective study evaluated 489 CBCT scans for the presence of ECACs. Two calibrated evaluators assessed the scans in all three orthogonal planes, using the axial plane to develop the staging system. Calcifications were graded on a scale from 0 to 5. Results: ECACs were found in 170 out of 489 scans (34.7%). There was a statistically significant increase in ECAC distribution with age progression. The prevalence of ECACs was similar between genders. Grade 1 calcifications were most common in the 51-60 age group, Grade 2 in the 61-70 and 71-80 groups, and Grades 3 and 4 in the 81-90 group. No Grade 5 calcifications were observed in any age group. The inter-rater reliability showed an excellent correlation in the identification and grading of ECACs. Conclusions: The proposed grading system enables oral and maxillofacial radiologists to quantitatively report ECACs, facilitating timely referrals to physicians for further evaluation and early intervention, thereby potentially reducing the risk of cardiovascular events.
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Affiliation(s)
- Varsha Kadyan
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
| | - Anusha Vaddi
- Oral and Maxillofacial Radiology, Department of Oral Diagnostic Sciences, Virginia Commonwealth University School of Dentistry, Richmond, VA 23298, USA
| | - Archna Nagpal
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
| | - Marco R. Molina
- Department of Diagnostic Imaging, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA;
| | - Alan G. Lurie
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
| | - Aditya Tadinada
- Division of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; (V.K.); (A.N.); (A.G.L.); (A.T.)
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Zhu J, Jhang J, Yu H, Mushlin AI, Kamel H, Alemayehu N, Giardina JC, Gupta A, Pandya A. Cost-Effectiveness of Screening Asymptomatic Carotid Stenosis by Atherosclerotic Cardiovascular Risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.11.28.23299146. [PMID: 38798437 PMCID: PMC11118553 DOI: 10.1101/2023.11.28.23299146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Importance Extracranial internal carotid artery stenosis (50-99% arterial narrowing) is an important risk factor for ischemic stroke. Yet, the benefits and harms of targeted screening for asymptomatic carotid artery stenosis (ACAS) have not been assessed in population-based studies. Objective To estimate the cost-effectiveness of one-time, targeted ACAS screening stratified by atherosclerotic cardiovascular disease (ASCVD) risk using the American Heart Association's Pooled Cohort Equations. Design Setting and Participants We developed a lifetime microsimulation model of ACAS and stroke for a hypothetical cohort representative of US adults aged 50-80 years without stroke history. We used the Cardiovascular Health Study to estimate the probability and severity of ACAS based on individual characteristics (e.g., age, sex, smoking status, blood pressure, and cholesterol). Stroke risks were functions of these characteristics and ACAS severity. In the model, individuals testing positive for >70% stenosis with Duplex ultrasound and a confirmatory diagnostic test undergo revascularization, which may reduce the risk of stroke but also introduces complication risks. Diagnostic performance parameters, revascularization benefits and risks, utility weights, and costs were estimated from published sources. Cost-effectiveness was assessed from the health care sector perspective using a $100,000/quality-adjusted life year (QALY) threshold. Main Outcomes and Measures Estimated stroke events prevented, lifetime costs, QALYs, and incremental cost-effectiveness ratios (ICERs) associated with ACAS screening. Costs (2023 USD) and QALYs were discounted at 3% annually. Results We found that screening individuals with a 10-year ASCVD risk >30% was the most cost-effective strategy, with an ICER of $89,000/QALY. This strategy would make approximately 11.9% of the population eligible for screening, averting an estimated 24,084 strokes. Results were sensitive to variations in the efficacy and complication risk of revascularization. In probabilistic sensitivity analysis, screening those in lower ASCVD risk groups (0-20%) only had a 0.6% chance of being cost-effective. Conclusion and Relevance A one-time screening may only be cost-effective for adults at a relatively high ASCVD risk. Our findings provide a framework that can be adapted as future clinical trial data continue to improve our understanding of the role of revascularization and intensive medical therapy in contemporary stroke prevention secondary to carotid disease.
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Pulukool SK, Srimadh Bhagavatham SK, Vijay SK, Almansour AI, Chaudhary S, Abuyousef F, Saleh N, Tripathi P. Noninvasive cardiac-specific biomarkers for the diagnosis and prevention of vascular stenosis in cardiovascular disorder. Front Pharmacol 2024; 15:1376226. [PMID: 38725669 PMCID: PMC11079267 DOI: 10.3389/fphar.2024.1376226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
Background The most frequent lesion in the blood vessels feeding the myocardium is vascular stenosis, a condition that develops slowly but can prove to be deadly in a long run. Non-invasive biomarkers could play a significant role in timely diagnosis, detection and management for vascular stenosis events associated with cardiovascular disorders. Aims The study aimed to investigate high sensitivity troponin I (hs-TnI), cardiac troponin I (c-TnI) and high sensitivity C-reactive protein (hs-CRP) that may be used solely or in combination in detecting the extent of vascular stenosis in CVD patients. Methodology 274 patients with dyspnea/orthopnea complaints visiting the cardiologists were enrolled in this study. Angiographic study was conducted on the enrolled patients to examine the extent of stenosis in the five prominent vessels (LDA, LCX, PDA/PLV, RCA, and OM) connected to the myocardium. Samples from all the cases suspected to be having coronary artery stenosis were collected, and subjected to biochemical evaluation of certain cardiac inflammatory biomarkers (c-TnI, hsTn-I and hs-CRP) to check their sensitivity with the level of vascular stenosis. The extent of mild and culprit stenosis was detected during angiographic examination and the same was reported in the form significant (≥50% stenosis in the vessels) and non-significant (<50% stenosis in the vessels) Carotid Stenosis. Ethical Clearance for the study was provided by Dr. Ram Manohar Lohia Institute of Medical Sciences Institutional Ethical Committee. Informed consent was obtained from all the participants enrolled in the study. Results We observed that 85% of the total population enrolled in this study was suffering from hypertension followed by 62.40% detected with sporadic episodes of chest pain. Most of the subjects (42% of the total population) had stenosis in their LAD followed by 38% who had stenosis in their RCA. Almost 23% patients were reported to have stenosis in their LCX followed by OM (18% patients), PDA/PLV (13%) and only 10% patients had blockage problem in their diagonal. 24% of the subjects were found to have stenosis in a single vessel and hence were categorized in the Single Vessel Disease (SVD) group while 76% were having stenosis in two or more than two arteries (Multiple Vessel Disease). hs-TnI level was found to be correlated with the levels of stenosis and was higher in the MVD group as compared to the SVD group. Conclusion hs-TnI could be used as a novel marker as it shows prominence in detecting the level of stenosis quite earlier as compared to c-TnI which gets detected only after a long duration in the CVD patients admitted for angiography. hs- CRP gets readily detected as inflammation marker in these patients and hence could be used in combination with hs-TnI to detect the risk of developing coronary artery disease.
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Affiliation(s)
- Sujith Kumar Pulukool
- Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Puttaparthi, Andhra Pradesh, India
| | | | - Sudarshan K. Vijay
- Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Sandeep Chaudhary
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER-R), Lucknow, Uttar Pradesh, India
| | - Farah Abuyousef
- Department of Chemistry, College of Science, United Arab Emirates (UAE) University, Al Ain, United Arab Emirates
| | - Na’il Saleh
- Department of Chemistry, College of Science, United Arab Emirates (UAE) University, Al Ain, United Arab Emirates
| | - Pratima Tripathi
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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12
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Pandey A, Schreiber C, Garton ALA, Araveti N, Goldberg JL, Kocharian G, Carnevale JA, Boddu SR. Foundations of the Diagnosis and Management of Idiopathic Intracranial Hypertension and Pulsatile Tinnitus. World Neurosurg 2024; 184:361-371. [PMID: 38590070 DOI: 10.1016/j.wneu.2023.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
Venous sinus stenosis has garnered increasing academic attention as a potential etiology of idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). The complex anatomy of the cerebral venous sinuses and veins plays a crucial role in the pathophysiology of these conditions. Venous sinus stenosis, often found in the superior sagittal or transverse sinus, can lead to elevated intracranial pressure (ICP) and characteristic IIH symptoms. Stenosis, variations in dural venous anatomy, and flow dominance patterns contribute to aberrant flow and subsequent PT. Accurate imaging plays a vital role in diagnosis, and magnetic resonance (MR) venography is particularly useful for detecting stenosis. Management strategies for IIH and PT focus on treating the underlying disease, weight management, medical interventions, and, in severe cases, surgical or endovascular procedures. Recently, venous sinus stenting has gained interest as a minimally invasive treatment option for IIH and PT. Stenting addresses venous sinus stenosis, breaking the feedback loop between elevated ICP and stenosis, thus reducing ICP and promoting cerebrospinal fluid outflow. The correction and resolution of flow aberrances can also mitigate or resolve PT symptoms. While venous sinus stenting remains an emerging field, initial results are promising. Further research is needed to refine patient selection criteria and evaluate the long-term efficacy of stenting as compared to traditional treatments.
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Affiliation(s)
- Abhinav Pandey
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Craig Schreiber
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Andrew L A Garton
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Gary Kocharian
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Srikanth R Boddu
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
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13
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Lo CM, Hung PH. Predictive stroke risk model with vision transformer-based Doppler features. Med Phys 2024; 51:126-138. [PMID: 38043124 DOI: 10.1002/mp.16861] [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: 04/08/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Acute stroke is the leading cause of death and disability globally, with an estimated 16 million cases each year. The progression of carotid stenosis reduces blood flow to the intracranial vasculature, causing stroke. Early recognition of ischemic stroke is crucial for disease treatment and management. PURPOSE A computer-aided diagnosis (CAD) system was proposed in this study to rapidly evaluate ischemic stroke in carotid color Doppler (CCD). METHODS Based on the ground truth from the clinical examination report, the vision transformer (ViT) features extracted from all CCD images (513 stroke and 458 normal images) were combined in machine learning classifiers to generate the likelihood of ischemic stroke for each image. The pretrained weights from ImageNet reduced the time-consuming training process. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve were calculated to evaluate the stroke prediction model. The chi-square test, DeLong test, and Bonferroni correction for multiple comparisons were applied to deal with the type-I error. Only p values equal to or less than 0.00125 were considered to be statistically significant. RESULTS The proposed CAD system achieved an accuracy of 89%, a sensitivity of 94%, a specificity of 84%, and an area under the receiver operating characteristic curve of 0.95, outperforming the convolutional neural networks AlexNet (82%, p < 0.001), Inception-v3 (78%, p < 0.001), ResNet101 (84%, p < 0.001), and DenseNet201 (85%, p < 0.01). The computational time in model training was only 30 s, which would be efficient and practical in clinical use. CONCLUSIONS The experiment shows the promising use of CCD images in stroke estimation. Using the pretrained ViT architecture, the image features can be automatically and efficiently generated without human intervention. The proposed CAD system provides a rapid and reliable suggestion for diagnosing ischemic stroke.
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Affiliation(s)
- Chung-Ming Lo
- Graduate Institute of Library, Information and Archival Studies, National Chengchi University, Taipei, Taiwan
| | - Peng-Hsiang Hung
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan
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14
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Li B, Xie G, Zou Q, Zhao Y, Han B, Yu C, Pan J, Sun SK. Non-invasive Diagnosis and Postoperative Evaluation of Carotid Artery Stenosis by BSA-Gd 2O 3 Nanoparticles-Based Magnetic Resonance Angiography. ACS APPLIED BIO MATERIALS 2023; 6:4906-4913. [PMID: 37917917 DOI: 10.1021/acsabm.3c00623] [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] [Indexed: 11/04/2023]
Abstract
Contrast-enhanced magnetic resonance angiography is a powerful and effective method to accurately diagnose carotid artery stenosis. Small molecular gadolinium (Gd)-based agents have reliable signal enhancement, but their short circulating time may result in a loss of image resolution due to insufficient vascular filling or contrast agent emptying. Here, we report an MRA imaging approach to diagnose carotid artery stenosis using long-circulating bovine serum albumin (BSA)-Gd2O3 nanoparticles (NPs). The BSA-Gd2O3 NPs synthesized by a simple biomineralization approach exhibit admirable monodispersity, uniform size, favorable aqueous solubility, good biocompatibility, and high relaxivity (14.86 mM-1 s-1 in water, 6.41 mM-1 s-1 in plasma). In vivo MRA imaging shows that outstanding vascular enhancement of BSA-Gd2O3 NPs (0.05 mmol Gd/kg, half the dose in the clinic) can be maintained for at least 2 h, much longer than Gd-DTPA. Vessels as small as 0.3 mm can be clearly observed in MRA images with high resolution. In a rat carotid artery stenosis model, the BSA-Gd2O3 NPs-based MRA enables the precise diagnosis of the severity and location and the therapeutic effect following the surgery of carotid artery stenosis, which provides a method for the theranostics of vascular diseases.
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Affiliation(s)
- Bingjie Li
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Guangchao Xie
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Quan Zou
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yujie Zhao
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bing Han
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jinbin Pan
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China
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15
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Sundaram SS, King RW, Genovese EA, Veeraswamy RK. Ultrasound Examination Without Axial Imaging is Sufficient for Preoperative Planning in Transcarotid Artery Revascularization (TCAR). Ann Vasc Surg 2023; 97:192-202. [PMID: 37657676 DOI: 10.1016/j.avsg.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Duplex ultrasound is frequently used to determine the degree of carotid stenosis. However, axial imaging is typically obtained for operative planning for transcarotid artery revascularization (TCAR). We examined if ultrasound alone is sufficient before TCAR. METHODS Data from the Vascular Quality Initiative TCAR Surveillance Project registry between 2016 and 2021 was obtained. Patients were divided into 2 groups-those with preoperative ultrasound-alone (US) and those with additional axial imaging (AX). Perioperative outcomes were compared utilizing univariate Chi-square, independent t-test, multivariate logistic regression, and Kaplan-Meier analysis. RESULTS There were 3,418 patients identified: 682 in the US group and 2,736 in the AX group. More preoperative hypertension was reported in US (16.1% vs. 10.2%, P < 0.001) while cardiovascular disease (23% vs. 28.9%, P = 0.006) and prior ipsilateral stroke (22% vs. 32.7%, P = 0.002) were more prevalent in AX. More patients had history of contralateral carotid endarterectomy (13.6% vs. 16.7%, P = 0.035) or either ipsilateral (2.6% vs. 1.2%, P = 0.002) or contralateral (7.9% vs. 4.9%, P = 0.008) carotid artery stenting in the US group. Lower preoperative creatinine was reported in the US cohort (1.09 ± 0.01 vs. 1.18 ± 0.02, P < 0.001) while more were symptomatic in AX (28.2% vs. 36.2%, P < 0.001). There were no significant differences between lesion characteristics or operative decision making. A slightly higher total procedure time was seen in AX (73.7 ± 0.6 vs. 68.6 ± 1.3 min, P = 0.017). No differences were seen in perioperative transient ischemic attack/stroke or other immediate complications. At 2-year follow-up, both groups reported no significant differences in stroke-free survival (P = 0.750) and independent functional status remained near-identical (97.3% vs. 97.4%, P = 0.921). Kaplan-Meier analysis yielded no significant difference between mortality at 2 years (P = 0.563). Bivariate logistic regression modeling did reveal a statistically significant increase in likelihood of long-term ipsilateral stroke (odds ratio 1.77, P = 0.015) and non stroke-related complication in the postoperative period (odds ratio 4.81, P = 0.005). However, only a statistically significant relationship persisted in non-stroke complication when the model was controlled for between-group differences. CONCLUSIONS No significant differences in postoperative or long-term complications were noted with additional AX in preoperative TCAR planning. Thus, duplex ultrasound offers a safe and effective alternative for those with contraindication or axial imaging.
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Affiliation(s)
- Saranya S Sundaram
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC.
| | - Ryan W King
- Division of Vascular and Endovascular Surgery, University of Kentucky, Lexington, KY
| | - Elizabeth A Genovese
- Division of Vascular and Endovascular Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ravi K Veeraswamy
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
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16
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Tekieli L, Kablak-Ziembicka A, Dabrowski W, Dzierwa K, Moczulski Z, Urbanczyk-Zawadzka M, Mazurek A, Stefaniak J, Paluszek P, Krupinski M, Przewlocki T, Pieniazek P, Musialek P. Imaging modality-dependent carotid stenosis severity variations against intravascular ultrasound as a reference: Carotid Artery intravasculaR Ultrasound Study (CARUS). Int J Cardiovasc Imaging 2023; 39:1909-1920. [PMID: 37603155 PMCID: PMC10589130 DOI: 10.1007/s10554-023-02875-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/14/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Different non-invasive and invasive imaging modalities are used to determine carotid artery stenosis severity that remains a principal parameter in clinical decision-making. We compared stenosis degree obtained with different modalities against vascular imaging gold standard, intravascular ultrasound, IVUS. METHODS 300 consecutive patients (age 47-83 years, 192 men, 64% asymptomatic) with carotid artery stenosis of " ≥ 50%" referred for potential revascularization received as per study protocol (i) duplex ultrasound (DUS), (ii) computed tomography angiography (CTA), (iii) intraarterial quantitative angiography (iQA) and (iv) and (iv) IVUS. Correlation of measurements with IVUS (r), proportion of those concordant (within 10%) and proportion of under/overestimated were calculated along with recipient-operating-characteristics (ROC). RESULTS For IVUS area stenosis (AS) and IVUS minimal lumen area (MLA), there was only a moderate correlation with DUS velocities (peak-systolic, PSV; end-diastolic, EDV; r values of 0.42-0.51, p < 0.001 for all). CTA systematically underestimated both reference area and MLA (80.4% and 92.3% cases) but CTA error was lesser for AS (proportion concordant-57.4%; CTA under/overestimation-12.5%/30.1%). iQA diameter stenosis (DS) was found concordant with IVUS in 41.1% measurements (iQA under/overestimation 7.9%/51.0%). By univariate model, PSV (ROC area-under-the-curve, AUC, 0.77, cutoff 2.6 m/s), EDV (AUC 0.72, cutoff 0.71 m/s) and CTA-DS (AUC 0.83, cutoff 59.6%) were predictors of ≥ 50% DS by IVUS (p < 0.001 for all). Best predictor, however, of ≥ 50% DS by IVUS was stenosis severity evaluation by automated contrast column density measurement on iQA (AUC 0.87, cutoff 68%, p < 0.001). Regarding non-invasive techniques, CTA was the only independent diagnostic modality against IVUS on multivariate model (p = 0.008). CONCLUSION IVUS validation shows significant imaging modality-dependent variations in carotid stenosis severity determination.
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Affiliation(s)
- Lukasz Tekieli
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
- John Paul II Hospital, Krakow, Poland.
| | - Anna Kablak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | - Wladyslaw Dabrowski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- KCRI Angiographic and IVUS Core Laboratory, Krakow, Poland
| | - Karolina Dzierwa
- John Paul II Hospital, Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | - Zbigniew Moczulski
- Department of Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland
| | | | - Adam Mazurek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
| | - Justyna Stefaniak
- Data Management and Statistical Analysis (DMSA), Krakow, Poland
- Department of Bioinformatic and Telemedicine, Jagiellonian University, Krakow, Poland
| | - Piotr Paluszek
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Maciej Krupinski
- Department of Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland
| | - Tadeusz Przewlocki
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Piotr Pieniazek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
- John Paul II Hospital, Krakow, Poland.
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Lareyre F, Chaudhuri A, Behrendt CA, Pouhin A, Teraa M, Boyle JR, Tulamo R, Raffort J. Artificial intelligence-based predictive models in vascular diseases. Semin Vasc Surg 2023; 36:440-447. [PMID: 37863618 DOI: 10.1053/j.semvascsurg.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/24/2023] [Accepted: 05/24/2023] [Indexed: 10/22/2023]
Abstract
Cardiovascular disease represents a source of major health problems worldwide, and although medical and technical advances have been achieved, they are still associated with high morbidity and mortality rates. Personalized medicine would benefit from novel tools to better predict individual prognosis and outcomes after intervention. Artificial intelligence (AI) has brought new insights to cardiovascular medicine, especially with the use of machine learning techniques that allow the identification of hidden patterns and complex associations in health data without any a priori assumptions. This review provides an overview on the use of artificial intelligence-based prediction models in vascular diseases, specifically focusing on aortic aneurysm, lower extremity arterial disease, and carotid stenosis. Potential benefits include the development of precision medicine in patients with vascular diseases. In addition, the main challenges that remain to be overcome to integrate artificial intelligence-based predictive models in clinical practice are discussed.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, INSERM U1065, C3M, Nice, France
| | - Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Christian-Alexander Behrendt
- Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany; Department of Vascular and Endovascular Surgery, Asklepios Medical School Hamburg, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Alexandre Pouhin
- Division of Vascular Surgery, Dijon University Hospital, Dijon, France
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Riikka Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juliette Raffort
- Université Côte d'Azur, INSERM U1065, C3M, Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France; Clinical Chemistry Laboratory, University Hospital of Nice, France.
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18
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Cao L, Wang H, Kwapong WR, Wang R, Liu J, Wu B. Length of Carotid Plaque Impacts Retinal Microvascular Densities of Carotid Artery Stenosis Patients. Transl Vis Sci Technol 2023; 12:3. [PMID: 37672253 PMCID: PMC10484014 DOI: 10.1167/tvst.12.9.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose We explored the retinal microvascular changes in carotid artery stenosis (CAS) and their relationship with carotid plaque morphology. Methods All participants were diagnosed with carotid artery stenosis by a neurologist. Participants underwent digital subtraction angiography (DSA) and optical coherence tomography angiography (OCTA) imaging. The degree and length of carotid plaque were obtained from the DSA tool. OCTA tool measured the densities in the superficial vascular complex (SVC) and deep vascular complex (DVC). Results One hundred seventeen patients with CAS patients were included in our data analysis. Eyes with ipsilateral stenosis had reduced retinal microvascular densities when compared to contralateral eyes in patients with CAS (P = 0.016 for SVC, and P = 0.004 for DVC). Microvascular densities correlated with the length of carotid plaque (P = 0.015 for SVC, and P = 0.022 for DVC) in our CAS cohort, although they did not correlate with the degree of carotid plaque (P = 0.264 for SVC, and P = 0.298 for DVC). However, when stratified into moderate and severe subgroups, the degree of carotid plaque correlated with microvascular densities in patients with severe stenosis (P = 0.045 for SVC, and P = 0.038 for DVC). Conclusions Our study suggests that OCTA can noninvasively detect retinal microvascular changes in patients with CAS and that these changes correlated with the length of the stenosis, but future studies are required to confirm these findings. Translational Relevance Noninvasive and rapid acquisition of the OCTA image might have the potential to be used as a screening tool to detect microvascular changes in carotid artery stenosis.
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Affiliation(s)
- Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruilin Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ottakath N, Al-Maadeed S, Zughaier SM, Elharrouss O, Mohammed HH, Chowdhury MEH, Bouridane A. Ultrasound-Based Image Analysis for Predicting Carotid Artery Stenosis Risk: A Comprehensive Review of the Problem, Techniques, Datasets, and Future Directions. Diagnostics (Basel) 2023; 13:2614. [PMID: 37568976 PMCID: PMC10417708 DOI: 10.3390/diagnostics13152614] [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: 06/15/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The carotid artery is a major blood vessel that supplies blood to the brain. Plaque buildup in the arteries can lead to cardiovascular diseases such as atherosclerosis, stroke, ruptured arteries, and even death. Both invasive and non-invasive methods are used to detect plaque buildup in the arteries, with ultrasound imaging being the first line of diagnosis. This paper presents a comprehensive review of the existing literature on ultrasound image analysis methods for detecting and characterizing plaque buildup in the carotid artery. The review includes an in-depth analysis of datasets; image segmentation techniques for the carotid artery plaque area, lumen area, and intima-media thickness (IMT); and plaque measurement, characterization, classification, and stenosis grading using deep learning and machine learning. Additionally, the paper provides an overview of the performance of these methods, including challenges in analysis, and future directions for research.
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Affiliation(s)
- Najmath Ottakath
- Department of Computer Science and Engineering, Qatar University, Doha 2713, Qatar; (S.A.-M.); (O.E.); (H.H.M.)
| | - Somaya Al-Maadeed
- Department of Computer Science and Engineering, Qatar University, Doha 2713, Qatar; (S.A.-M.); (O.E.); (H.H.M.)
| | | | - Omar Elharrouss
- Department of Computer Science and Engineering, Qatar University, Doha 2713, Qatar; (S.A.-M.); (O.E.); (H.H.M.)
| | - Hanadi Hassen Mohammed
- Department of Computer Science and Engineering, Qatar University, Doha 2713, Qatar; (S.A.-M.); (O.E.); (H.H.M.)
| | | | - Ahmed Bouridane
- Centre for Data Analytics and Cybersecurity, University of Sharjah, Sharjah 27272, United Arab Emirates;
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Song Y, Li WB, Saleem N, Tian G, Ruan L, Zhang H. Viscoelastic Characteristics in Mouse Model of Hepatic Steatosis With Inflammation by Kelvin-Voigt Fractional Derivative Modeling. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1811-1816. [PMID: 37225609 DOI: 10.1016/j.ultrasmedbio.2023.04.004] [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: 11/23/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of the work described here was to measure the characteristics of viscoelasticity and fluidity in a mouse model of hepatic steatosis and inflammation using a nano-indentation test and the Kelvin-Voigt fractional derivative (KVFD) model and to explore the viscoelasticity and fluidity characteristics in mice with different degrees of hepatic steatosis with inflammation. METHODS Twenty-five ApoE mice were randomly divided into an experimental high-fat diet group (n = 15) and an ordinary-food control group (n = 10), then subdivided into four subgroups based on pathological degree of hepatic steatosis: S0 (normal), S1 (mild), S2 (moderate) and S3 (severe). The 25 liver specimens from these mice were evaluated by a slope-keeping relaxation nano-indentation test. RESULTS Elasticity (E0) was significantly higher in the S3 group than in the S1 and S2 groups, while fluidity (α) and viscosity (τ) were significantly lower in S3 than in S1 and S2 (all p values < 0.05). The following cutoff values for the diagnosis of hepatic steatosis >33% with inflammation were also determined: E0 > 85.01 Pa (area under the curve [AUC]: 0.917, 95% confidence interval [CI]: 0.735-0.989), α ≤ 0.38 (AUC: 0.885, 95% CI: 0.695-0.977),\ and τ ≤ 3.92 (AUC: 0.813, 95% CI: 0.607-0.939). CONCLUSION Increases in the degree of hepatic steatosis with inflammation in mice paralleled gradual increases in the stiffness of the liver and gradual decreases in the fluidity and viscosity of the liver.
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Affiliation(s)
- Yan Song
- Department of Ultrasound, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wen-Bin Li
- Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nimra Saleem
- Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Gang Tian
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Litao Ruan
- Department of Ultrasound, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hongmei Zhang
- Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Martelli E, Enea I, Zamboni M, Federici M, Bracale UM, Sangiorgi G, Martelli AR, Messina T, Settembrini AM. Focus on the Most Common Paucisymptomatic Vasculopathic Population, from Diagnosis to Secondary Prevention of Complications. Diagnostics (Basel) 2023; 13:2356. [PMID: 37510100 PMCID: PMC10377859 DOI: 10.3390/diagnostics13142356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Middle-aged adults can start to be affected by some arterial diseases (ADs), such as abdominal aortic or popliteal artery aneurysms, lower extremity arterial disease, internal carotid, or renal artery or subclavian artery stenosis. These vasculopathies are often asymptomatic or paucisymptomatic before manifesting themselves with dramatic complications. Therefore, early detection of ADs is fundamental to reduce the risk of major adverse cardiovascular and limb events. Furthermore, ADs carry a high correlation with silent coronary artery disease (CAD). This study focuses on the most common ADs, in the attempt to summarize some key points which should selectively drive screening. Since the human and economic possibilities to instrumentally screen wide populations is not evident, deep knowledge of semeiotics and careful anamnesis must play a central role in our daily activity as physicians. The presence of some risk factors for atherosclerosis, or an already known history of CAD, can raise the clinical suspicion of ADs after a careful clinical history and a deep physical examination. The clinical suspicion must then be confirmed by a first-level ultrasound investigation and, if so, adequate treatments can be adopted to prevent dreadful complications.
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Affiliation(s)
- Eugenio Martelli
- Department of General and Specialist Surgery, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy
- Medicine and Surgery School of Medicine, Saint Camillus International University of Health Sciences, 8 Via di Sant'Alessandro, 00131 Rome, Italy
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Iolanda Enea
- Emergency Department, S. Anna and S. Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Matilde Zamboni
- Division of Vascular Surgery, Saint Martin Hospital, 22 Viale Europa, 32100 Belluno, Italy
| | - Massimo Federici
- Department of Systems Medicine, School of Medicine and Surgery, University of Rome Tor Vergata, 1 Viale Montpellier, 00133 Rome, Italy
| | - Umberto M Bracale
- Division of Vascular Surgery, Federico II Polyclinic, Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, 5 Via S. Pansini, 80131 Naples, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, School of Medicine and Surgery, University of Rome Tor Vergata, 1 Viale Montpellier, 00133 Rome, Italy
| | - Allegra R Martelli
- Faculty-Medicine & Surgery, Campus Bio-Medico University of Rome, 21 Via À. del Portillo, 00128 Rome, Italy
| | - Teresa Messina
- Division of Anesthesia and Intensive Care of Organ Transplants, Umberto I Polyclinic University Hospital, 155 Viale del Policlinico, 00161 Rome, Italy
| | - Alberto M Settembrini
- Division of Vascular Surgery, Maggiore Polyclinic Hospital Ca' Granda IRCCS and Foundation, 35 Via Francesco Sforza, 20122 Milan, Italy
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22
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Ismail A, Ravipati S, Gonzalez-Hernandez D, Mahmood H, Imran A, Munoz EJ, Naeem S, Abdin ZU, Siddiqui HF. Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications. Cureus 2023; 15:e38794. [PMID: 37303351 PMCID: PMC10250083 DOI: 10.7759/cureus.38794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Carotid stenosis (CS) is a buildup of atherosclerotic plaque within the artery leading to a wide range of symptoms, from mild symptoms, including blurred vision and confusion, to much more life-threatening presentations, including paralysis due to stroke. The presentation is insidious, with symptoms exhibiting predominantly at severe stenosis; hence the emphasis is placed on the importance of early diagnosis, treatment, and lifestyle modifications. CS is seen undergoing almost the same pathogenesis of any atherosclerotic plaque formation, from endothelial damage of the artery lumen to the formation of a fibrous cap with a foam cell, lipid-filled core. The findings of our review article were consistent with the recent literature, depicting that comorbid hypertension, diabetes, and chronic kidney disease (CKD), and lifestyle aspects, including smoking and diet, played the most salient role in plaque development. Among several imaging modalities, duplex ultrasound (DUS) imaging is the widely preferred method in clinical practice. Carotid endarterectomy (CEA) and carotid stenting are the primarily advocated procedures for symptomatic severe stenosis, with similar long-term outcomes. Although, earlier clinical trials showed promising results in mitigating the risk of stroke among asymptomatic severe CS with surgical intervention. However, recent advancements have shifted the focus to medical management alone due to comparable results among the asymptomatic population. Both surgical and medical regimens are beneficial in treating patients, but it is still an ongoing debate as to which is predominantly superior. The currently advancing trials and research will help elucidate definitive guidelines. However, the massive impact of lifestyle modifications advocates some degree of individualized multidisciplinary management strategies.
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Affiliation(s)
- Aqsa Ismail
- Department of Medicine, United Medical and Dental College, Karachi, PAK
| | - Shivani Ravipati
- Department of Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
| | | | - Hashim Mahmood
- Department of Medicine, University College of Medicine and Dentistry, University of Lahore, Lahore, PAK
| | - Alizay Imran
- Department of Surgery, Windsor University School of Medicine, Chicago, USA
| | - Eduardo J Munoz
- Department of General Medicine, Montemorelos University, Montemorelos, MEX
| | - Saad Naeem
- Department of Internal Medicine, Faisalabad Medical University, Faisalabad, PAK
- Department of Internal Medicine, Punjab Social Security Hospital, Faisalabad, PAK
| | - Zain U Abdin
- Department of Medicine, District Head Quarters Hospital, Faisalabad, PAK
| | - Humza F Siddiqui
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
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23
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Yang R, Wang M, Dong Q, Zhou X. Transcranial Doppler versus CT angiography: a comparative analysis for the diagnosis of ischaemic cerebrovascular disease. Clin Radiol 2023; 78:e350-e357. [PMID: 36746722 DOI: 10.1016/j.crad.2022.12.014] [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: 08/26/2022] [Revised: 11/23/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Abstract
AIMS To compare the sensitivity, specificity, accuracy, and clinical usefulness of transcranial Doppler (TCD) ultrasound against computed tomography angiography (CTA) for the diagnosis of ischaemic cerebrovascular disease. METHODS A total of 1,183 sites (vascular segments) of 169 patients who had been diagnosed with cerebrovascular disease using digital subtraction angiography (DSA) were evaluated by CTA and TCD for the diagnosis of the arterial lesions. RESULTS Lesions were identified in 509 sites and 674 sites did not have lesions according to the DSA examination. Each individual site had higher sensitivity, specificity, and accuracy for TCD than those for CTA, respectively. For all sites, TCD had higher true-positive (p=0.0029) and -negative (p=0.0151) values and fewer false-positive and -negative (p<0.0001 for both) values than those of CTA. The sensitivity, specificity, and accuracy of CTA for all sites to detect lesions were 77%, 88%, and 84%, respectively. The same parameters for TCD were 94%, 97%, and 95%, respectively. The beneficial scores for CTA and TCD to detect lesions were 0-0.795 diagnostic confidence and 0-0.91 diagnostic confidence, respectively. Beneficial scores >0.795 and >0.91 indicated a risk of underdiagnosis of lesions at CTA and TCD, respectively. CONCLUSIONS Compared with DSA (reference standard) and CTA, the study underscores the use of TCD in cerebrovascular pathology.
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Affiliation(s)
- R Yang
- Department of Neurological Function, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222001, China
| | - M Wang
- Department of Neurological Function, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222001, China
| | - Q Dong
- Department of Neurological Function, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222001, China
| | - X Zhou
- Department of Neurology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222001, China.
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24
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Hernandez AM, Burkett GW, Pham N, Abbey CK, Boone JM. Performance of high-resolution CT for detection and discrimination tasks related to stenotic lesions - A phantom study using model observers. Med Phys 2023; 50:2037-2048. [PMID: 36583447 PMCID: PMC11318568 DOI: 10.1002/mp.16194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Accurate detection and grading of atheromatous stenotic lesions within the cardiac, renal, and intracranial vasculature is imperative for early recognition of disease and guiding treatment strategies. PURPOSE In this work, a stenotic lesion phantom was used to compare high resolution and normal resolution modes on the same CT scanner in terms of detection and size discrimination performance. MATERIALS AND METHODS The phantom is comprised of three acrylic cylinders (each 15.0 cm in diameter and 1.3 cm thick) with a matching array of holes in each module. The outer two modules contain holes that are slightly larger than the corresponding hole in the central module to simulate stenotic narrowing in vasculature. The stack of modules was submerged in an iodine solution simulating contrast-enhanced stenotic lesions with a range of lumen diameters (1.32-10.08 mm) and stenosis severity (0%, 50%, 60%, 70%, and 80%). The phantom was imaged on the Canon Aquilion Precision high-resolution CT scanner in high-resolution (HR) mode (0.25 mm × 0.50 mm detector element size) and normal-resolution (NR) mode (0.50 mm × 0.50 mm) using 120 kV and two dose levels (14 and 21 mGy SSDE) with 30 repeat scans acquired for each combination. Filtered back-projection (FBP) and a hybrid-iterative reconstruction (AIDR) were used with the FC18 kernel, as well as a deep learning algorithm (AiCE) which is only available for HR. A non-prewhitening model observer with an eye filter was implemented to quantify performance for detection and size discrimination tasks in the axial plane. RESULTS Detection performance improved with increasing diameter, dose, and for AIDR in comparison to FBP for a fixed resolution mode. Performance in the HR mode was generally higher than NR for the smaller lumen diameters (1-5 mm) with decreasing differences as the diameter increased. Performance in NR mode surpassed HR mode for lumen diameters greater than ∼4 mm and ∼5 mm for 14 mGy and 21 mGy, respectively. AiCE provided consistently higher detection performance compared with AIDR-FC18 (48% higher for a 6 mm lumen diameter). Discrimination performance increased with increasing nominal diameter, dose, and for larger differences in stenosis severity. When comparing discrimination performance in HR to NR modes, the largest relative differences occur at the smallest nominal diameters and smallest differences in stenosis severity. The AiCE reconstruction algorithm produced the highest overall discrimination performance values, and these were significantly higher than AIDR-FC18 for nominal diameters of 7.14 and 10.08 mm. CONCLUSIONS HR mode outperforms NR for detection up to a specific diameter and the results improve with AiCE and for higher dose levels. For the task of size discrimination, HR mode consistently outperforms NR if AIDR-FC18 is used for dose levels of at least 21 mGy, and the results improve with AiCE and for the smallest differences in stenosis severity investigated (50% vs. 60%). High-resolution CT appears to be beneficial for detecting smaller simulated lumen diameters (<5 mm) and is generally advantageous for discrimination tasks related to stenotic lesions, which inherently contain information at higher frequencies, given the right reconstruction algorithm and dose level.
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Affiliation(s)
- Andrew M Hernandez
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - George W Burkett
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - Nancy Pham
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Craig K Abbey
- Department of Psychological & Brain Sciences, University of California Santa Barbara, Santa Barbara, California, USA
| | - John M Boone
- Department of Radiology, University of California Davis, Sacramento, California, USA
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
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25
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Fu F, Shan Y, Yang G, Zheng C, Zhang M, Rong D, Wang X, Lu J. Deep Learning for Head and Neck CT Angiography: Stenosis and Plaque Classification. Radiology 2023; 307:e220996. [PMID: 36880944 DOI: 10.1148/radiol.220996] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Background Studies have rarely investigated stenosis detection from head and neck CT angiography scans because accurate interpretation is time consuming and labor intensive. Purpose To develop an automated convolutional neural network-based method for accurate stenosis detection and plaque classification in head and neck CT angiography images and compare its performance with that of radiologists. Materials and Methods A deep learning (DL) algorithm was constructed and trained with use of head and neck CT angiography images that were collected retrospectively from four tertiary hospitals between March 2020 and July 2021. CT scans were partitioned into training, validation, and independent test sets at a ratio of 7:2:1. An independent test set of CT angiography scans was collected prospectively between October 2021 and December 2021 in one of the four tertiary centers. Stenosis grade categories were as follows: mild stenosis (<50%), moderate stenosis (50%-69%), severe stenosis (70%-99%), and occlusion (100%). The stenosis diagnosis and plaque classification of the algorithm were compared with the ground truth of consensus by two radiologists (with more than 10 years of experience). The performance of the models was analyzed in terms of accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve. Results There were 3266 patients (mean age ± SD, 62 years ± 12; 2096 men) evaluated. The consistency between radiologists and the DL-assisted algorithm on plaque classification was 85.6% (320 of 374 cases [95% CI: 83.2, 88.6]) on a per-vessel basis. Moreover, the artificial intelligence model assisted in visual assessment, such as increasing confidence in the degree of stenosis. This reduced the time needed for diagnosis and report writing of radiologists from 28.8 minutes ± 5.6 to 12.4 minutes ± 2.0 (P < .001). Conclusion A deep learning algorithm for head and neck CT angiography interpretation accurately determined vessel stenosis and plaque classification and had equivalent diagnostic performance when compared with experienced radiologists. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Fan Fu
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
| | - Yi Shan
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
| | - Guang Yang
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
| | - Chao Zheng
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
| | - Miao Zhang
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
| | - Dongdong Rong
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
| | - Ximing Wang
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
| | - Jie Lu
- From the Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St, Xicheng District, Beijing 100053, China (F.F., Y.S., M.Z., D.R., J.L.); Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (F.F., Y.S., M.Z., D.R., J.L.); Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (F.F.); Shukun (Beijing) Technology Co, Beijing, China (G.Y., C.Z.); and Department of Radiology, Shandong Provincial Hospital, Jinan, China (X.W.)
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Arsenescu T, Chifor R, Marita T, Santoma A, Lebovici A, Duma D, Vacaras V, Badea AF. 3D Ultrasound Reconstructions of the Carotid Artery and Thyroid Gland Using Artificial-Intelligence-Based Automatic Segmentation-Qualitative and Quantitative Evaluation of the Segmentation Results via Comparison with CT Angiography. SENSORS (BASEL, SWITZERLAND) 2023; 23:2806. [PMID: 36905009 PMCID: PMC10007177 DOI: 10.3390/s23052806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to evaluate the feasibility of a noninvasive and low-operator-dependent imaging method for carotid-artery-stenosis diagnosis. A previously developed prototype for 3D ultrasound scans based on a standard ultrasound machine and a pose reading sensor was used for this study. Working in a 3D space and processing data using automatic segmentation lowers operator dependency. Additionally, ultrasound imaging is a noninvasive diagnosis method. Artificial intelligence (AI)-based automatic segmentation of the acquired data was performed for the reconstruction and visualization of the scanned area: the carotid artery wall, the carotid artery circulated lumen, soft plaque, and calcified plaque. A qualitative evaluation was conducted via comparing the US reconstruction results with the CT angiographies of healthy and carotid-artery-disease patients. The overall scores for the automated segmentation using the MultiResUNet model for all segmented classes in our study were 0.80 for the IoU and 0.94 for the Dice. The present study demonstrated the potential of the MultiResUNet-based model for 2D-ultrasound-image automated segmentation for atherosclerosis diagnosis purposes. Using 3D ultrasound reconstructions may help operators achieve better spatial orientation and evaluation of segmentation results.
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Affiliation(s)
- Tudor Arsenescu
- Computer Science Department, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
- Chifor Research SRL, 400068 Cluj-Napoca, Romania
| | - Radu Chifor
- Chifor Research SRL, 400068 Cluj-Napoca, Romania
- Department of Preventive Dentistry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania
| | - Tiberiu Marita
- Computer Science Department, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Andrei Santoma
- Computer Science Department, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Andrei Lebovici
- Radiology, Surgical Specialties Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Radiology and Imaging Department, Cluj County Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Daniel Duma
- Radiology and Imaging Department, Cluj County Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Vitalie Vacaras
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Neurology Department, Cluj County Emergency Hospital, 400012 Cluj-Napoca, Romania
| | - Alexandru Florin Badea
- Anatomy and Embryology, Faculty of General Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
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Wang Y, Liu X, Wang J, Wang Y, Qi H, Kong X, Liu D, Liu J, Zheng H, Xiong F, Zhang L, Fu X, Zhang X, Guo R, Qiao H, Chen Z, Si D, Chen H. Simultaneous T1, T2, and T2* Mapping of Carotid Plaque: The SIMPLE* Technique. Radiology 2023; 307:e222061. [PMID: 36853181 DOI: 10.1148/radiol.222061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Quantitative T1, T2, and T2* measurements of carotid atherosclerotic plaque are important in evaluating plaque vulnerability and monitoring its progression. Purpose To develop a sequence to simultaneously quantify T1, T2, and T2* of carotid plaque. Materials and Methods The simultaneous T1, T2, and T2* mapping of carotid plaque (SIMPLE*) sequence is composed of three modules with different T2 preparation pulses, inversion-recovery pulses, and acquisition schemas. Single-echo data were used for T1 and T2 quantification, while the multiecho (ME) data were used for T2* quantification. The quantitative accuracy of SIMPLE* was tested in a phantom study by comparing its measurements with those of reference standard sequences. In vivo feasibility of the technique was prospectively evaluated between November 2020 and February 2022 in healthy volunteers and participants with carotid atherosclerotic plaque. The Pearson or Spearman correlation test, Student t test, and Wilcoxon rank-sum test were used. Results T1, T2, and T2* estimated with SIMPLE* strongly correlated with inversion-recovery spin-echo (SE) (correlation coefficient [r] = 0.99), ME-SE (r = 0.99), and ME gradient-echo (r = 0.99) sequences in the phantom study. In five healthy volunteers (mean age, 25 years ± 3 [SD]; three women), measurements were similar between SIMPLE* and modified Look-Locker inversion recovery, or MOLLI (1151 msec ± 71 vs 1098 msec ± 64; P = .14), ME turbo SE (31 msec ± 1 vs 31 msec ± 1; P = .32), and ME turbo field echo (24 msec ± 2 vs 25 msec ± 2; P = .19). In 18 participants with carotid plaque (mean age, 65 years ± 9; 16 men), quantitative T1, T2, and T2* of plaque components were consistent with their signal characteristics on multicontrast images. Conclusion A quantitative technique for simultaneous T1, T2, and T2* mapping of carotid plaque with 100-mm3 coverage and 0.8-mm3 resolution was developed using the proposed SIMPLE* sequence and demonstrated high accuracy and in vivo feasibility. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Yajie Wang
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Xiaoming Liu
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Jing Wang
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Yishi Wang
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Haikun Qi
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Xiangchuang Kong
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Dingxi Liu
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Jia Liu
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Hanpei Zheng
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Fu Xiong
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Lan Zhang
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Xiaona Fu
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Xinli Zhang
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Rui Guo
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Huiyu Qiao
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Zhensen Chen
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Dongyue Si
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
| | - Huijun Chen
- From the Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Haidian District, Beijing, China 100084 (Yajie Wang, H. Qiao, D.S., H.C.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (X.L., J.W., X.K., D.L., J.L., H.Z., F.X., L.Z., X.F., X.Z.); Philips Healthcare, Beijing, China (Yishi Wang); School of Biomedical Engineering, ShanghaiTech University, Shanghai, China (H. Qi); School of Medical Technology, Beijing Institution of Technology, Beijing, China (R.G.); and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China (Z.C.)
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James SL, Fedewa RJ, Lyden S, Geoffrey Vince D. Spectral analysis of ultrasound backscatter for non-invasive measurement of plaque composition. ULTRASONICS 2023; 128:106861. [PMID: 36283264 DOI: 10.1016/j.ultras.2022.106861] [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: 05/07/2021] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Carotid atherosclerotic plaque composition may be an important indication of patient risk for future cerebrovascular events. Ultrasound spectral analysis has the potential to provide a robust measure of plaque composition in vivo if the backscatter transfer function can be sufficiently isolated from the effects of attenuation from overlying tissue, receive and transmit transfer functions from the ultrasound system and transducer, and diffraction. This study examines the usefulness of the nonlinearly generated second harmonic portion of the backscatter signal and the effects of a variety of attenuation compensation techniques for noninvasively characterizing human carotid plaque using spectral analysis and machine learning. Post-beamformed ultrasound backscatter radiofrequency (RF) data were acquired from 6 normal subjects and 119 carotid endarterectomy patients prior to surgery. Plaque obtained following surgery was histologically processed, and regions of interest (ROI) corresponding to homogenous tissue types (fibrous/fibro-lipidic, hemorrhagic and/or necrotic core and calcified) were selected from RF data. Both the harmonic and fundamental power spectra for each ROI was obtained and normalized by data from a uniform phantom (0.5 dB/cm-MHz slope of attenuation). Additional attenuation compensation approaches were compared to simply using the reference phantom: (1) optimum power spectral shift estimation, (2) one-step adventitial, or (3) two-step adventitial. Spectral parameters extracted from both the fundamental and harmonic estimates of the backscatter transfer function of 363 ROI's from 152 plaque specimens were used to train and test random forest and support vector machine classification models. The best results came from using spectral parameters derived from both the fundamental and second harmonic bands with a predictive accuracy of 65-68%, kappa statistic of 0.49-0.54, and accuracies of 84% for fibrous, 68-74% for hemorrhagic and/or necrotic core, and 78-81% for calcified ROI's. The result indicated that the nonlinearly generated second harmonic portion of backscatter is useful for carotid plaque tissue characterization and that a reference phantom approach with a 0.5 dB/cm-MHz slope of attenuation works as well as more complicated approaches.
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Affiliation(s)
- Sheronica L James
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
| | - Russell J Fedewa
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
| | - Sean Lyden
- Department of Vascular Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
| | - D Geoffrey Vince
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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Niu J, Ran Y, Chen R, Zhang F, Lei X, Wang X, Li T, Zhu J, Zhang Y, Cheng J, Zhang Y, Zhu C. Use of PETRA-MRA to assess intracranial arterial stenosis: Comparison with TOF-MRA, CTA, and DSA. Front Neurol 2023; 13:1068132. [PMID: 36726752 PMCID: PMC9884682 DOI: 10.3389/fneur.2022.1068132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/22/2022] [Indexed: 01/18/2023] Open
Abstract
Background and purpose Non-invasive and accurate assessment of intracranial arterial stenosis (ICAS) is important for the evaluation of intracranial atherosclerotic disease. This study aimed to evaluate the performance of 3D pointwise encoding time reduction magnetic resonance angiography (PETRA-MRA) and compare its performance with that of 3D time-of-flight (TOF) MRA and computed tomography angiography (CTA), using digital subtraction angiography (DSA) as the reference standard in measuring the degree of stenosis and lesion length. Materials and methods This single-center, prospective study included a total of 52 patients (mean age 57 ± 11 years, 27 men, 25 women) with 90 intracranial arterial stenoses who underwent PETRA-MRA, TOF-MRA, CTA, and DSA within 1 month. The degree of stenosis and lesion length were measured independently by two radiologists on these four datasets. The degree of stenosis was classified according to DSA measurement. Severe stenosis was defined as a single lesion with >70% diameter stenosis. The smaller artery stenosis referred to the stenosis, which occurred at the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery, except for the first segment of them. The continuous variables were compared using paired t-test or Wilcoxon signed rank test. The intraclass correlation coefficients (ICCs) were used to assess the agreement between MRAs/CTA and DSA as well as inter-reader variabilities. The ICC value >0.80 indicated excellent agreement. The agreement of data was assessed further by Bland-Altman analysis and Spearman's correlation coefficients. When the difference between MRAs/CTA and DSA was statistically significant in the degree of stenosis, the measurement of MRAs/CTA was larger than that of DSA, which referred to the overestimation of MRAs/CTA for the degree of stenosis. Results The four imaging methods exhibited excellent inter-reader agreement [intraclass correlation coefficients (ICCs) > 0.80]. PETRA-MRA was more consistent with DSA than with TOF-MRA and CTA in measuring the degree of stenosis (ICC = 0.94 vs. 0.79 and 0.89) and lesion length (ICC = 0.99 vs. 0.97 and 0.73). PETRA-MRA obtained the highest specificity and positive predictive value (PPV) than TOF-MRA and CTA for detecting stenosis of >50% and stenosis of >75%. TOF-MRA and CTA overestimated considerably the degree of stenosis compared with DSA (63.0% ± 15.8% and 61.0% ± 18.6% vs. 54.0% ± 18.6%, P < 0.01, respectively), whereas PETRA-MRA did not overestimate (P = 0.13). The degree of stenosis acquired on PETRA-MRA was also more consistent with that on DSA than with that on TOF-MRA and CTA in severe stenosis (ICC = 0.78 vs. 0.30 and 0.57) and smaller artery stenosis (ICC = 0.95 vs. 0.70 and 0.80). In anterior artery circulation stenosis, PETRA-MRA also achieved a little bigger ICC than TOF-MRA and CTA in measuring the degree of stenosis (0.93 vs. 0.78 and 0.88). In posterior artery circulation stenosis, PETRA-MRA had a bigger ICC than TOF-MRA (0.94 vs. 0.71) and a comparable ICC to CTA (0.94 vs. 0.91) in measuring the degree of stenosis. Conclusion PETRA-MRA is more accurate than TOF-MRA and CTA for the evaluation of intracranial stenosis and lesion length when using DSA as a reference standard. PETRA-MRA is a promising non-invasive tool for ICAS assessment.
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Affiliation(s)
- Junxia Niu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Chen
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Zhang
- Department of Magnetic Resonance, Pingmei Shenma Medical Group General Hospital, Pingdingshan, China
| | - Xiaowen Lei
- Department of Magnetic Resonance, Xuchang Central Hospital, Xuchang, China
| | - Xiao Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tengfei Li
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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Giordano C, Morello A, Corcione N, Giordano S, Gaudino S, Colosimo C. Choice of imaging to evaluate carotid stenosis and guide management. Minerva Med 2022; 113:1017-1026. [PMID: 35671001 DOI: 10.23736/s0026-4806.22.07996-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Carotid artery disease is a cause of ischemic stroke and is associated with cognitive decline. Besides the evaluation of the degree of stenosis, it is also crucial to assess the morphology of the atherosclerotic plaque, for a prompt and accurate diagnosis, and to make the best decision for the patient. On top of noninvasive duplex ultrasound (DUS) and invasive digital subtraction angiography (DSA), compute tomography angiography (CTA) and magnetic resonance angiography (MRA) are often used effectively as noninvasive imaging tools to study carotid stenoses. This review describes the fundamental characteristics of carotid artery plaques, and how they can be best evaluated with currently available imaging methods.
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Affiliation(s)
- Carolina Giordano
- Department of Radiology and Neuroradiology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Alberto Morello
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Nicola Corcione
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Simona Gaudino
- Department of Radiology and Neuroradiology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Cesare Colosimo
- Department of Radiology and Neuroradiology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
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31
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Flores Gerónimo J, Keramat A, Alastruey J, Duan HF. Computational modelling and application of mechanical waves to detect arterial network anomalies: Diagnosis of common carotid stenosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 227:107213. [PMID: 36356386 DOI: 10.1016/j.cmpb.2022.107213] [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: 09/04/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE This paper proposes a novel strategy to localize anomalies in the arterial network based on its response to controlled transient waves. The idea is borrowed from system identification theories in which wave reflections can render significant information about a target system. Cardiovascular system studies often focus on the waves originating from the heart pulsations, which are of low bandwidth and, hence, can hardly carry information about the arteries with the desired resolution. METHODS Our strategy uses a relatively higher bandwidth transient signal to characterize healthy and unhealthy arterial networks through a frequency response function (FRF). We tested our novel approach on data simulated using a one-dimensional cardiovascular model that produced pulse waves in the larger arteries of the arterial network. Specifically, we excited the blood flow from the brachial artery with a relatively high bandwidth flow disturbance and collected the subsequent pressure waveform at peripheral positions. To better differentiate FRFs of healthy and unhealthy networks, we used a FRF that removes the effects of heart pulsations. RESULTS Results demonstrate the ability of the proposed FRF to detect and follow-up on the development of a common carotid artery (CCA) stenosis. We tested distinct geometrical variations of the stenosis (size, length and position) and observed differences between the FRFs of healthy and unhealthy networks in all cases; such differences were mainly due to geometrical variations determined by the stenosis. CONCLUSIONS We have provided a theoretical proof of concept that demonstrates the ability of our novel strategy to detect and track the development of CCA stenosis by using peripheral pressure waves that can be measured non-invasively in clinical practice.
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Affiliation(s)
- Joaquín Flores Gerónimo
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alireza Keramat
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Huan-Feng Duan
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Northrup H, He Y, Le H, Berceli SA, Cheung AK, Shiu YT. Differential hemodynamics between arteriovenous fistulas with or without intervention before successful use. Front Cardiovasc Med 2022; 9:1001267. [PMID: 36407418 PMCID: PMC9669082 DOI: 10.3389/fcvm.2022.1001267] [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: 07/23/2022] [Accepted: 10/17/2022] [Indexed: 08/22/2023] Open
Abstract
A significant number of arteriovenous fistulas (AVFs) fail to maturate for dialysis. Although interventions promote maturation, functional primary patency loss is higher for AVFs with interventions (assisted maturation) than AVFs without interventions (un-assisted maturation). Although blood flow-associated hemodynamics have long been proposed to affect AVF remodeling, the optimal hemodynamic parameters for un-assisted maturation are unclear. Additionally, AVF maturation progress is generally not investigated until 6 weeks after AVF creation, and the examination is focused on the AVF's venous limb. In this exploratory study, patients (n = 6) underwent magnetic resonance imaging (MRI) at 1 day, 6 weeks, and 6 months after AVF creation surgery. Before successful use for hemodialysis, three AVFs required intervention and three did not. MRI of the AVFs were used to calculate lumen cross-sectional area (CSA) and perform computational fluid dynamics (CFD) to analyze hemodynamics, including velocity, wall shear stress (WSS), and vorticity. For the venous limb, the no-intervention group and intervention group had similar pre-surgery vein diameter and 1-day post-surgery venous CSA. However, the no-intervention group had statistically larger 1-day venous velocity (0.97 ± 0.67 m/s; mean ± SD), WSS (333 ± 336 dyne/cm2) and vorticity (1709 ± 1290 1/s) than the intervention group (velocity = 0.23 ± 0.10 m/s; WSS = 49 ± 40 dyne/cm2; vorticity = 493.1 ± 227 1/s) (P < 0.05). At 6 months, the no-intervention group had statistically larger venous CSA (43.5 ± 27.4 mm2) than the intervention group (15.1 ± 6.2 mm2) (P < 0.05). Regarding the arterial limb, no-intervention AVF arteries also had statistically larger 1-day velocity (1.17 ± 1.0 m/s), WSS (340 ± 423 dyne/cm2), vorticity (1787 ± 1694 1/s), and 6-month CSA (22.6 ± 22.7 mm2) than the intervention group (velocity = 0.64 ± 0.36 m/s; WSS = 104 ± 116 dyne/cm2, P < 0.05; vorticity = 867 ± 4551/s; CSA = 10.7 ± 6.0 mm2, P < 0.05). Larger venous velocity, WSS, and vorticity immediately after AVF creation surgery may be important for later lumen enlargement and AVF maturation, with the potential to be used as a tool to help diagnose poor AVF maturation earlier. However, future studies using a larger cohort are needed to validate this finding and determine cut off values, if any.
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Affiliation(s)
- Hannah Northrup
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - Ha Le
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Yan-Ting Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Medical Center, Salt Lake City, UT, United States
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Takekawa H, Tsukui D, Kobayasi S, Suzuki K, Hamaguchi H. Ultrasound diagnosis of carotid artery stenosis and occlusion. J Med Ultrason (2001) 2022; 49:675-687. [PMID: 36175716 DOI: 10.1007/s10396-022-01259-7] [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: 05/01/2022] [Accepted: 08/14/2022] [Indexed: 11/25/2022]
Abstract
Carotid artery ultrasonography is capable of diagnosing or inferring the presence or absence of stenosis or occlusion of the internal carotid artery (ICA) and vertebral artery (VA), as well as the not directly observable distal ICA, middle cerebral artery (MCA), and basilar artery (BA). Stenosis at the origin of the ICA is mainly evaluated using the parameter peak systolic velocity (PSV), with values of ≥ 200-230 cm/s indicating severe stenosis. Recently, the acceleration time ratio has been reported for diagnosis of ICA origin stenosis. An indicator called the end-diastolic (ED) ratio can be used for diagnosing occlusion of the distal ICA or the M1 segment of the MCA. The PSV of stenosis can be used to diagnose stenosis at the beginning of the VA or V1, and mean flow velocity, mean ratio, and diameter ratio can be used to diagnose distal VA occlusion. Furthermore, the usefulness of the VA pulsatility index and resistance index has been suggested for diagnosing stenosis or occlusion of the BA. This review outlines diagnostic sonography criteria for stenosis and occlusion of extracranial and intracranial arteries.
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Affiliation(s)
- Hidehiro Takekawa
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan.
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan.
- Center of Medical Ultrasonics, Dokkyo Medical University, Mibu, Tochigi, Japan.
| | - Daisuke Tsukui
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Saro Kobayasi
- Stroke Center, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
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Wang L, Dong D, Tian FB. Fast prediction of blood flow in stenosed arteries using machine learning and immersed boundary-lattice Boltzmann method. Front Physiol 2022; 13:953702. [PMID: 36091404 PMCID: PMC9459013 DOI: 10.3389/fphys.2022.953702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
A fast prediction of blood flow in stenosed arteries with a hybrid framework of machine learning and immersed boundary-lattice Boltzmann method (IB–LBM) is presented. The integrated framework incorporates the immersed boundary method for its excellent capability in handling complex boundaries, the multi-relaxation-time LBM for its efficient modelling for unsteady flows and the deep neural network (DNN) for its high efficiency in artificial learning. Specifically, the stenosed artery is modelled by a channel for two-dimensional (2D) cases or a tube for three-dimensional (3D) cases with a stenosis approximated by a fifth-order polynomial. An IB–LBM is adopted to obtain the training data for the DNN which is constructed to generate an approximate model for the fast flow prediction. In the DNN, the inputs are the characteristic parameters of the stenosis and fluid node coordinates, and the outputs are the mean velocity and pressure at each node. To characterise complex stenosis, a convolutional neural network (CNN) is built to extract the stenosis properties by using the data generated by the aforementioned polynomial. Both 2D and 3D cases (including 3D asymmetrical case) are constructed and examined to demonstrate the effectiveness of the proposed method. Once the DNN model is trained, the prediction efficiency of blood flow in stenosed arteries is much higher compared with the direct computational fluid dynamics simulations. The proposed method has a potential for applications in clinical diagnosis and treatment where the real-time modelling results are desired.
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Lim EY, Cho AH. Dynamic Changes of Carotid Atherosclerosis and Their Relation with Stroke Recurrence in Patients with Stroke or Transient Ischemic Attack. Curr Neurovasc Res 2022; 19:303-310. [PMID: 35996235 DOI: 10.2174/1567202619666220822141804] [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: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to show dynamic changes in carotid and vertebral artery using carotid Doppler ultrasonography (DUS) through a long-term follow- up exam, and determine their associations with stroke recurrence. METHODS We consecutively enrolled stroke or transient ischemic attack (TIA) patients who had undergone DUS more than twice with intervals of three months or more. Stroke recurrence during follow-up was also investigated by reviewing medical records. Progress or regress of plaque was defined as more than 0.1 mm change from the initial scan with a semi-quantitative measurement. The development of new plaque was also regarded as plaque progress. Increased intima-media thickness and plaque presence were interpreted at the initial and follow-up scans. Factors related to progression or regression were analyzed. The relationship between plaque change and stroke recurrence was investigated. RESULTS A total of 201 patients were enrolled (186 ischemic stroke patients and 15 TIA patients). There were 61 (30.3%) females. Their mean age was 64.2 ± 9.9 years. During a follow-up of 35.0 ± 22.6 (mean ± SD) months, plaque progress was observed in 92 (45.8%) and plaque regress in 13 (6.5%). Stroke recurred in 18 patients. Plaque progression showed no significant association with age, risk factors, statin use, or subtype. After adjustment of age, sex, diabetes, and stroke subtype, multiple logistic regression showed a significant association of plaque progression with stroke recurrence (odds ratio: 3.8, 95% confidence interval: 1.1 to 13.1, p = 0.034). Patients with plaque regress were significantly younger than those without plaque regress (57.8 years vs. 64.6 years, p = 0.041). CONCLUSION Plaque progression occurred in 46% of stroke or TIA patients. Plaque progression was significantly associated with clinical stroke recurrence. Plaque regressed in 6.5% of patients. Patients with regression were younger than those without.
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Affiliation(s)
- Eun-Ye Lim
- Department of Neurology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - A-Hyun Cho
- Department of Neurology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Li B, Eisenberg N, Howe KL, Forbes TL, Roche-Nagle G. The impact of sex on outcomes following carotid endarterectomy. Ann Vasc Surg 2022; 88:210-217. [PMID: 36029946 DOI: 10.1016/j.avsg.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Previous studies have demonstrated significant sex differences in vascular surgery outcomes. We assessed stroke or death rates following carotid endarterectomy (CEA) in women vs. men. METHODS The Vascular Quality Initiative (VQI) was used to identify all patients who underwent CEA between 2010-2019. Demographic, clinical, and procedural characteristics were recorded and differences between women vs. men were assessed using independent t-test and chi-square test. The primary outcomes were 30-day and 1-year stroke or death. Associations between sex and outcomes were assessed using univariate/multivariate logistic regression and Cox proportional hazards analysis. RESULTS 52,137 women and 79,974 men underwent CEA in VQI sites during the study period. Women were younger (70.3 vs. 70.5 years, p < 0.001) and more likely to have hypertension (89.2% vs. 88.9%, p < 0.05) and diabetes (36.2% vs. 35.8%, p < 0.001), but less likely to be diagnosed with coronary artery disease (23.2% vs. 31.0%, p < 0.001). A greater proportion of men were receiving cardiovascular risk reduction medications and had symptomatic carotid stenosis (28.5% vs. 26.7%, p < 0.001). Women had shorter procedure times (113 vs. 122 minutes, p < 0.001) and were less likely to receive electroencephalography neuromonitoring (27.9% vs. 28.8%, p < 0.001), drain (35.9% vs. 37.3%, p < 0.001), and protamine (67.4% vs. 68.0%, p < 0.01). Stroke or death at 30 days (1.9% vs. 1.8%, p = 0.60) and 1 year (HR 0.98 [95% CI 0.94 - 1.01], p = 0.20) were similar between groups, which persisted in asymptomatic patients (HR 0.97 [95% CI 0.93 - 1.01], p = 0.17) and symptomatic patients (HR 0.99 [95% CI 0.93 - 1.05], p = 0.71). The similarities in 1-year stroke or death rates existed in both the US (HR 0.96 [95% CI 0.92 - 1.01], p = 0.09) and Canada (HR 1.21 [95% CI 0.47 - 3.11], p = 0.70). CONCLUSIONS Despite sex differences in clinical and procedural characteristics, women and men have similar 30-day and 1-year outcomes following carotid endarterectomy.
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Affiliation(s)
- Ben Li
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Eisenberg
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn L Howe
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Application of susceptibility weighted imaging (SWI) in diagnostic imaging of brain pathologies – a practical approach. Clin Neurol Neurosurg 2022; 221:107368. [DOI: 10.1016/j.clineuro.2022.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
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Zhang Y, Zhang H. Identification of Biomarkers of Autophagy-Related Genes Between Early and Advanced Carotid Atherosclerosis. Int J Gen Med 2022; 15:5321-5334. [PMID: 35669594 PMCID: PMC9166959 DOI: 10.2147/ijgm.s350232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Accumulating evidence demonstrates that autophagy is important in inhibiting inflammation and cholesterol efflux. It suggested the autophagy may be a treatment of atherosclerosis. Thus, we screened autophagy-related mRNA to explore their mechanism of scientific basis for early diagnosis and therapy of atherosclerosis. Methods The GSE28829 datasets were assessed to analyze differentially expressed genes by GEO2R. And autophagy-related hub genes were identified by HADb. The biological function of autophagy-related DEmRNAs was examined by Metascape. The construction of a protein–protein network was explored by String. Cytohubba was utilized to screen hub genes. Analysis of DEmiRNA-mRNA pairs was executed by DIANA microT-CDS database. Finally, correlation analysis was carried out to identify the relationship between DEARGs and clinical and prognostic factors. Results A number of 1087 DEGs and 19 autophagy-related DEmRNAs were identified in advanced carotid atherosclerotic plaque compared with the early. The biological function containing development and growth was enriched. Moreover, we screened the top hub nodes with the highest degrees. MicroRNAs (miRNAs) are confirmed to participate in genesis and progression of atherosclerosis, so we further analyzed the miRNA–mRNA regulatory network genes with four hub genes to explore their potential mechanism in atherosclerosis. Then, we revealed co-expression of four key genes CTSB, ITGB1, CXCR4, TNFSF10 and autophagy-related genes. As for the clinical factors, hypertension factor showed higher expression of ITGB1. The probability of coronary heart disease factor was significantly increased with high expression of CTSB and CXCR4, as well as low expression of ITGB1 and TNFSF10. Diabetes factor tended to express distinguished levels of CTSB and ITGB1. TNFSF10 was highly expressed in both hyperlipidemia and ischemic stroke factor. Conclusion CTSB, ITGB1, CXCR4 and TNFSF10 may be critical in atherosclerosis development and were thought to be potential diagnostic biomarkers for atherosclerosis.
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Affiliation(s)
- Yuanyuan Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - He Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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Hersant J, Ramondou P, Douillet D, Abrard S, Vandeputte P, Lapébie FX, Abraham P, Henni S. Comparison between conventional duplex ultrasonography and the dual-gate Doppler mode for hemodynamic measurements of the carotid arteries. Ultrasonography 2022; 41:373-381. [PMID: 34974673 PMCID: PMC8942739 DOI: 10.14366/usg.21175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose This study investigated the correlations of hemodynamic parameters measured to quantify stenosis between the gold-standard duplex ultrasonography and the dual-gate Doppler mode. Methods Patients examined due to suspicion of carotid artery stenosis or for surveillance of known stenosis were invited to participate in this prospective single-center study. Upon acceptance, the hemodynamic characteristics of the carotid arteries were determined successively in standard duplex and dual-gate Doppler modes. The correlations between the two modes were analyzed by computing Pearson coefficients (r2) and Lin concordance coefficients (ρc). The degree of agreement between the two methods was visualized using Bland-Altman graphical representations. Results The correlation between internal carotid artery peak systolic velocity measured by standard duplex ultrasonography and dual-gate Doppler mode was good (r2=0.642). The same high level of correlation was observed for the carotid ratio (r2=0.544). However, the Bland-Altman graphical representation and the Lin concordance coefficients (ρc=0.75 and ρc=0.74 for the internal carotid artery peak systolic velocity and carotid ratio, respectively) showed that a lack of precision generated some discrepancies between the two measurement methods. Conclusion Although some discrepancies were observed, the hemodynamic measurements were closely correlated between the two ultrasonography modes. Therefore, the dual-gate Doppler mode may have obvious advantages over conventional ultrasonography, offering interesting development possibilities.
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Affiliation(s)
- Jeanne Hersant
- Vascular Medicine, University Hospital Center, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital Center, Angers, France
| | | | | | | | | | - Pierre Abraham
- Sports Medicine, University Hospital Center, Angers, France.,MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital Center, Angers, France.,MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, Angers, France
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Peng C, Liu J, He W, Qin W, Yuan T, Kan Y, Wang K, Wang S, Shi Y. Numerical simulation in the abdominal aorta and the visceral arteries with or without stenosis based on 2D PCMRI. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3569. [PMID: 34967124 DOI: 10.1002/cnm.3569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
It is important to obtain accurate boundary conditions (BCs) in hemodynamic simulations. This article aimed to improve the accuracy of BCs in computational fluid dynamics (CFD) simulation and analyze the differences in hemodynamics between healthy volunteers and patients with visceral arterial stenosis (VAS). The geometric models of seven cases were reconstructed using the magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA) imaging data. The physiological flow waveforms obtained from 2D Phase Contrast Magnetic Resonance Imaging (PCMRI) were imposed on the aortic inlet and the visceral arteries' outlets. The individualized RCR values of the three-element Windkessel model were imposed on the aortic outlet. CFD simulations were run in the open-source software: svSolver. Two specific time points were selected to compare the hemodynamics of healthy volunteers and patients with VAS. The results suggested that blood in the stenotic visceral arteries flowed at high speed throughout the cardiac cycle. The low pressure is distributed at stenotic lesions. The wall shear stress (WSS) reached 4 Pa near stenotic locations. The low time average wall shear stress (TAWSS), high oscillatory shear index (OSI), and high relative residence time (RRT) concentrated in the abdominal aorta. Besides, the ratios of the areas with low TAWSS, high OSI, and high RRT to the computational domain were higher in patients with VAS than which in the healthy volunteers. The individualized BCs were used for hemodynamic simulations and results suggest that patients with stenosis have a higher risk of blood retention and atherosclerosis formation in the abdominal aorta.
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Affiliation(s)
- Chen Peng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Junzhen Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Qin
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Keqiang Wang
- Institute of Panvascular Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Cummins DD, Caton MT, Shah V, Meisel K, Glastonbury C, Amans MR. MRI and MR angiography evaluation of pulsatile tinnitus: A focused, physiology-based protocol. J Neuroimaging 2022; 32:253-263. [PMID: 34910345 PMCID: PMC8917066 DOI: 10.1111/jon.12955] [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] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Pulsatile tinnitus (PT) is the subjective sensation of a pulse-synchronous sound, most often due to a cerebrovascular etiology. PT can severely impact quality of life and may indicate a life-threatening process, yet a timely and accurate diagnosis can often lead to effective treatment. Clinical assessment with a history and physical examination can often suggest a diagnosis for PT, but is rarely definitive. Therefore, PT should be evaluated with a comprehensive and targeted radiographic imaging protocol. MR imaging provides a safe and effective means to evaluate PT. Specific MR sequences may be used to highlight different elements of cerebrovascular anatomy and physiology. However, routine MR evaluation of PT must comply with economic and practical constraints, while effectively capturing both common and rarer, life-threatening etiologies of PT. METHODS In this state-of-the-art review, we describe our institutional MR protocol for evaluating PT. RESULTS This protocol includes the following dedicated sequences: time-of-flight magnetic resonance angiography; arterial spin labeling; spoiled gradient recalled acquisition in the steady state; time-resolved imaging of contrast kinetics; diffusion weighted imaging, and 3-dimensional fluid-attenuated inversion recovery. CONCLUSIONS We describe the physiologic and clinical rationale for including each MR sequence in a comprehensive PT imaging protocol, and detail the role of MR within the broader evaluation of PT, from clinical presentation to treatment.
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Affiliation(s)
- Daniel D. Cummins
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael T. Caton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Karl Meisel
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew R. Amans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA,Corresponding author: Matthew R. Amans, Address: 505 Parnassus Ave, Room L349, San Francisco, CA 94143, Telephone: 415-353-1863, Fax: 415-353-8606,
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BİNBOĞA AB, GÜZEL G, ONAY M, ALTAY ÇM. Carotid artery stenting: a single-center experience. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1016133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kelley R, Bir S. Carotid atherosclerotic disease: A systematic review of pathogenesis and management. Brain Circ 2022; 8:127-136. [PMID: 36267431 PMCID: PMC9578307 DOI: 10.4103/bc.bc_36_22] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/12/2022] Open
Abstract
Carotid stenosis is an important contributor to ischemic stroke risk with resultant significant impact on neurological disability and death in adults and with worldwide implications. Management of carotid stenosis is impacted by whether there are associated symptoms along with the degree of stenosis. Understanding of the pathogenesis of carotid atherosclerosis or stenosis is important in management of carotid stenosis. Atherosclerotic plaque formation is a chronic insidious process with a number of potential contributors to the formation of such a plaque. The definition of atherosclerosis is not simply limited to abnormal deposition of lipid but also includes a chronic, complex, inflammatory process. Molecularly, in atherosclerosis, there is decreasing nitric oxide (NO) bioavailability, activity and/or expression of endothelial NO synthase, or increasing degradation of NO secondary to enhanced superoxide production. These above changes cause endothelial dysfunction leading to formation of foam cell followed by formation on lipid plaque. After lipid plaque formation, stable or unstable atherosclerotic plaque is formed depending on the calcium deposition over the lipid plaque. It continues to be clearly established that carotid intervention for symptomatic high-grade carotid stenosis is best managed with intervention either by carotid endarterectomy or carotid stenting. However, asymptomatic carotid stenosis is the subject of considerable controversy in terms of optimal management. This review of carotid atherosclerosis is an attempt to incorporate the information provided by more recent studies on pathogenesis and management which may help in the decision-making process for optimal management for protection against stroke.
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Neira JA, Connolly ES. Indications for Carotid Endarterectomy in Patients With Asymptomatic and Symptomatic Carotid Stenosis. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yang Q, Guo H, Shi X, Xu X, Zha M, Cai H, Yang D, Huang F, Zhang X, Lv Q, Liu R, Liu X. Identification of Symptomatic Carotid Artery Plaque: A Three-Item Scale Combined Angiography With Optical Coherence Tomography. Front Neurosci 2021; 15:792437. [PMID: 34955737 PMCID: PMC8702715 DOI: 10.3389/fnins.2021.792437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/12/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Symptomatic carotid disease conveys a high risk of recurrent stroke. Plaque morphology and specific plaque characteristics are associated with the risk of stroke. This study aimed to evaluate the detailed plaque features by optical coherence tomography (OCT) and develop a simple scale combining clinical indicators, digital subtraction angiography (DSA), and OCT imaging markers to identify symptomatic carotid plaque. Methods: Carotid plaques from consecutive patients who underwent carotid OCT imaging between June 2017 and June 2021 were evaluated. Clinical characteristics, DSA, and OCT data were compared between the symptomatic and asymptomatic groups. Logistic regression was performed to identify the factors associated with symptomatic carotid plaque and to develop a scale. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of the scale. Results: A total of 90 carotid plaques from 90 patients were included (symptomatic 35.6%, asymptomatic 64.4%). Three main factors were found to be associated with symptomatic carotid plaque: high-density lipoprotein cholesterol (HDL-C) <0.925 mmol/L (OR, 4.708; 95% CI, 1.640 to 13.517; P = 0.004), irregular plaque (OR, 4.017; 95% CI, 1.250 to 12.910; P = 0.020), and white thrombus (OR, 4.594; 95% CI, 1.141 to 18.487; P = 0.032). The corresponding score of three items produced a scale with good discrimination (AUC, 0.768; 95% CI, 0.665 to 0.871). The optimal cutoff value of the scale was 1.5 points with 59.4% sensitivity and 84.5% specificity. Conclusion: The three-item scale comprising HDL-C <0.925 mmol/L, angiographical irregular plaque, and white thrombus detected by OCT may provide information to identify symptomatic carotid plaque. Further large-scale studies are required to validate whether the symptomatic carotid plaque scale is clinically valuable in recognizing carotid atherosclerosis in the early stages.
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Affiliation(s)
- Qingwen Yang
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xuan Shi
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaohui Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mingming Zha
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Dahong Yang
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Feihong Huang
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xiaohao Zhang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Kigka VI, Potsika V, Mantzaris M, Tsakanikas V, Koncar I, Fotiadis DI. Serum Biomarkers in Carotid Artery Disease. Diagnostics (Basel) 2021; 11:diagnostics11112143. [PMID: 34829489 PMCID: PMC8619296 DOI: 10.3390/diagnostics11112143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Carotid artery disease is considered a major cause of strokes and there is a need for early disease detection and management. Although imaging techniques have been developed for the diagnosis of carotid artery disease and different imaging-based markers have been proposed for the characterization of atherosclerotic plaques, there is still need for a definition of high-risk plaques in asymptomatic patients who may benefit from surgical intervention. Measurement of circulating biomarkers is a promising method to assist in patient-specific disease management, but the lack of robust clinical evidence limits their use as a standard of care. The purpose of this review paper is to present circulating biomarkers related to carotid artery diagnosis and prognosis, which are mainly provided by statistical-based clinical studies. The result of our investigation showed that typical well-established inflammatory biomarkers and biomarkers related to patient lipid profiles are associated with carotid artery disease. In addition to this, more specialized types of biomarkers, such as endothelial and cell adhesion, matrix degrading, and metabolic biomarkers seem to be associated with different carotid artery disease outputs, assisting vascular specialists in selecting patients at high risk for stroke and in need of intervention.
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Affiliation(s)
- Vassiliki I. Kigka
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece; (V.I.K.); (V.P.); (M.M.); (V.T.)
| | - Vassiliki Potsika
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece; (V.I.K.); (V.P.); (M.M.); (V.T.)
| | - Michalis Mantzaris
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece; (V.I.K.); (V.P.); (M.M.); (V.T.)
| | - Vassilis Tsakanikas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece; (V.I.K.); (V.P.); (M.M.); (V.T.)
| | - Igor Koncar
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Vascular and Endovascular Surgery, Clinic Center of Serbia, 11000 Belgrade, Serbia
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece; (V.I.K.); (V.P.); (M.M.); (V.T.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research Institute—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece
- Correspondence: ; Tel.: +30-26510-09006; Fax: +30-26510-08889
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Symptom Status of Patients Undergoing Carotid Endarterectomy in Canada and United States. Ann Vasc Surg 2021; 81:183-195. [PMID: 34780953 DOI: 10.1016/j.avsg.2021.10.034] [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: 08/24/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous studies have demonstrated significant geographic variations in the management of carotid artery stenosis despite standard guidelines. To further characterize these practice variations, we assessed differences in patient selection, operative technique, and outcomes for carotid endarterectomy (CEA) in Canada vs. United States. METHODS The Vascular Quality Initiative (VQI) was used to identify all patients who underwent CEA between 2010 and 2019 in Canada and United States. Demographic, clinical, and procedural characteristics were recorded and differences between countries were assessed using independent t-test and chi-square test. The primary outcome was the percentage of CEA performed for asymptomatic versus symptomatic disease. The secondary outcomes were 30-day and long-term stroke or death. Associations between country and outcomes were assessed using univariate/multivariate logistic regression and Cox proportional hazards analysis. RESULTS During the study period, 131,411 US patients and 701 Canadian patients underwent CEA in VQI sites. Patients from the US were older with more comorbidities including hypertension, diabetes, congestive heart failure, and chronic kidney disease. The use of a shunt, patch, drain, or protamine was less common in the US. Most patients had 70 - 99% stenosis, with no difference between regions. The percentage of CEA performed for asymptomatic disease was significantly higher in the US even after adjusting for demographic, clinical, and procedural characteristics (72.4% vs. 30.7%, adjusted OR 3.91 [95% CI 3.21 - 4.78], p < 0.001). Thirty-day stroke/death was low (1.8% vs. 1.9%) and 1-year stroke/death was similar between groups (HR 0.98 [95% CI 0.69 - 1.39], P = 0.89). The similarities in 1-year stroke/death persisted in asymptomatic patients (HR 0.70 [95% CI 0.37 - 1.30], P = 0.26) and symptomatic patients (HR 1.14 [95% CI 0.74 - 1.73], P = 0.56). CONCLUSIONS There are significant variations in CEA practice between Canada and US. In particular, most US patients are treated for asymptomatic disease, whereas most Canadian patients are treated for symptomatic disease. Furthermore, adjunctive procedures including shunting, patch use, and protamine administration are performed less commonly in the US. Despite these differences, perioperative and 1-year stroke/death rates are similar between countries. Future studies should investigate reasons for these variations and quality improvement projects are needed to standardize care.
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Dakok KK, Matjafri MZ, Suardi N, Oglat AA, Nabasu SE. A Review of Carotid Artery Phantoms for Doppler Ultrasound Applications. J Med Ultrasound 2021; 29:157-166. [PMID: 34729323 PMCID: PMC8515632 DOI: 10.4103/jmu.jmu_164_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
Ultrasound imaging systems need tissue-mimicking phantoms with a good range of acoustic properties. Many studies on carotid artery phantoms have been carried out using ultrasound; hence this study presents a review of the different forms of carotid artery phantoms used to examine blood hemodynamics by Doppler ultrasound (DU) methods and explains the ingredients that constitute every phantom with their advantages and disadvantages. Different research databases were consulted to access relevant information on carotid artery phantoms used for DU measurements after which the information were presented systematically spanning from walled phantoms to wall-less phantoms. This review points out the fact that carotid artery phantoms are made up of tissue mimicking materials, vessel mimicking materials, and blood mimicking fluid whose properties matched those of real human tissues and vessels. These materials are a combination of substances such as water, gelatin, glycerol, scatterers, and other powders in their right proportions.
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Affiliation(s)
- Kyermang Kyense Dakok
- Department of Medical Physics and Radiation Science, School of Physics, Univirsti Sains Malaysia, Penang Malaysia, Nigeria
| | - Mohammed Zubir Matjafri
- Department of Medical Physics and Radiation Science, School of Physics, Univirsti Sains Malaysia, Penang Malaysia, Nigeria
| | - Nursakinah Suardi
- Department of Medical Physics and Radiation Science, School of Physics, Univirsti Sains Malaysia, Penang Malaysia, Nigeria
| | - Ammar Anwar Oglat
- Department of Medical Imaging, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Joradan, Nigeria
| | - Seth Ezra Nabasu
- Department of Physics, Plateau State University Bokkos, Plateau State, Nigeria
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Yin Y, Cheng Z, Fu X, Ji S. MicroRNA-375-3p is implicated in carotid artery stenosis by promoting the cell proliferation and migration of vascular smooth muscle cells. BMC Cardiovasc Disord 2021; 21:518. [PMID: 34702176 PMCID: PMC8549333 DOI: 10.1186/s12872-021-02326-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/13/2021] [Indexed: 01/15/2023] Open
Abstract
Background Atherosclerosis is the main cause of carotid artery stenosis (CAS) which mostly occurs in the elderly. In this paper, the expression level of miR-375-3p in asymptomatic CAS patients and its diagnostic value for asymptomatic CAS were investigated, and the effects of miR-375-3p on the cell proliferation and migration of vascular smooth muscle cells (VSMCs) was further explored. Methods
98 healthy subjects and 101 asymptomatic CAS patients were participated in this study. qRT-PCR was used to measure the expression level of serum miR-375-3p, and the ROC curve was established to evaluate the predictive value of miR-375-3p for asymptomatic CAS. After transfection with miR-375-3p mimic or inhibitor in vitro, cell proliferation and migration were detected by CCK-8 assay, colony formation assay, and Transwell assay, respectively. The levels of TNF-α, IL-1β, IL-6 were detected by ELISA. Western blot was used to detect the protein expression of XIAP. Finally, luciferase reporter gene assay was applied to assess the interaction of miR-375-3p with target genes. Results The expression level of serum miR-375-3p in asymptomatic CAS patients was significantly higher than that in healthy controls, and the AUC value of ROC curve was 0.888. The sensitivity and specificity were 80.2 and 86.7%, respectively, indicating that miR-375-3p had high diagnostic value for asymptomatic CAS. In vitro cell experiments showed that up-regulation of miR-375-3p significantly promoted the proliferation and migration of VSMCs, and also promoted the generation of inflammatory factors and phenotypic transformation of VSMCs. Luciferase reporter gene assay confirmed that XIAP was a target gene of miR-375-3p and was negatively regulated by miR-375-3p. Conclusions In this study, miR-375-3p may have a clinical diagnostic value for asymptomatic CAS patients which need further validation. Increased miR-375-3p levels in CAS may be associated with increased proliferation and migration of VSMCs via downregulation of the apoptosis inducing gene XIAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02326-6.
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Affiliation(s)
- Yuxia Yin
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China
| | - Zhen Cheng
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China
| | - Xiaoling Fu
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China
| | - Shishun Ji
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China.
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Ahmed M, McPherson R, Abruzzo A, Thomas SE, Gorantla VR. Carotid Artery Calcification: What We Know So Far. Cureus 2021; 13:e18938. [PMID: 34815892 PMCID: PMC8605497 DOI: 10.7759/cureus.18938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/27/2022] Open
Abstract
Carotid artery calcification (CAC) is a well-known marker of atherosclerosis and is linked to a high rate of morbidity and mortality. CAC is divided into two types: intimal and medial calcifications, each with its own set of risk factors. Vascular calcification is now understood to be an active, enzymatically regulated process involving dystrophic calcification and endothelial dysfunction at an early stage. This causes a pathogenic inflammatory response, resulting in calcium phosphate deposition in the form of microcalcifications, which causes plaque formation, ultimately becoming unstable with sequelae of complications. If the inflammation goes away, hydroxyapatite crystal formation takes over, resulting in macro-calcifications that help to keep the plaque stable. As CAC can be asymptomatic, it is critical to identify it early using diagnostic imaging. The carotid artery calcification score is calculated using computed tomography angiography (CTA), which is a confirmatory test that enables the examination of plaque composition and computation of the carotid artery calcification score. Magnetic resonance angiography (MRA), which is sensitive as CTA, duplex ultrasound (DUS), positron emission tomography, and computed tomography (PET-CT) imaging with (18) F-Sodium Fluoride, and Optical Coherence Tomography (OCT) are some of the other diagnostic imaging modalities used. The current therapeutic method starts with the best medical care and is advised for all CAC patients. Carotid endarterectomy and carotid stenting are two treatment options that have mixed results in terms of effectiveness and safety. When patient age and anatomy, operator expertise, and surgical risk are all considered, the agreement is that both techniques are equally beneficial.
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Affiliation(s)
- Madeeha Ahmed
- Family Medicine, American University of Antigua College of Medicine, Antigua, ATG
| | - Regina McPherson
- Anatomical Sciences, American University of Antigua, St.John's, ATG
| | - Alexandra Abruzzo
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Sneha E Thomas
- Internal Medicine, University of Maryland Medical Center, Baltimore, USA
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