1
|
Ryu JC, Jang CR, Lee SH. Contrast enhancement patterns associated with acute stroke in moyamoya disease using MR vessel wall imaging. J Neuroimaging 2024. [PMID: 39086117 DOI: 10.1111/jon.13226] [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: 05/24/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND AND PURPOSE High-resolution magnetic resonance imaging (HR-MRI) can provide valuable insights into the histopathological characteristics of moyamoya disease (MMD). However, the patterns of vessel wall contrast enhancement have not been well established. We aimed to identify the contrast enhancement patterns of the vessel walls associated with acute cerebral infarction using HR-MRI in MMD. METHODS In this retrospective study, we conducted genetic tests for Ring Finger Protein 213 (RNF 213) and performed HR-MRI on patients suspected of having MMD. We analyzed wall enhancement patterns including concentric, eccentric, or mixed enhancement types, and the occurrence of acute cerebral infarction in patients who simultaneously tested positive for RNF 213 and exhibited definite features of MMD on HR-MRI. RESULTS Among 306 patients who underwent RNF 213 tests for the evaluation of MMD, 56 showed positive RNF 213, and HR-MRI was performed on 32 of them. Among the patients with acute cerebral infarction, the incidence rate was significantly higher in the group with concentric wall enhancement compared to patients without acute cerebral infarction (73.3% vs. 17.0%, p < .002). Furthermore, the incidence was notably elevated, even in patients with pure concentric wall enhancement (40.0% vs. 5.9%, p = .033). The area under the curve (AUC) for the group with any concentric wall enhancement showed a significant result of .78 (95% confidence interval [CI]: .61-.95, p = .007), whereas the predictive ability for pure concentric wall enhancement did not reach significance (AUC = .67, 95% CI: .48-.86, p = .100). CONCLUSIONS Concentric wall enhancement was a significant predictor of acute cerebral infarction in patients with MMD.
Collapse
Affiliation(s)
- Jae-Chan Ryu
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Chul-Rae Jang
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| |
Collapse
|
2
|
Ayoub M, Liao Z, Li L, Wong KKL. HViT: Hybrid vision inspired transformer for the assessment of carotid artery plaque by addressing the cross-modality domain adaptation problem in MRI. Comput Med Imaging Graph 2023; 109:102295. [PMID: 37717365 DOI: 10.1016/j.compmedimag.2023.102295] [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: 04/12/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Medical image classification is crucial for accurate and efficient diagnosis, and deep learning frameworks have shown significant potential in this area. When a general learning deep model is directly deployed to a new dataset with heterogeneous features, the effect of domain shifts is usually ignored, which degrades the performance of deep learning models and leads to inaccurate predictions. PURPOSE This study aims to propose a framework that utilized the cross-modality domain adaptation and accurately diagnose and classify MRI scans and domain knowledge into stable and vulnerable plaque categories by a modified Vision Transformer (ViT) model for the classification of MRI scans and transformer model for domain knowledge classification. METHODS This study proposes a Hybrid Vision Inspired Transformer (HViT) framework that employs a convolutional layer for image pre-processing and normalization and a 3D convolutional layer to enable ViT to classify 3D images. Our proposed HViT framework introduces a slim design with a multi-branch network and channel attention, improving patch embedding extraction and information learning. Auxiliary losses target shallow features, linking them with deeper ones, enhancing information gain, and model generalization. Furthermore, replacing the MLP Head with RNN enables better backpropagation for improved performance. Moreover, we utilized a modified transformer model with LSTM positional encoding and Golve word vector to classify domain knowledge. By using ensemble learning techniques, specifically stacking ensemble learning with hard and soft prediction, we combine the predictive power of both models to address the cross-modality domain adaptation problem and improve overall performance. RESULTS The proposed framework achieved an accuracy of 94.32% for carotid artery plaque classification into stable and vulnerable plaque by addressing the cross-modality domain adaptation problem and improving overall performance. CONCLUSION The model was further evaluated using an independent dataset acquired from different hardware protocols. The results demonstrate that the proposed deep learning model significantly improves the generalization ability across different MRI scans acquired from different hardware protocols without requiring additional calibration data.
Collapse
Affiliation(s)
- Muhammad Ayoub
- School of Computer Science and Engineering, Central South University, Changsha 410017, Hunan, China
| | - Zhifang Liao
- School of Computer Science and Engineering, Central South University, Changsha 410017, Hunan, China.
| | - Lifeng Li
- Department of Radiology, The Affiliated Changsha Central Hospital, Hengyang Medical school, University of South China, Changsha 410017, China
| | - Kelvin K L Wong
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada.
| |
Collapse
|
3
|
Sun B, Ge X, Li X, Zhang J, Zhao Z, Liu X, Zhou Y, Xu J, Zhao H, Sun J. Elevated Hemoglobin A1c Is Associated With Leaky Plaque Neovasculature as Detected by Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Arterioscler Thromb Vasc Biol 2022; 42:504-513. [PMID: 35236109 DOI: 10.1161/atvbaha.121.317190] [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: 07/08/2020] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with diabetes have accelerated atherosclerosis progression, but the underlying mechanisms are not fully understood. Dynamic contrast-enhanced magnetic resonance imaging has allowed in vivo characterization of plaque neovasculature, which plays a critical role in plaque progression. We aimed to evaluate the impact of diabetes on carotid plaque neovasculature as assessed by dynamic contrast-enhanced magnetic resonance imaging. METHODS Patients with recent ischemic stroke and ipsilateral carotid plaque underwent multicontrast magnetic resonance imaging for characterizing plaque morphology and dynamic contrast-enhanced magnetic resonance imaging for pharmacokinetic parameters of plaque neovasculature, including transfer constant (Ktrans, reflecting flow, endothelial surface area, and permeability) and fractional plasma volume (νp). RESULTS Sixty-five patients were enrolled, including 30 patients with diabetes (years since diagnosis: median 5.0 [interquartile range, [3.0-12.0]) and 35 patients without diabetes. Subjects with diabetes had a greater plaque burden and a higher prevalence of high-risk characteristics. Additionally, carotid plaques in the subjects with diabetes showed higher Ktrans than those in the subjects without diabetes (0.100±0.048 min-1 versus 0.067±0.042 min-1, P=0.005) but νp was numerically lower in the subjects with diabetes (5.2±3.7% versus 6.2±4.3%, P=0.31). The association of diabetes with high Ktrans (β=0.033, P=0.005) was independent of patient and plaque characteristics and remained largely intact after adjusting for serum lipids, glucose, or hs-CRP (high-sensitivity C-reactive protein). However, it became nonexistent after adjusting for hemoglobin A1c (β=-0.010, P=0.49). CONCLUSIONS Dynamic contrast-enhanced magnetic resonance imaging of carotid plaques suggested that plaque neovasculature in patients with diabetes is leaky, indicating enhanced capability of bringing blood constituents and facilitating extravasation of inflammatory cells, erythrocytes, and plasma proteins. Leaky plaque neovasculature correlated with hemoglobin A1c and may play a role in accelerated atherosclerosis progression in diabetes.
Collapse
Affiliation(s)
- Beibei Sun
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Xiaoqian Ge
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
- Department of Radiology, Shandong Second Provincial General Hospital, Jinan, China (X.G.)
| | - Xiao Li
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
- Department of Radiology, Shandong Second Provincial General Hospital, Jinan, China (X.G.)
| | - Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Zizhou Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Xiaosheng Liu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle (J.S.)
| |
Collapse
|
4
|
MURAOKA S, TAOKA T, KAWAI H, OKAMOTO S, UDA K, NAGANAWA S, ARAKI Y. Changes in Vessel Wall Enhancement Related to the Recent Neurological Symptoms in Patients with Moyamoya Disease. Neurol Med Chir (Tokyo) 2021; 61:515-520. [PMID: 34078772 PMCID: PMC8443970 DOI: 10.2176/nmc.oa.2021-0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022] Open
Abstract
Moyamoya disease (MMD) causes intracranial arterial stenosis progression. The progression of intracranial arterial stenosis will increase the risk of ischemic cerebrovascular events. This study aims to investigate the relationship between intracranial arterial stenosis progression, vessel wall enhancement (VWE), and the recent neurological symptoms. A total of 39 MMD patients (12 male; 37.6 ± 18.0 years old) were registered in this study analysis between April 2016 and July 2018. All patients received MRI at registration and 6, 12, and 24 months post-registration. The incidence of ischemic cerebrovascular events (transit ischemic attacks or cerebral infarction) was checked until December 2018. We evaluated the relationship between the intensity of VWE, intracranial arterial stenosis, and the recent neurological symptoms. During the mean follow-up period of 13.8 ± 5.5 months, the changes in VWE were observed in 33 hemispheres (42.3%), stenosis progression was observed in 21 hemispheres (26.9%), and recent neurological symptoms occurred in 10 hemispheres (12.8%). Stenosis progression was observed in 11 hemispheres (33.3%) in the VWE(+) group and ten hemispheres (22.2%) in the VWE(-) group (p = 0.310). The recent neurological symptoms were observed in eight hemispheres (21.2%) in the VWE(+) group and two hemispheres (4.44%) in the VWE(-) group (odds ratio 6.88, 95% confidence interval 1.35-34.98, p = 0.015). The intensity of VWE sometimes changes. The changes in VWE were significantly associated with the recent neurological symptoms but not with stenosis progression.
Collapse
Affiliation(s)
- Shinsuke MURAOKA
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshiaki TAOKA
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hisashi KAWAI
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sho OKAMOTO
- Department of Neurosurgery, Aichi Rehabilitation Hospital, Nishio, Aichi, Japan
| | - Kenji UDA
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji NAGANAWA
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio ARAKI
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
5
|
Saba L, Sanagala SS, Gupta SK, Koppula VK, Johri AM, Khanna NN, Mavrogeni S, Laird JR, Pareek G, Miner M, Sfikakis PP, Protogerou A, Misra DP, Agarwal V, Sharma AM, Viswanathan V, Rathore VS, Turk M, Kolluri R, Viskovic K, Cuadrado-Godia E, Kitas GD, Sharma N, Nicolaides A, Suri JS. Multimodality carotid plaque tissue characterization and classification in the artificial intelligence paradigm: a narrative review for stroke application. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1206. [PMID: 34430647 PMCID: PMC8350643 DOI: 10.21037/atm-20-7676] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non-invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most.
Collapse
Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari, Italy
| | - Skandha S Sanagala
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India.,CSE Department, Bennett University, Greater Noida, UP, India
| | - Suneet K Gupta
- CSE Department, Bennett University, Greater Noida, UP, India
| | - Vijaya K Koppula
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, Rhode Island, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, Rhode Island, USA
| | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention, National and Kapodistrian University of Athens, Athens, Greece
| | - Durga P Misra
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, VA, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Vijay S Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | | | | | | | - George D Kitas
- R & D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Neeraj Sharma
- Department of Biomedical Engineering, IIT-BHU, Banaras, UP, India
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia, Nicosia, Cyprus
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| |
Collapse
|
6
|
Fujiwara Y, Mio M. Improvement in the contrast-to-noise ratio and quantitative measurement of T 1 and T 2* values for carotid atherosclerotic plaque using multi-echo phase-sensitive inversion recovery. Radiol Phys Technol 2021; 14:186-192. [PMID: 33942236 DOI: 10.1007/s12194-021-00619-1] [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: 01/20/2021] [Revised: 04/04/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Quantitative magnetic resonance imaging is required to accurately evaluate carotid plaque vulnerability. We prospectively evaluated the potential for fast quantitative black-blood carotid vessel wall imaging using a three-dimensional (3D) multi-echo phase-sensitive inversion recovery (mPSIR) sequence. Forty-nine patients with carotid atherosclerotic plaques were examined. Two-dimensional (2D) turbo spin-echo (TSE), 3D volumetric isotropic turbo spin-echo, and 3D mPSIR imaging were performed. The contrast-to-noise ratios (CNRs) between the carotid plaque and adjacent muscle were compared for the three imaging methods. The T1 and T2* values of the carotid plaques were measured using 3D mPSIR images. These values were compared with those of symptomatic and asymptomatic plaques. For carotid plaques with a signal intensity ratio ≥ 1.55, between the carotid plaque and adjacent muscle in 2D TSE images, the CNR of the mPSIR images was significantly higher than that of the other sequences. T1 values for symptomatic and asymptomatic plaques were 544.0 ± 258.0 and 569.1 ± 301.7, respectively. T2* values for symptomatic and asymptomatic plaques were 34.0 ± 33.0 and 21.8 ± 20.3 ms, respectively. There were no significant differences in the T1 and T2* values between the symptomatic and asymptomatic plaques. 3D mPSIR improves the CNR of T1-weighted images for carotid plaques and the adjacent muscle while simultaneously providing the T1 and T2* values of the carotid plaque. This improved CNR may be useful for assessing the vulnerability of carotid plaques.
Collapse
Affiliation(s)
- Yasuhiro Fujiwara
- Department of Medical Image Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto, 862-0976, Japan.
| | - Motohira Mio
- Department of Radiology, Fukuoka Chikushi Hospital, Fukuoka, Japan
| |
Collapse
|
7
|
Ishikawa T, Yamazaki T, Sato M, Kato N, Ishikawa E, Matsumaru Y, Matsumura A. Endovascular Stent Grafting for Recurrent Strokes Due to Fragile Innominate Artery Plaque: A Case Report. NMC Case Rep J 2021; 8:21-25. [PMID: 34012744 PMCID: PMC8116917 DOI: 10.2176/nmccrj.cr.2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022] Open
Abstract
Here we describe a case of recurrent ischemic strokes due to fragile innominate artery plaque successfully treated using endovascular stent grafting. An 80-year-old man presented with a history of recurrent strokes that were refractory to medical treatment. Computed tomography and magnetic resonance images of the thorax revealed a gross intramural plaque in the innominate artery. He was successfully treated using endovascular stent grafting. An AFX stent graft device was used to prevent further embolic strokes. The AFX stent graft has a unique endoskeleton design with a thin-walled expanded polytetrafluoroethylene fabric—known as active sealing structure—attached to the implant. Postoperatively, the patient has experienced no recurrent strokes in over 2 years of follow-up. The stent grafting procedure could be an optimal treatment option for treating fragile innominate artery plaques.
Collapse
Affiliation(s)
- Takaaki Ishikawa
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Tomosato Yamazaki
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Masataka Sato
- Department of Cardiovascular Surgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Ibaraki, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
8
|
Kathuveetil A, Sylaja PN, Senthilvelan S, Kesavadas C, Banerjee M, Jayanand Sudhir B. Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease. AJNR Am J Neuroradiol 2020; 41:100-105. [PMID: 31896569 DOI: 10.3174/ajnr.a6360] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Very few data are available with regard to high-resolution intracranial vessel wall imaging characteristics of Moyamoya disease and their relation to ischemic stroke risk. We investigated the high resolution imaging characteristics of MMD and its correlation with recent ischemic events. MATERIALS AND METHODS Patients with Moyamoya disease confirmed by DSA, including patients after revascularization, were enrolled. All the patients underwent high-resolution intracranial vessel wall imaging. Vessel wall thickening, enhancement, and the remodeling index of the bilateral distal ICA and proximal MCA were noted. The patients were followed up at 3 months and 6 months after high-resolution intracranial vessel wall imaging and the association of ischemic events with imaging characteristics was assessed. RESULTS Twenty-nine patients with Moyamoya disease were enrolled. The median age at symptom onset was 12 years (range, 1-51 years). A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 3 patients (4 lesions) showed grade II enhancement. The presence of contrast enhancement (P = .01) and wall thickening (P ≤ .001) showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. Grade II enhancement showed a statistically significant (P = .02) association with ischemic events within 4 weeks of high-resolution intracranial vessel wall imaging. The mean ± standard deviation outer diameter of the distal ICA (right, -3.3 ± 0.68 mm; left, 3.4 ± 0.60 mm) and the remodeling index (right, 0.71 ± 0.13; left, 0.69 ± 0.13) were lower in Moyamoya disease. CONCLUSIONS High-resolution intracranial vessel wall imaging characteristics of concentric wall thickening and enhancement are relatively rare in our cohort of patients with Moyamoya disease. The presence of wall thickening and enhancement may predict future ischemic events in patients with Moyamoya disease.
Collapse
Affiliation(s)
- A Kathuveetil
- From the Comprehensive Stroke Care Program (A.K., P.N.S.), Department of Neurology
| | - P N Sylaja
- From the Comprehensive Stroke Care Program (A.K., P.N.S.), Department of Neurology
| | | | | | - M Banerjee
- Neurosurgery (B.J.S.), Rajiv Gandhi Centre for Biotechnology, Trivandrum, Kerala, India
| | - B Jayanand Sudhir
- Sree Chitra Tirunal Institute for Medical Sciences and Technology (M.B.), Trivandrum, Kerala, India
| |
Collapse
|
9
|
Oshida S, Mori F, Sasaki M, Sato Y, Kobayshi M, Yoshida K, Fujiwara S, Ogasawara K. Wall Shear Stress and T1 Contrast Ratio Are Associated With Embolic Signals During Carotid Exposure in Endarterectomy. Stroke 2019; 49:2061-2066. [PMID: 30354998 PMCID: PMC6116793 DOI: 10.1161/strokeaha.118.022322] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The frictional force because of blood flow may dislodge masses present on the surface of a plaque. Such frictional force is calculated as wall shear stress (WSS) using computational fluid dynamics. The aims of the present study were to determine whether, in addition to carotid plaque intensity on T1-weighted magnetic resonance (MR) imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy. Methods— One hundred patients with internal carotid artery stenosis (≥70%) underwent carotid plaque imaging with MR, and 54 patients with a vulnerable plaque (intraplaque hemorrhage or lipid/necrotic core) displayed as a high-intensity lesion underwent additional cervical 3-dimensional MR angiography. The maximum value of WSS within the most severe stenotic segment of the internal carotid artery was calculated using MR angiography. Transcranial Doppler monitoring of microembolic signals (MES) in the ipsilateral middle cerebral artery was performed during carotid endarterectomy. Results— Although none of the 46 patients with a nonvulnerable carotid plaque had MES during exposure of carotid arteries, 24 of the 54 patients with a vulnerable carotid plaque (44%) had MES. Logistic regression analysis showed that higher plaque intensity (P=0.0107) and higher WSS (P=0.0029) were significantly associated with the development of MES. When both cutoff points of plaque intensity and WSS in the receiver operating characteristic curves for predicting development of MES were combined, specificity (from 63% to 93%) and positive predictive value (from 66% to 90%) became greater than those for plaque intensity alone. Conclusions— In addition to carotid plaque intensity on T1-weighted MR imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy.
Collapse
Affiliation(s)
- Sotaro Oshida
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
| | - Futoshi Mori
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (F.M., M.S.), Iwate Medical University, Morioka, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (F.M., M.S.), Iwate Medical University, Morioka, Japan
| | - Yuiko Sato
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
| | | | - Kenji Yoshida
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
| | - Shunrou Fujiwara
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
| | | |
Collapse
|
10
|
Saba L, Lanzino G, Lucatelli P, Lavra F, Sanfilippo R, Montisci R, Suri JS, Yuan C. Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraparenchymal Hemorrhage: A Preliminary Analysis. AJNR Am J Neuroradiol 2019; 40:1538-1545. [PMID: 31395662 DOI: 10.3174/ajnr.a6160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/28/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The presence of IPH is considered the most dangerous feature because it is significantly associated with clinical ipsilateral cerebrovascular events. Our aim was to explore the characterization of plaque with CT in symptomatic subjects with bilateral intraplaque hemorrhage. MATERIALS AND METHODS Three-hundred-forty-three consecutive patients with recent anterior circulation ischemic events (<2 weeks) and CT of the carotid arteries (performed within 14 days of the cerebrovascular event) evaluated between June 2012 and September 2017 were analyzed for plaque volume composition to identify all subjects with bilateral intraplaque hemorrhage. Plaque volume was semiautomatically measured, and tissue components were classified according to the attenuation values such as the following: calcified (for values of ≥130 HU), mixed (for values of ≥60 and <130 HU), lipid (for values of ≥25 and <60 HU), and intraplaque hemorrhage (for values of <25 HU). Twenty-one subjects (15 men; mean age, 70 ± 11 years; range, 44-87 years) had bilateral intraplaque hemorrhage and were included in the analysis. RESULTS Volume measurement revealed significantly larger plaques on the symptomatic side compared with the asymptomatic one (mean, 28 ± 9 versus 22 ± 8 mm, P = .007). Intraplaque hemorrhage volume and percentage were also significantly higher in the plaque ipsilateral to the cerebrovascular event (P < .001 and < .001, respectively). The volume of other plaque components did not show a statically significant association except for lipid and lipid + intraplaque hemorrhage percentages (23% versus 18% and 11% versus 15%), which were significantly different between the symptomatic and the asymptomatic sides (.016 and .011, respectively). The intraplaque hemorrhage/lipid ratio was higher on the symptomatic side (0.596 versus 0.171, P = .001). CONCLUSIONS In patients with bilateral intraplaque hemorrhage and recent ischemic symptoms, the plaque ipsilateral to the symptomatic side has significantly larger volume and a higher percentage of intraplaque hemorrhage compared with the contralateral, asymptomatic side.
Collapse
Affiliation(s)
- L Saba
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - G Lanzino
- Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - P Lucatelli
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology (P.L.), Sapienza University of Rome, Rome, Italy
| | - F Lavra
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - R Sanfilippo
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - R Montisci
- From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - J S Suri
- Diagnostic and Monitoring Division (J.S.S.), Atheropoint, Roseville, California.,Department of Electrical Engineering (J.S.S.), University of Idaho, Moscow, Idaho
| | - C Yuan
- Center for Biomedical Imaging Research (C.Y.), Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Department of Radiology (C.Y.), University of Washington, Seattle, Washington
| |
Collapse
|
11
|
Muraoka S, Araki Y, Taoka T, Kawai H, Okamoto S, Uda K, Ota S, Naganawa S, Wakabayashi T. Prediction of Intracranial Arterial Stenosis Progression in Patients with Moyamoya Vasculopathy: Contrast-Enhanced High-Resolution Magnetic Resonance Vessel Wall Imaging. World Neurosurg 2018; 116:e1114-e1121. [PMID: 29864569 DOI: 10.1016/j.wneu.2018.05.181] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Moyamoya vasculopathy (MMV) is characterized by progressive stenosis of the intracranial arteries. MMV currently has no curative treatments, and cerebral ischemia and hemorrhage are the major outcomes. Evaluation of the stroke risk of each patient resulting from the progression of intracranial arterial stenosis is clinically important. METHODS We prospectively reviewed patients with intracranial arterial stenosis and already diagnosed MMV. High-resolution magnetic resonance imaging using contrast agent is the novel vessel wall imaging (VWI) technique for directly evaluating vascular walls and intracranial artery disease. All patients underwent high-resolution vessel wall imaging and magnetic resonance angiography at the time of registration, and they underwent follow-up magnetic resonance angiography. The Fisher exact test was used to assess associations between the degrees of wall enhancement and between stable and progressive intracranial arterial stenosis. RESULTS A total of 24 patients (17 female; mean age, 36.1 ± 16.8 years; range 3-67 years) with MMV were consecutively recruited to this study. Progression of stenosis was shown in 6 lesions (66.6%) on strong enhancement, 2 lesions (12.5%) on mild enhancement, and 1 lesion (4.3%) on lack of enhancement. Arterial vessel wall enhancement in MMV patients correlated closely with progression of intracranial arterial stenosis (P = 0.002). CONCLUSIONS Arterial vessel wall enhancement in MMV patients was closely related to progression of intracranial arterial stenosis. Strong enhancement of the intracranial vessel wall was associated with intracranial arterial stenosis progression, and lack of enhancement correlated with the stability of intracranial arterial stenosis.
Collapse
Affiliation(s)
- Shinsuke Muraoka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshiaki Taoka
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hisashi Kawai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sho Okamoto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Ota
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
12
|
Kirkham EM, Hatsukami TS, Heckbert SR, Sun J, Canton G, Yuan C, Weaver EM. Association between Snoring and High-Risk Carotid Plaque Features. Otolaryngol Head Neck Surg 2017; 157:336-344. [PMID: 28695757 PMCID: PMC5940929 DOI: 10.1177/0194599817715634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/14/2017] [Indexed: 01/17/2023]
Abstract
Objectives Previous studies have demonstrated an association between snoring and carotid disease independent of sleep apnea. The aim of this study was to quantify the association between self-reported snoring and high-risk carotid plaque features on magnetic resonance imaging (MRI) that predict stroke. Study Design Cross-sectional. Setting Tertiary care university hospital and affiliated county hospital. Methods We surveyed 133 subjects with asymptomatic carotid artery disease that had been previously evaluated with high-resolution MRI. The survey captured data on self-reported snoring (exposure) and covariates (age, sex, body mass index, and sleep apnea via the STOP-Bang questionnaire). A subset of patients underwent home sleep apnea testing. High-risk carotid plaque features were identified on the high-resolution MRI and included thin/ruptured fibrous cap and intraplaque hemorrhage (outcomes). We quantified the association between snoring and high-risk carotid plaque features with the chi-square test (unadjusted analysis) and multivariate logistic regression adjusting for the covariates. Results Of 133 subjects surveyed, 61 (46%) responded; 32 (52%) reported snoring. Significantly higher proportions of snorers than nonsnorers had a thin/ruptured fibrous cap (56% vs 25%, P = .01) and intraplaque hemorrhage (63% vs 29%, P < .01). In multivariate analysis, snoring was associated with thin/ruptured fibrous cap (odds ratio, 4.4; 95% CI, 1.1-16.6; P = .04) and intraplaque hemorrhage (odds ratio, 8.2; 95% CI, 2.1-31.6; P < .01) after adjusting for age, sex, body mass index, and sleep apnea. Conclusion This pilot study suggests a significant independent association between snoring and high-risk carotid plaque features on MRI. Further study is warranted to confirm these results in a larger cohort of subjects.
Collapse
Affiliation(s)
- Erin M Kirkham
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- 2 Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Susan R Heckbert
- 3 Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jie Sun
- 4 Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Gador Canton
- 5 Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- 4 Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Edward M Weaver
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| |
Collapse
|
13
|
The Contrast Enhancement of Intracranial Arterial Wall on High-resolution MRI and Its Clinical Relevance in Patients with Moyamoya Vasculopathy. Sci Rep 2017; 7:44264. [PMID: 28276529 PMCID: PMC5381100 DOI: 10.1038/srep44264] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/07/2017] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study is to investigate the characteristics of intracranial vessel wall enhancement and its relationship with ischemic infarction in patients with Moyamoya vasculopathy (MMV). Forty-seven patients with MMV confirmed by angiography were enrolled in this study. The vessel wall enhancement of the distal internal carotid artery, anterior cerebral artery and middle cerebral artery was classified into eccentric and concentric patterns, as well as divided into three grades: grade 0, grade 1 and grade 2. The relationship between ischemic infarction and vessel wall enhancement was also determined. Fifty-six enhanced lesions were found in patients with (n = 25) and without acute infarction (n = 22). The incidence of lesions with grade 2 enhancement in patients with acute infarction was greater than that in those without acute infarction (p = 0.011). In addition, grade 2 enhancement of the intracranial vessel wall was significantly associated with acute ischemic infarction (Odds ratio, 26.7; 95% confidence interval: 2.8-258.2; p = 0.005). Higher-grade enhancement of the intracranial vessel wall is independently associated with acute ischemic infarction in patients with MMV. The characteristics of intracranial vessel wall enhancement may serve as a marker of its stability and provide important insight into ischemic stroke risk factors.
Collapse
|
14
|
Ge X, Zhou Z, Zhao H, Li X, Sun B, Suo S, Hackett ML, Wan J, Xu J, Liu X. Evaluation of carotid plaque vulnerability in vivo: Correlation between dynamic contrast-enhanced MRI and MRI-modified AHA classification. J Magn Reson Imaging 2017; 46:870-876. [PMID: 28120364 DOI: 10.1002/jmri.25637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/03/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To noninvasively monitor carotid plaque vulnerability by exploring the relationship between pharmacokinetic parameters (PPs) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and plaque types based on MRI-modified American Heart Association (AHA) classification, as well as to assess the ability of PPs in discrimination between stable and vulnerable plaques suspected on MRI. MATERIALS AND METHODS Of 70 consecutive patients with carotid plaques who volunteered for 3.0T MRI (3D time-of-flight [TOF], T1 -weighted, T2 -weighted, 3D magnetization-prepared rapid acquisition gradient-echo [MP-RAGE] and DCE-MRI), 66 participants were available for analysis. After plaque classification according to MRI-modified AHA Lesion-Type (LT), PPs (Ktrans , kep , ve , and vp ) of DCE-MRI were measured. The Extended Tofts model was used for calculation of PPs. For participants with multiple carotid plaques, the plaque with the worst MRI-modified AHA LT was chosen for analysis. Correlations between PPs and plaque types and the ability of these parameters to distinguish stable and vulnerable plaques suspected on MRI were assessed. RESULTS Significant positive correlation between Ktrans and LT III to VI was found (ρ = 0.532, P < 0.001), as was the correlation between kep and LT III to VI (ρ = 0.409, P < 0.001). Stable and vulnerable plaques suspected on MRI could potentially be distinguished by Ktrans (sensitivity 83%, specificity 100%) and kep (sensitivity 77%, specificity 91%). CONCLUSION Ktrans and kep from DCE-MRI can provide quantitative information to monitor plaque vulnerability in vivo and differentiate vulnerable plaques suspected on MRI from stable ones. These two parameters could be adopted as imaging biomarkers for plaque characterization and risk stratification. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:870-876.
Collapse
Affiliation(s)
- Xiaoqian Ge
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Zien Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Xiao Li
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Beibei Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Shiteng Suo
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Maree L Hackett
- Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Jieqing Wan
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Xiaosheng Liu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| |
Collapse
|
15
|
Leong SS, Vijayananthan A, Yaakup NA, Shah N, Ng KH, Acharya UR, Bilgen M. Observer performance in characterization of carotid plaque texture and surface characteristics with 3D versus 2D ultrasound. Comput Biol Med 2016; 78:58-64. [PMID: 27658262 DOI: 10.1016/j.compbiomed.2016.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/10/2016] [Accepted: 09/10/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the reproducibility of three-dimensional (3D) ultrasound (US) over two-dimensional (2D) US in characterizing atherosclerotic carotid plaques using inter- and intra-observer agreement metrics. METHODS A Total of 51 patients with 105 carotid artery plaques were screened using 3D and 2D US probes attached to the same US scanner. Two independent observers characterized the plaques based on the morphological features namely echotexture, echogenicity and surface characteristics. The scores assigned to each morphological feature were used to determine intra- and inter-observer performance. The level of agreement was measured using Kappa coefficient. RESULTS The first observer with 2D US showed fair (k=0.4-0.59) and very strong (k>0.8) with 3D US intra-observer agreements using three morphological features. The second observer indicated moderate strong (k=0.6-0.79) with 2D US and very strong with 3D US (k>0.8) intra-observer performances. Moderate strong (k=0.6-0.79) and very strong (k>0.8) inter-observer agreements were reported with 2D US and 3D US respectively. The results with 2D and 3D US were correlated 62% using only echotexture and 56% using surface morphology coupled with echogenicity. 3D US gave a lower score than 2D 71% of the time (p=0.005) in disagreement cases. CONCLUSION High reproducibility in carotid plaque characterization was obtained using 3D US rather than 2D US. Hence, it can be a preferred imaging modality in routine or follow up plaque screening of patients with carotid artery disease.
Collapse
Affiliation(s)
- Sook Sam Leong
- Department of Biomedical Imaging, University Malaya Medical Centre Kuala Lumpur, Malaysia.
| | - Anushya Vijayananthan
- Department of Biomedical Imaging, University Malaya Medical Centre Kuala Lumpur, Malaysia
| | - Nur Adura Yaakup
- Department of Biomedical Imaging, University Malaya Medical Centre Kuala Lumpur, Malaysia
| | - Nazri Shah
- Department of Biomedical Imaging, University Malaya Medical Centre Kuala Lumpur, Malaysia
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, University Malaya Medical Centre Kuala Lumpur, Malaysia
| | - U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore; Department of Biomedical Engineering, School of Science and Technology, SIM University, Singapore; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia
| | - Mehmet Bilgen
- Department of Biophysics, University of Adnan Menderes, Aydin, Turkey
| |
Collapse
|
16
|
Sato Y, Ogasawara K, Narumi S, Sasaki M, Saito A, Tsushima E, Namba T, Kobayashi M, Yoshida K, Terayama Y, Ogawa A. Optimal MR Plaque Imaging for Cervical Carotid Artery Stenosis in Predicting the Development of Microembolic Signals during Exposure of Carotid Arteries in Endarterectomy: Comparison of 4 T1-Weighted Imaging Techniques. AJNR Am J Neuroradiol 2016; 37:1146-54. [PMID: 26846926 DOI: 10.3174/ajnr.a4674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative identification of plaque vulnerability may allow improved risk stratification for patients considered for carotid endarterectomy. The present study aimed to determine which plaque imaging technique, cardiac-gated black-blood fast spin-echo, magnetization-prepared rapid acquisition of gradient echo, source image of 3D time-of-flight MR angiography, or noncardiac-gated spin-echo, most accurately predicts development of microembolic signals during exposure of carotid arteries in carotid endarterectomy. MATERIALS AND METHODS Eighty patients with ICA stenosis (≥70%) underwent the 4 sequences of preoperative MR plaque imaging of the affected carotid bifurcation and then carotid endarterectomy under transcranial Doppler monitoring of microembolic signals in the ipsilateral middle cerebral artery. The contrast ratio of the carotid plaque was calculated by dividing plaque signal intensity by sternocleidomastoid muscle signal intensity. RESULTS Microembolic signals during exposure of carotid arteries were detected in 23 patients (29%), 3 of whom developed new neurologic deficits postoperatively. Those deficits remained at 24 hours after surgery in only 1 patient. The area under the receiver operating characteristic curve to discriminate between the presence and absence of microembolic signals during exposure of the carotid arteries was significantly greater with nongated spin-echo than with black-blood fast spin-echo (difference between areas, 0.258; P < .0001), MPRAGE (difference between areas, 0.106; P = .0023), or source image of 3D time-of-flight MR angiography (difference between areas, 0.128; P = .0010). Negative binomial regression showed that in the 23 patients with microembolic signals, the contrast ratio was associated with the number of microembolic signals only in nongated spin-echo (risk ratio, 1.36; 95% confidence interval, 1.01-1.97; P < .001). CONCLUSIONS Nongated spin-echo may predict the development of microembolic signals during exposure of the carotid arteries in carotid endarterectomy more accurately than other MR plaque imaging techniques.
Collapse
Affiliation(s)
- Y Sato
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Ogasawara
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - S Narumi
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - M Sasaki
- Division of Ultra-High Field MRI and Department of Radiology (M.S.), Iwate Medical University School of Medicine, Morioka, Japan
| | - A Saito
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - E Tsushima
- Graduate School of Health Sciences (E.T.), Hirosaki University, Hirosaki, Japan
| | - T Namba
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - M Kobayashi
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Yoshida
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - Y Terayama
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - A Ogawa
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| |
Collapse
|
17
|
Doherty JR, Dahl JJ, Kranz PG, El Husseini N, Chang HC, Chen NK, Allen JD, Ham KL, Trahey GE. Comparison of Acoustic Radiation Force Impulse Imaging Derived Carotid Plaque Stiffness With Spatially Registered MRI Determined Composition. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:2354-65. [PMID: 25974933 PMCID: PMC4678151 DOI: 10.1109/tmi.2015.2432797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Measurements of plaque stiffness may provide important prognostic and diagnostic information to help clinicians distinguish vulnerable plaques containing soft lipid pools from more stable, stiffer plaques. In this preliminary study, we compare in vivo ultrasonic Acoustic Radiation Force Impulse (ARFI) imaging derived measures of carotid plaque stiffness with composition determined by spatially registered Magnetic Resonance Imaging (MRI) in five human subjects with stenosis > 50%. Ultrasound imaging was implemented on a commercial diagnostic scanner with custom pulse sequences to collect spatially registered 2D longitudinal B-mode and ARFI images. A standardized, multi-contrast weighted MRI sequence was used to obtain 3D Time of Flight (TOF), T1 weighted (T1W), T2 weighted (T2W), and Proton Density Weighted (PDW) transverse image stacks of volumetric data. The MRI data was segmented to identify lipid, calcium, and normal loose matrix components using commercially available software. 3D MRI segmented plaque models were rendered and spatially registered with 2D B-mode images to create fused ultrasound and MRI volumetric images for each subject. ARFI imaging displacements in regions of interest (ROIs) derived from MRI segmented contours of varying composition were compared. Regions of calcium and normal loose matrix components identified by MRI presented as homogeneously stiff regions of similarly low (typically ≈ 1 μm) displacement in ARFI imaging. MRI identified lipid pools > 2 mm(2), found in three out of five subjects, presented as softer regions of increased displacement that were on average 1.8 times greater than the displacements in adjacent regions of loose matrix components in spatially registered ARFI images. This work provides early evidence supporting the use of ARFI imaging to noninvasively identify lipid regions in carotid artery plaques in vivo that are believed to increase the propensity of a plaque to rupture. Additionally, the results provide early training data for future studies and aid in the interpretation and possible clinical utility of ARFI imaging for identifying the elusive vulnerable plaque.
Collapse
|
18
|
Gustafsson H, Hallbeck M, Norell M, Lindgren M, Engström M, Rosén A, Zachrisson H. Fe(III) distribution varies substantially within and between atherosclerotic plaques. Magn Reson Med 2015; 71:885-92. [PMID: 23447110 DOI: 10.1002/mrm.24687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Vulnerable atherosclerotic plaques are structurally weak and prone to rupture, presumably due to local oxidative stress. Redox active iron is linked to oxidative stress and the aim of this study was to investigate the distribution of Fe(III) in carotid plaques and its relation to vulnerability for rupture. METHODS Atherosclerotic plaques from 10 patients (three asymptomatic and seven symptomatic) were investigated. Plaque vulnerability was classified using ultrasound and immunohistochemistry and correlated to Fe(III) measured by electron paramagnetic resonance spectroscopy. RESULTS Large intra-plaque Fe(III) variations were found. Plaques from symptomatic patients had a higher Fe(III) concentration as compared with asymptomatic plaques (0.36 ± 0.21 vs. 0.06 ± 0.04 nmol Fe(III)/mg tissue, P < 0.05, in sections adjoining narrowest part of the plaques). All but one plaque from symptomatic patients showed signs of cap rupture. No plaque from asymptomatic patients showed signs of cap rupture. There was a significant increase in cap macrophages in plaques from symptomatic patients compared with asymptomatic patients (31 ± 11% vs. 2.3 ± 2.3%, P < 0.01). CONCLUSION Fe(III) distribution varies substantially within atherosclerotic plaques. Plaques from symptomatic patients had significantly higher concentrations of Fe(III), signs of cap rupture and increased cap macrophage activity.
Collapse
Affiliation(s)
- H Gustafsson
- Department of Medical and Health Sciences (IMH), Division of Radiological Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | | | | | | | | | | |
Collapse
|
19
|
Magnoni M, Ammirati E, Camici PG. Non-invasive molecular imaging of vulnerable atherosclerotic plaques. J Cardiol 2015; 65:261-9. [PMID: 25702846 DOI: 10.1016/j.jjcc.2015.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
The growing discoveries coming from clinical and basic research during the past decades have revolutionized our knowledge regarding pathophysiologic mechanisms underlying the atherosclerotic process and its thrombotic complications. The traditional view focusing on the severity of stenosis of atherosclerotic plaque has given way to the evidence that the clinical complications of atherosclerotic vascular disease, particularly the propensity to develop thrombotic complications, are determined mainly by the biological composition of the plaque. This paradigm shift has reinforced the need to move from the sole anatomical assessment toward combined anatomic and functional imaging modalities enabling the molecular and cellular characterization of the disease on top of its structural properties. Together, the progress to identify molecular targets related to plaque vulnerability and the improvement of imaging techniques for the detection of such molecular targets have allowed us to obtain new important pathophysiological information. This might allow better patient stratification for the identification of subjects at high risk to develop premature atherosclerosis who might need an aggressive therapeutic approach. Nuclear techniques, magnetic resonance imaging, computed tomography angiography, and contrast-enhanced ultrasound represent the currently available non-invasive imaging modalities for molecular imaging which can provide different and complementary insights into the biological features of the atherosclerotic process. This clinical review will discuss the evidence and potential translational applications of the individual imaging techniques particularly concerning their ability to detect the main atherosclerotic features related to plaque vulnerability, such as plaque inflammation and intertwined neovascularization.
Collapse
Affiliation(s)
- Marco Magnoni
- Università Vita-Salute San Raffaele and Department of Cardiothoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy; Heart Care Foundation, Florence, Italy.
| | - Enrico Ammirati
- Università Vita-Salute San Raffaele and Department of Cardiothoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy; Cardiovascular and Thoracic Department, AO Niguarda Ca' Granda, Milan, Italy
| | - Paolo G Camici
- Università Vita-Salute San Raffaele and Department of Cardiothoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
20
|
Jacobin-Valat MJ, Laroche-Traineau J, Larivière M, Mornet S, Sanchez S, Biran M, Lebaron C, Boudon J, Lacomme S, Cérutti M, Clofent-Sanchez G. Nanoparticles functionalised with an anti-platelet human antibody for in vivo detection of atherosclerotic plaque by magnetic resonance imaging. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:927-37. [PMID: 25684334 DOI: 10.1016/j.nano.2014.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 11/29/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Atherosclerosis is an inflammatory disease associated with the formation of atheroma plaques likely to rupture in which platelets are involved both in atherogenesis and atherothrombosis. The rupture is linked to the molecular composition of vulnerable plaques, causing acute cardiovascular events. In this study we propose an original targeted contrast agent for molecular imaging of atherosclerosis. Versatile USPIO (VUSPIO) nanoparticles, enhancing contrast in MR imaging, were functionalised with a recombinant human IgG4 antibody, rIgG4 TEG4, targeting human activated platelets. The maintenance of immunoreactivity of the targeted VUSPIO against platelets was confirmed in vitro by flow cytometry, transmission electronic and optical microscopy. In the atherosclerotic ApoE(-/-) mouse model, high-resolution ex vivo MRI demonstrated the selective binding of TEG4-VUSPIO on atheroma plaques. It is noteworthy that the rationale for targeting platelets within atherosclerotic lesions is highlighted by our targeted contrast agent using a human anti-αIIbβ3 antibody as a targeting moiety. FROM THE CLINICAL EDITOR Current clinical assessment of atherosclerotic plagues is suboptimal. The authors in the article designed functionalized superparamagnetic iron oxide nanoparticles with TEG4, a recombinant human antibody, to target activated platelets. By using MRI, these nanoparticles can be utilized to study the process of atheroma pathogenesis.
Collapse
Affiliation(s)
- Marie-Josée Jacobin-Valat
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Jeanny Laroche-Traineau
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Mélusine Larivière
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Stéphane Mornet
- CNRS, UPR9048, Université de Bordeaux, Institut de Chimie de la Matière Condensée de Bordeaux, Pessac, France
| | - Stéphane Sanchez
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Marc Biran
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France
| | - Caroline Lebaron
- CNRS, UPS3044, "Baculovirus et thérapie", St Christol-Les-Alez, France
| | - Julien Boudon
- CNRS, UPR9048, Université de Bordeaux, Institut de Chimie de la Matière Condensée de Bordeaux, Pessac, France
| | - Sabrina Lacomme
- Bordeaux Imaging Center, Université Bordeaux, Bordeaux, France
| | - Martine Cérutti
- CNRS, UPS3044, "Baculovirus et thérapie", St Christol-Les-Alez, France
| | - Gisèle Clofent-Sanchez
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France.
| |
Collapse
|
21
|
Liu CH, Sastre A, Conroy R, Seto B, Pettigrew RI. NIH workshop on clinical translation of molecular imaging probes and technology--meeting report. Mol Imaging Biol 2014; 16:595-604. [PMID: 24833042 PMCID: PMC4161932 DOI: 10.1007/s11307-014-0746-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A workshop on "Clinical Translation of Molecular Imaging Probes and Technology" was held August 2, 2013 in Bethesda, Maryland, organized and supported by the National Institute of Biomedical Imaging and Bioengineering (NIBIB). This workshop brought together researchers, clinicians, representatives from pharmaceutical companies, molecular probe developers, and regulatory science experts. Attendees met to talk over current challenges in the discovery, validation, and translation of molecular imaging (MI) probes for key clinical applications. Participants also discussed potential strategies to address these challenges. The workshop consisted of 4 sessions, with 14 presentations and 2 panel discussions. Topics of discussion included (1) challenges and opportunities for clinical research and patient care, (2) advances in molecular probe design, (3) current approaches used by industry and pharmaceutical companies, and (4) clinical translation of MI probes. In the presentations and discussions, there were general agreement that while the barriers for validation and translation of MI probes remain high, there are pressing clinical needs and development opportunities for targets in cardiovascular, cancer, endocrine, neurological, and inflammatory diseases. The strengths of different imaging modalities, and the synergy of multimodality imaging, were highlighted. Participants also underscored the continuing need for close interactions and collaborations between academic and industrial partners, and federal agencies in the imaging probe development process.
Collapse
Affiliation(s)
- Christina H Liu
- National Institute of Biomedical Imaging and Bioengineering, 6707 Democracy Blvd., Suite 200, Bethesda, MD, 20892, USA,
| | | | | | | | | |
Collapse
|
22
|
Anderson NG, Butler AP. Clinical applications of spectral molecular imaging: potential and challenges. CONTRAST MEDIA & MOLECULAR IMAGING 2014; 9:3-12. [PMID: 24470290 DOI: 10.1002/cmmi.1550] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/20/2013] [Accepted: 05/28/2013] [Indexed: 12/22/2022]
Abstract
Spectral molecular imaging is a new X-ray-based imaging technology providing highly specific 3D imaging at high spatial resolution that has the potential to measure disease activity and response to treatment noninvasively. The ability to identify and quantify components of tissue and biomarkers of disease activity derive from the properties of the photon-processing detector. Multiple narrow sections of the energy spectrum are sampled simultaneously, providing a range of energy dependent Hounsfield units. As each material has a specific measurable X-ray spectrum, spectroscopic imaging allows for multiple materials to be quantified and differentiated from each other simultaneously. The technology, currently in its infancy, is set to grow rapidly, much as magnetic resonance did. The critical clinical applications have not yet been established, but it is likely to play a major role in identifying and directing treatment for unstable atherosclerotic plaque, assessing activity and response to treatment of a range of inflammatory diseases, and monitoring biomarkers of cancer and its treatment. If combined with Positron-emission tomography (PET), spectral molecular imaging could have a far greater effective role in cancer diagnosis and treatment monitoring than PET-CT does at present. It is currently used for small animal and specimen imaging. There are many challenges to be overcome before spectral imaging can be introduced into clinical medicine - these include technological improvements to detector design, bonding to the semiconductor layer, image reconstruction and display software, identifying which biomarkers are of most relevance to the disease in question, and accelerating drug discovery enabled by the new capabilities provided by spectral imaging.
Collapse
Affiliation(s)
- Nigel G Anderson
- Academic Radiology and Centre for Bioengineering, University of Otago, Christchurch, New Zealand; Medical Imaging, Royal Hobart Hospital, Hobart, Australia
| | | |
Collapse
|
23
|
Du R, Cai J, Zhao XQ, Wang QJ, Liu DQ, Leng WX, Gao P, Wu HM, Ma L, Ye P. Early decrease in carotid plaque lipid content as assessed by magnetic resonance imaging during treatment of rosuvastatin. BMC Cardiovasc Disord 2014; 14:83. [PMID: 25022285 PMCID: PMC4107586 DOI: 10.1186/1471-2261-14-83] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 06/26/2014] [Indexed: 12/05/2022] Open
Abstract
Background Statin therapy has shown to deplete atherosclerotic plaque lipid content and induce plaque regression. However, how early the plaque lipid depletion can occur with low-density lipoprotein cholesterol (LDL-C) lowering in humans in vivo has not been fully described. Methods We enrolled 43 lipid treatment naïve subjects with asymptomatic carotid atherosclerosis and LDL-C ≥ 100 and ≤ 250 mg/dl. Rosuvastatin 5–20 mg/day was used to lower LDL-C levels to < 80 mg/dl. Lipid profile and carotid MRI scans were obtained at baseline, 3, 12, and 24 months. Carotid plaque lipid-rich necrotic core (LRNC) and plaque burden were measured and compared between baseline and during treatment. Results Among the 32 subjects who completed the study, at 3 months, an average dose of rosuvastatin of 11 mg/day lowered LDL-C levels by 47% (125.2 ± 24.4 mg/dl vs. 66.7 ± 17.3 mg/dl, p < 0.001). There were no statistically significant changes in total wall volume, percent wall volume or lumen volume. However, LRNC volume was significantly decreased by 7.9 mm3, a reduction of 7.3% (111.5 ± 104.2 mm3 vs. 103.6 ± 95.8 mm3, p = 0.044). Similarly, % LRNC was also significantly decreased from 18.9 ± 11.9% to 17.9 ± 11.5% (p = 0.02) at 3 months. Both LRNC volume and % LRNC continued to decrease moderately at 12 and 24 months, although this trend was not significant. Conclusions Among a small number of lipid treatment naïve subjects, rosuvastatin therapy may induce a rapid and lasting decrease in carotid plaque lipid content as assessed by MRI. Trial registration ClinicalTrials.Gov numbers NCT00885872
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Lin Ma
- Department of Geriatric Cardiology, Chinese PLA General Hospital, No, 28, Fuxing Road, Beijing 100853, China.
| | | |
Collapse
|
24
|
Wan T, Madabhushi A, Phinikaridou A, Hamilton JA, Hua N, Pham T, Danagoulian J, Kleiman R, Buckler AJ. Spatio-temporal texture (SpTeT) for distinguishing vulnerable from stable atherosclerotic plaque on dynamic contrast enhancement (DCE) MRI in a rabbit model. Med Phys 2014; 41:042303. [PMID: 24694153 PMCID: PMC3987744 DOI: 10.1118/1.4867861] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To develop a new spatio-temporal texture (SpTeT) based method for distinguishing vulnerable versus stable atherosclerotic plaques on DCE-MRI using a rabbit model of atherothrombosis. METHODS Aortic atherosclerosis was induced in 20 New Zealand White rabbits by cholesterol diet and endothelial denudation. MRI was performed before (pretrigger) and after (posttrigger) inducing plaque disruption with Russell's-viper-venom and histamine. Of the 30 vascular targets (segments) under histology analysis, 16 contained thrombus (vulnerable) and 14 did not (stable). A total of 352 voxel-wise computerized SpTeT features, including 192 Gabor, 36 Kirsch, 12 Sobel, 52 Haralick, and 60 first-order textural features, were extracted on DCE-MRI to capture subtle texture changes in the plaques over the course of contrast uptake. Different combinations of SpTeT feature sets, in which the features were ranked by a minimum-redundancy-maximum-relevance feature selection technique, were evaluated via a random forest classifier. A 500 iterative 2-fold cross validation was performed for discriminating the vulnerable atherosclerotic plaque and stable atherosclerotic plaque on per voxel basis. Four quantitative metrics were utilized to measure the classification results in separating between vulnerable and stable plaques. RESULTS The quantitative results show that the combination of five classes of SpTeT features can distinguish between vulnerable (disrupted plaques with an overlying thrombus) and stable plaques with the best AUC values of 0.9631 ± 0.0088, accuracy of 89.98% ± 0.57%, sensitivity of 83.71% ± 1.71%, and specificity of 94.55% ± 0.48%. CONCLUSIONS Vulnerable and stable plaque can be distinguished by SpTeT based features. The SpTeT features, following validation on larger datasets, could be established as effective and reliable imaging biomarkers for noninvasively assessing atherosclerotic risk.
Collapse
Affiliation(s)
- Tao Wan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
| | - Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, United Kingdom
| | - James A Hamilton
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Ning Hua
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Tuan Pham
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts 02215
| | | | - Ross Kleiman
- Elucid Bioimaging Inc., Wenham, Massachusetts 01984
| | | |
Collapse
|
25
|
Huang X, Yang C, Canton G, Ferguson M, Yuan C, Tang D. Quantifying effect of intraplaque hemorrhage on critical plaque wall stress in human atherosclerotic plaques using three-dimensional fluid-structure interaction models. J Biomech Eng 2014; 134:121004. [PMID: 23363206 DOI: 10.1115/1.4007954] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent magnetic resonance studies have indicated that intraplaque hemorrhage (IPH) may accelerate plaque progression and play an important role in plaque destabilization. However, the impact of hemorrhage on critical plaque wall stress (CPWS) and strain (CPWSn) has yet to be determined. The objective of this study was to assess the effect of the presence and size of IPH on wall mechanics. The magnetic resonance image (MRI) of one patient with histology-confirmed IPH was used to build eight 3D fluid-structure interaction (FSI) models by altering the dimensions of the existing IPH. As a secondary end point, the combined effect of IPH and fibrous cap thickness (FCT) was assessed. A volume curve fitting method (VCFM) was applied to generate a mesh that would guarantee numerical convergence. Plaque wall stress (PWS), strain (PWSn), and flow shear stress (FSS) were extracted from all nodal points on the lumen surface for analysis. Keeping other conditions unchanged, the presence of intraplaque hemorrhage caused a significant increase (27.5%) in CPWS; reduced FCT caused an increase of 22.6% of CPWS. Similar results were found for CPWSn. Furthermore, combination of IPH presence, reduced FCT, and increased IPH volume caused an 85% and 75% increase in CPWS and CPWSn, respectively. These results show that intraplaque hemorrhage has considerable impact on plaque stress and strain conditions and accurate quantification of IPH could lead to more accurate assessment of plaque vulnerability. Large-scale studies are needed to further validate our findings.
Collapse
Affiliation(s)
- Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, PRC.
| | | | | | | | | | | |
Collapse
|
26
|
Beer AJ, Pelisek J, Heider P, Saraste A, Reeps C, Metz S, Seidl S, Kessler H, Wester HJ, Eckstein HH, Schwaiger M. PET/CT imaging of integrin αvβ3 expression in human carotid atherosclerosis. JACC Cardiovasc Imaging 2014; 7:178-87. [PMID: 24412187 DOI: 10.1016/j.jcmg.2013.12.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the feasibility of [(18)F]Galacto-RGD positron emission tomography (PET)/computed tomography (CT) imaging of αvβ3 expression in human carotid plaques. BACKGROUND The integrin αvβ3 is expressed by macrophages and angiogenic endothelial cells in atherosclerotic lesions and thus is a marker of plaque inflammation and, potentially, of plaque vulnerability. [(18)F]Galacto-RGD is a PET tracer binding specifically to αvβ3. Therefore, [(18)F]Galacto-RGD PET/CT imaging of αvβ3 expression in human carotid plaques might provide a novel noninvasive biomarker of plaque vulnerability. METHODS [(18)F]Galacto-RGD PET/CT imaging was performed in 10 patients with high-grade carotid artery stenosis scheduled for carotid endarterectomy. Tracer uptake was measured in the stenotic areas of the carotid arteries, as well as on the contralateral side, and was corrected for blood pool activity, measured in the distal common carotid artery (target-to-background [TB] ratio). TB ratio was correlated with immunohistochemistry of αvβ3 expression (LM609), macrophage density (CD68), and microvessel density (CD31) of the surgical specimen. In addition, ex vivo autoradiography of the surgical specimen with [(18)F]Galacto-RGD and competition experiments with an unlabeled αvβ3-specific RGD peptide were performed. RESULTS [(18)F]Galacto-RGD PET/CT showed significantly higher TB ratios in stenotic areas compared with nonstenotic areas (p = 0.01). TB ratios correlated significantly with αvβ3 expression (R = 0.787, p = 0.026) and intensity of ex vivo autoradiography (R = 0.733, p = 0.038). Binding to atherosclerotic plaques was efficiently blocked in ex vivo competition experiments. A weak-to-moderate correlation was found with macrophage density (R = 0.367, p = 0.299) and microvessel density (R = 0.479, p = 0.176), which did not reach statistical significance. CONCLUSIONS [(18)F]Galacto-RGD PET/CT shows specific tracer accumulation in human atherosclerotic carotid plaques, which correlates with αvβ3 expression. Based on these initial data, larger prospective studies are now warranted to evaluate the potential of molecular imaging of αvβ3 expression for assessment of plaque inflammation in patients.
Collapse
Affiliation(s)
- Ambros J Beer
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany.
| | - Jaroslav Pelisek
- Department of Vascular Surgery, Technische Universität München, Munich, Germany
| | - Peter Heider
- Department of Vascular Surgery, Technische Universität München, Munich, Germany
| | - Antti Saraste
- Turku PET Centre and Department of Cardiology, Turku, Finland
| | - Christian Reeps
- Department of Vascular Surgery, Technische Universität München, Munich, Germany
| | - Stephan Metz
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Stefan Seidl
- Department of Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Horst Kessler
- Institute for Advanced Study and Center of Integrated Protein Science, Technische Universität München, Department Chemie, Garching, Germany; Chemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hans-Jürgen Wester
- Chair of Pharmaceutical Radiochemistry, Technische Universität München, Garching, Germany
| | | | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| |
Collapse
|
27
|
Saba L, Tamponi E, Raz E, Lai L, Montisci R, Piga M, Faa G. Correlation between fissured fibrous cap and contrast enhancement: preliminary results with the use of CTA and histologic validation. AJNR Am J Neuroradiol 2013; 35:754-9. [PMID: 24157737 DOI: 10.3174/ajnr.a3759] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies demonstrated that carotid plaques analyzed by CTA can show contrast plaque enhancement. The purpose of this preliminary work was to evaluate the possible association between the fissured fibrous cap and contrast plaque enhancement. MATERIALS AND METHODS Forty-seven consecutive (men = 25; average age = 66.8 ± 9 years) symptomatic patients studied by use of a multidetector row CT scanner were prospectively analyzed. CTA was performed before and after contrast and radiation doses were recorded; analysis of contrast plaque enhancement was performed. Patients underwent carotid endarterectomy en bloc; histologic sections were prepared and evaluated for fissured fibrous cap and microvessel attenuation. The Mann-Whitney test was performed to evaluate the differences between the 2 groups. A multiple logistic regression analysis was performed to assess the effect of fissured fibrous cap and microvessel attenuation on contrast plaque enhancement. Receiver operating characteristic curve and area under the curve were also calculated. RESULTS Twelve patients had fissured fibrous cap. In 92% (11/12) of fissured fibrous cap-positive plaques, we found contrast plaque enhancement, whereas in 69% (24/35) of the plaques without fissured fibrous cap contrast plaque enhancement was found. The Mann-Whitney test showed a statistically significant difference between the contrast enhancement in plaques with fissured fibrous cap (Hounsfield units = 22.6) and without fissured fibrous cap (Hounsfield units = 12.9) (P = .011). On the regression analysis, both fissured fibrous cap and neovascularization were associated with contrast plaque enhancement (P = .0366 and P = .0001). The receiver operating characteristic curve confirmed an association between fissured fibrous cap and contrast plaque enhancement with an area under the curve of 0.749 (P = .005). CONCLUSIONS The presence of fissured fibrous cap is associated with contrast plaque enhancement. Histologic analysis showed that the presence of fissured fibrous cap is associated with a larger contrast plaque enhancement compared with the contrast plaque enhancement of plaques without fissured fibrous cap.
Collapse
Affiliation(s)
- L Saba
- From the Departments of Radiology (L.S., M.P.)
| | | | | | | | | | | | | |
Collapse
|
28
|
Rantner B, Sojer M, Kremser C, Cartes-Zumelzu F, Fraedrich G, Jaschke W, Chemelli-Steingruber I. Enhancement patterns in the fibro cellular tissue in different kinds of plaques of the internal carotid artery. Eur J Radiol 2013; 82:1989-95. [PMID: 23910043 DOI: 10.1016/j.ejrad.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/11/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The differentiation between stable and vulnerable plaques in the internal carotid artery (ICA) remains a matter of interest. With the implementation of contrast agent in magnetic resonance imaging (MRI) a more detailed plaque characterization is possible. The study at hand focuses on enhancement patterns of fibro cellular tissue in different kinds of plaques in the ICA. METHODS Between May 2011 and December 2012, 49 patients (39 male) with >50% stenosis of the ICA were consecutively enrolled. In 10 patients with bilateral ICA stenosis, both plaques were included for analysis. We performed a classification of plaques according to Cai and observed 11 type 4-5 plaques, 15 type 6 plaques and 33 type 8 plaques. MRI was performed on a 3T whole body MR system. The standard 12 channel head coil was combined with the neck extension coil and two bilateral 7 cm loop coils. Post-contrast T1w images were subtracted from pre contrast images to identify late enhancement in fibro cellular tissue. Enhancement patterns were allocated as intraluminal, intraplaque and vasa vasorum enhancement in different types of plaques. RESULTS Fibro cellular tissue always exhibited a higher contrast enhancement compared to the sternocleidomastoid muscle. This reflects a higher grade of vascularization of the fibrocellular tissue. Contrast enhancement was present irrespective of the plaque type. In detail, intraluminal, intraplaque and vasa vasorum enhancement were observed in all types of plaques. Even type 8 plaques, according to the classification of Cai, had a significant contrast enhancement, though supposed to be with low inflammatory activity. CONCLUSION Type 8 plaques might not be as stable as postulated. Whether the relevant uptake of contrast agent is due to the fibrous tissue or reflects the inflammatory activity of the plaque should be matter of further investigations.
Collapse
Affiliation(s)
- Barbara Rantner
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria.
| | | | | | | | | | | | | |
Collapse
|
29
|
MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients. PLoS One 2013; 8:e67927. [PMID: 23894291 PMCID: PMC3722215 DOI: 10.1371/journal.pone.0067927] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I-VIII). Within these lesion types, lesion types IV-V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones. METHODS Eighty-three consecutive patients (45 male (54.2%); age 54-88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50-99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I-VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance. RESULTS Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV-V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV-V and VI) (log rank test P<0.0001). CONCLUSIONS MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.
Collapse
|
30
|
Fang R, Zhang N, Wang C, Zhao X, Liu L, Wang Y, Xu J, Wang X, Liu Z, Wang Y. Relations between plasma Ox-LDL and carotid plaque among Chinese Han ethnic group. Neurol Res 2013; 33:460-6. [DOI: 10.1179/016164111x13007856083927] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
31
|
den Hartog A, Bovens S, Koning W, Hendrikse J, Luijten P, Moll F, Pasterkamp G, de Borst G. Current Status of Clinical Magnetic Resonance Imaging for Plaque Characterisation in Patients with Carotid Artery Stenosis. Eur J Vasc Endovasc Surg 2013. [DOI: 10.1016/j.ejvs.2012.10.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Doherty JR, Dumont DM, Trahey GE, Palmeri ML. Acoustic radiation force impulse imaging of vulnerable plaques: a finite element method parametric analysis. J Biomech 2012; 46:83-90. [PMID: 23122224 DOI: 10.1016/j.jbiomech.2012.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/22/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
Abstract
Plaque rupture is the most common cause of complications such as stroke and coronary heart failure. Recent histopathological evidence suggests that several plaque features, including a large lipid core and a thin fibrous cap, are associated with plaques most at risk for rupture. Acoustic Radiation Force Impulse (ARFI) imaging, a recently developed ultrasound-based elasticity imaging technique, shows promise for imaging these features noninvasively. Clinically, this could be used to distinguish vulnerable plaques, for which surgical intervention may be required, from those less prone to rupture. In this study, a parametric analysis using Finite Element Method (FEM) models was performed to simulate ARFI imaging of five different carotid artery plaques across a wide range of material properties. It was demonstrated that ARFI imaging could resolve the softer lipid pool from the surrounding, stiffer media and fibrous cap and was most dependent upon the stiffness of the lipid pool component. Stress concentrations due to an ARFI excitation were located in the media and fibrous cap components. In all cases, the maximum Von Mises stress was<1.2 kPa. In comparing these results with others investigating plaque rupture, it is concluded that while the mechanisms may be different, the Von Mises stresses imposed by ARFI imaging are orders of magnitude lower than the stresses associated with blood pressure.
Collapse
Affiliation(s)
- Joshua R Doherty
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
| | | | | | | |
Collapse
|
33
|
Abstract
PURPOSE OF REVIEW Pulsatile tinnitus is an uncommon otologic symptom, which often presents a diagnostic and management dilemma to the otolaryngologist. The majority of patients with pulsatile tinnitus have a treatable cause. Failure to establish correct diagnosis may have disastrous consequences, because a potentially life-threatening, underlying disorder may be present. The purpose of this review is to familiarize the otolaryngologist with the most common causes, evaluation, and management of pulsatile tinnitus. RECENT FINDINGS The pathophysiology, classification, various causes, evaluation, and management of the most common causes of pulsatile tinnitus are presented in this review. SUMMARY Pulsatile tinnitus deserves a thorough evaluation and, in the majority of cases, there is a treatable underlying cause. The possibility of a life-threatening cause needs to be ruled out in every patient with pulsatile tinnitus. The otolaryngologist should be familiar with the evaluation and management of this symptom.
Collapse
|
34
|
Koning W, Bluemink JJ, Langenhuizen EAJ, Raaijmakers AJ, Andreychenko A, van den Berg CAT, Luijten PR, Zwanenburg JJM, Klomp DWJ. High-resolution MRI of the carotid arteries using a leaky waveguide transmitter and a high-density receive array at 7 T. Magn Reson Med 2012; 69:1186-93. [PMID: 22760686 DOI: 10.1002/mrm.24345] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/12/2012] [Accepted: 05/01/2012] [Indexed: 11/09/2022]
Affiliation(s)
- W. Koning
- Department of Radiology; UMC; Utrecht The Netherlands
| | - J. J. Bluemink
- Department of Radiotherapy; UMC; Utrecht The Netherlands
| | | | | | | | | | - P. R. Luijten
- Department of Radiology; UMC; Utrecht The Netherlands
| | | | | |
Collapse
|
35
|
Camici PG, Rimoldi OE, Gaemperli O, Libby P. Non-invasive anatomic and functional imaging of vascular inflammation and unstable plaque. Eur Heart J 2012; 33:1309-17. [PMID: 22507974 DOI: 10.1093/eurheartj/ehs067] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Over the last several decades, basic cardiovascular research has significantly enhanced our understanding of pathobiological processes leading to formation, progression, and complications of atherosclerotic plaques. By harnessing these advances in cardiovascular biology, imaging has advanced beyond its traditional anatomical domains to a tool that permits probing of particular molecular structures to image cellular behaviour and metabolic pathways involved in atherosclerosis. From the nascent atherosclerotic plaque to the death of inflammatory cells, several potential molecular and micro-anatomical targets for imaging with particular selective imaging probes and with a variety of imaging modalities have emerged from preclinical and animal investigations. Yet, substantive barriers stand between experimental use and wide clinical application of these novel imaging strategies. Each of the imaging modalities described herein faces hurdles-for example, sensitivity, resolution, radiation exposure, reproducibility, availability, standardization, or costs. This review summarizes the published literature reporting on functional imaging of vascular inflammation in atherosclerotic plaques emphasizing those techniques that have the greatest and/or most immediate potential for broad application in clinical practice. The prospective evaluation of these techniques and standardization of protocols by multinational networks could serve to determine their added value in clinical practice and guide their development and deployment.
Collapse
Affiliation(s)
- Paolo G Camici
- Vita-Salute University and Scientific Institute San Raffaele, Via Olgettina 60, Milan, Italy.
| | | | | | | |
Collapse
|
36
|
Carotid plaque signal differences among four kinds of T1-weighted magnetic resonance imaging techniques: A histopathological correlation study. Neuroradiology 2012; 54:1187-94. [DOI: 10.1007/s00234-012-1025-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 02/29/2012] [Indexed: 11/25/2022]
|