1
|
Kawai K, Kawakami R, Finn AV, Virmani R. Differences in Stable and Unstable Atherosclerotic Plaque. Arterioscler Thromb Vasc Biol 2024; 44:1474-1484. [PMID: 38924440 DOI: 10.1161/atvbaha.124.319396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
- Kenji Kawai
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
| | - Rika Kawakami
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
| | - Aloke V Finn
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
- University of Maryland School of Medicine, Baltimore (A.V.F.)
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
| |
Collapse
|
2
|
Shahbaz R, Charpentier E, Ponnaiah M, Deshours F, Kokabi H, Brochériou I, Le Naour G, Redheuil A, Koskas F, Davaine JM. In vitro analysis of carotid lesions using a preliminary microwave sensor to detect vulnerable plaques: Correlation with histology, Duplex ultrasound examination, and computed tomography scanner: The Imaging and Microwave Phenotyping Assessment of Carotid stenosis Threat (IMPACT) study. JVS Vasc Sci 2023; 5:100182. [PMID: 38384784 PMCID: PMC10879004 DOI: 10.1016/j.jvssci.2023.100182] [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: 08/08/2023] [Accepted: 11/03/2023] [Indexed: 02/23/2024] Open
Abstract
Objective Progress in best medical treatment have made identification of best candidates for carotid surgery more difficult. New diagnostic modalities could be helpful in this perspective. Microwaves (MWs) can quantify dielectric properties (complex relative permittivity) of biological tissues and MW technology has emerged as a promising field of research for distinguishing abnormal tissues from healthy ones. We here evaluated the ability of a dedicated MW sensor developed in our laboratory to identify vulnerable carotid lesions. Methods We included 50 carotid lesions in this study. The plaques were analyzed and classified preoperatively by ultrasound (US) examination, computed tomography angiography and tested postoperatively using a MW sensor. Histopathological analysis was used as a gold standard to separate vulnerable plaques (VPs) from nonvulnerable plaques (NVPs). Results VPs were more frequently types 2 or 3 plaques (on US examination), had a greater proportion of low (<60 Hounsfield unit) and moderate (60-130 Hounsfield unit) attenuation components (computed tomography angiography) and displayed higher dielectric constant values (MW) than NVPs, which had an opposite profile. NVPs were more frequently asymptomatic plaques compared with VPs (P = .035). Multivariate analysis showed that US examination and MW identified VPs with a sensitivity of 77% and a specificity of 76% (cutoff value, -0.045; area under the curve, 0.848; P < .0001). Conclusions We found that the presence of types 2 to 3 (on US examination) and high dielectric constant plaques in vitro was highly indicative of a VP based on histological analysis. Further studies are needed to determine the potential of MW to identify the most dangerous asymptomatic carotid lesions.
Collapse
Affiliation(s)
- Rania Shahbaz
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Etienne Charpentier
- Sorbonne Université, Unité d'imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Maharajah Ponnaiah
- IHU ICAN, Foundation for Innovation in Cardiometabolism and Nutrition, Pitié Salpêtrière Hospital, Paris, France
| | - Frédérique Deshours
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Hamid Kokabi
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | | | - Gilles Le Naour
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Alban Redheuil
- Sorbonne Université, Unité d'imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Fabien Koskas
- Department of Vascular and Endovascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Michel Davaine
- Medicine Faculty, Sorbonne Université, Paris, France
- Department of Vascular and Endovascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| |
Collapse
|
3
|
Benson JC, Shahid A, Larson A, Brinjikji W, Nasr D, Saba L, Lanzino G, Savastano LE. Carotid Artery Tortuosity and Internal Carotid Artery Plaque Composition. Clin Neuroradiol 2023; 33:1017-1021. [PMID: 37286876 DOI: 10.1007/s00062-023-01302-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/27/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known about the association between carotid artery tortuosity and internal carotid artery atherosclerosis. This study sought to evaluate the associations between various types of arterial tortuosity and vulnerable plaque components on magnetic resonance angiography (MRA). MATERIAL AND METHODS A retrospective review was completed of 102 patients who had undergone MRA neck imaging, with intraplaque hemorrhage (IPH) present in one or both cervical internal carotid arteries (ICA). Each ICA was assessed for two categories of tortuosity: variant arterial pathway(s) (retrojugular and/or retropharyngeal) and abnormal curvature (kinks, loops, and/or coils). All ICA plaques were assessed for the presence or absence of intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), ulceration, and enhancement, as well as the volume of IPH and degree of luminal stenosis. RESULTS The mean age of included patients was 73.5 years (SD = 9.0 years) and 88 (86.3%) subjects were male. The left carotid plaque was significantly more likely to have IPH (68.6% vs. 47.1%; p = 0.02). The left ICA was more likely to have a retrojugular course (22% vs. 9.9%; p = 0.002) and any variant arterial course (26.5% versus 14.67%, p = 0.01). On the right there was an association between the presence of a LRNC and retropharyngeal and/or retrojugular arterial pathway (p = 0.03). On the left there was an association between the presence of any abnormal arterial curvature and IPH volume (p = 0.03). Neither association met the adjusted statistical threshold after Bonferroni correction, with alpha set at 0.0028. CONCLUSION ICA tortuosity is not associated with carotid artery plaque composition, and likely does not play a role in the development of high-risk plaques.
Collapse
Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, 200 1st St. SW Rochester, 55905, Rochester, MN, USA.
| | - Adnan Shahid
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Anthony Larson
- Department of Radiology, Mayo Clinic, 200 1st St. SW Rochester, 55905, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 1st St. SW Rochester, 55905, Rochester, MN, USA
| | - Deena Nasr
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria of Cagliari-Polo di Monserrato, Cagliari, Italy
| | | | | |
Collapse
|
4
|
Homssi M, Saha A, Delgado D, RoyChoudhury A, Thomas C, Lin M, Baradaran H, Kamel H, Gupta A. Extracranial Carotid Plaque Calcification and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis. Stroke 2023; 54:2621-2628. [PMID: 37638399 PMCID: PMC10530110 DOI: 10.1161/strokeaha.123.042807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Although coronary calcification quantification is an established approach for cardiovascular risk assessment, the value of quantifying carotid calcification is less clear. As a result, we performed a systematic review and meta-analysis to evaluate the association between extracranial carotid artery plaque calcification burden and ipsilateral cerebrovascular ischemic events. METHODS A comprehensive literature search was performed in the following databases: Ovid MEDLINE(R) 1946 to July 6, 2022; OVID Embase 1974 to July 6, 2022; and The Cochrane Library (Wiley). We performed meta-analyses including studies in which investigators performed a computed tomography assessment of calcification volume, percentage, or other total calcium burden summarizable in a single continuous imaging biomarker and determined the association of these features with the occurrence of ipsilateral stroke or transient ischemic attack. RESULTS Our overall meta-analysis consisted of 2239 carotid arteries and 9 studies. The presence of calcification in carotid arteries ipsilateral to ischemic stroke or in stroke patients compared with asymptomatic patients did not demonstrate a significant association with ischemic cerebrovascular events (relative risk of 0.75 [95% CI, 0.44-1.28]; P=0.29). When restricted to studies of significant carotid artery stenosis (>50%), the presence of calcification was associated with a reduced risk of ischemic stroke (relative risk of 0.56 [95% CI, 0.38-0.85]; P=0.006). When the analysis was limited to studies of patients with mainly nonstenotic plaques, there was an increased relative risk of ipsilateral ischemic stroke of 1.72 ([95% CI, 1.01-2.91]; P=0.04). Subgroup meta-analyses of total calcium burden and morphological features of calcium showed wide variability in their strength of association with ischemic stroke and demonstrated significant heterogeneity. CONCLUSIONS The presence of calcification in carotid plaque confers a reduced association with ipsilateral ischemic events, although these results seem to be limited among carotid arteries with higher degrees of stenosis. Adoption of carotid calcification measures in clinical decision-making will require additional studies providing more reproducible and standardized methods of calcium characterization and testing these imaging strategies in prospective studies.
Collapse
Affiliation(s)
- Moayad Homssi
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Atin Saha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Charlene Thomas
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Matthew Lin
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Hediyeh Baradaran
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
5
|
Singh A, Nasir U, Segal J, Waheed TA, Ameen M, Hafeez H. The utility of ultrasound and computed tomography in the assessment of carotid artery plaque vulnerability-A mini review. Front Cardiovasc Med 2022; 9:1023562. [PMID: 36465468 PMCID: PMC9709330 DOI: 10.3389/fcvm.2022.1023562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 08/27/2023] Open
Abstract
As the burden of cardiovascular and cerebrovascular events continues to increase, emerging evidence supports the concept of plaque vulnerability as a strong marker of plaque rupture, and embolization. Qualitative assessment of the plaque can identify the degree of plaque instability. Ultrasound and computed tomography (CT) have emerged as safe and accurate techniques for the assessment of plaque vulnerability. Plaque features including but not limited to surface ulceration, large lipid core, thin fibrous cap (FC), intraplaque neovascularization and hemorrhage can be assessed and are linked to plaque instability.
Collapse
Affiliation(s)
- Aniruddha Singh
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Usama Nasir
- Tower Health, West Reading, PA, United States
| | - Jared Segal
- Tower Health, West Reading, PA, United States
| | | | | | | |
Collapse
|
6
|
Onnis C, Cadeddu Dessalvi C, Cademartiri F, Muscogiuri G, Angius S, Contini F, Suri JS, Sironi S, Salgado R, Esposito A, Saba L. Quantitative and qualitative features of carotid and coronary atherosclerotic plaque among men and women. Front Cardiovasc Med 2022; 9:970438. [PMID: 36176995 PMCID: PMC9513059 DOI: 10.3389/fcvm.2022.970438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Cardiovascular diseases (CVDs), particularly ischemic heart disease (IHD) and stroke, present epidemiologically in a different way among sexes. The reasons of these sex-based differences should be delved into sex-specific cardiovascular (CV) risk factors and different mechanisms of atherosclerotic progression. Imaging techniques of both carotid and coronary atherosclerotic plaques represent a tool to demonstrate sex-related features which might be used to further and better assess CV risk of male and female population. The aim of this review is to evaluate current knowledge on sex-specific qualitative and quantitative plaque features of coronary and carotid atherosclerosis. We also discuss the clinical implication of a sex-based plaque phenotype, evaluated with non-invasive imaging techniques, such as CT-angiography and MRI-angiography, to stratify CV risk.
Collapse
Affiliation(s)
- Carlotta Onnis
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari—Polo di Monserrato, Cagliari, Italy
| | - Christian Cadeddu Dessalvi
- Department of Medical Sciences and Public Health, Università Degli Studi di Cagliari, Cagliari, Italy
- *Correspondence: Christian Cadeddu Dessalvi,
| | | | - Giuseppe Muscogiuri
- Department of Radiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, University of Milano-Bicocca, Milan, Italy
| | - Simone Angius
- Department of Medical Sciences and Public Health, Università Degli Studi di Cagliari, Cagliari, Italy
| | - Francesca Contini
- Department of Medical Sciences and Public Health, Università Degli Studi di Cagliari, Cagliari, Italy
| | - Jasjit S. Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, United States and Advanced Knowledge Engineering Centre, Global Biomedical Technologies Inc. (GBTI), Roseville, CA, United States
| | - Sandro Sironi
- Department of Radiology, San Luca Hospital, Istituto Auxologico Italiano IRCCS, University of Milano-Bicocca, Milan, Italy
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Antonio Esposito
- Experimental Imaging Center, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari—Polo di Monserrato, Cagliari, Italy
| |
Collapse
|
7
|
Suri JS, Bhagawati M, Paul S, Protogerou AD, Sfikakis PP, Kitas GD, Khanna NN, Ruzsa Z, Sharma AM, Saxena S, Faa G, Laird JR, Johri AM, Kalra MK, Paraskevas KI, Saba L. A Powerful Paradigm for Cardiovascular Risk Stratification Using Multiclass, Multi-Label, and Ensemble-Based Machine Learning Paradigms: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12030722. [PMID: 35328275 PMCID: PMC8947682 DOI: 10.3390/diagnostics12030722] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 12/16/2022] Open
Abstract
Background and Motivation: Cardiovascular disease (CVD) causes the highest mortality globally. With escalating healthcare costs, early non-invasive CVD risk assessment is vital. Conventional methods have shown poor performance compared to more recent and fast-evolving Artificial Intelligence (AI) methods. The proposed study reviews the three most recent paradigms for CVD risk assessment, namely multiclass, multi-label, and ensemble-based methods in (i) office-based and (ii) stress-test laboratories. Methods: A total of 265 CVD-based studies were selected using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) model. Due to its popularity and recent development, the study analyzed the above three paradigms using machine learning (ML) frameworks. We review comprehensively these three methods using attributes, such as architecture, applications, pro-and-cons, scientific validation, clinical evaluation, and AI risk-of-bias (RoB) in the CVD framework. These ML techniques were then extended under mobile and cloud-based infrastructure. Findings: Most popular biomarkers used were office-based, laboratory-based, image-based phenotypes, and medication usage. Surrogate carotid scanning for coronary artery risk prediction had shown promising results. Ground truth (GT) selection for AI-based training along with scientific and clinical validation is very important for CVD stratification to avoid RoB. It was observed that the most popular classification paradigm is multiclass followed by the ensemble, and multi-label. The use of deep learning techniques in CVD risk stratification is in a very early stage of development. Mobile and cloud-based AI technologies are more likely to be the future. Conclusions: AI-based methods for CVD risk assessment are most promising and successful. Choice of GT is most vital in AI-based models to prevent the RoB. The amalgamation of image-based strategies with conventional risk factors provides the highest stability when using the three CVD paradigms in non-cloud and cloud-based frameworks.
Collapse
Affiliation(s)
- Jasjit S. Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA 95661, USA
- Correspondence: ; Tel.: +1-(916)-749-5628
| | - Mrinalini Bhagawati
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong 793022, India; (M.B.); (S.P.)
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong 793022, India; (M.B.); (S.P.)
| | - Athanasios D. Protogerou
- Research Unit Clinic, Laboratory of Pathophysiology, Department of Cardiovascular Prevention, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Petros P. Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, 11527 Athens, Greece;
| | - George D. Kitas
- Arthritis Research UK Centre for Epidemiology, Manchester University, Manchester 46962, UK;
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110020, India;
| | - Zoltan Ruzsa
- Department of Internal Medicines, Invasive Cardiology Division, University of Szeged, 6720 Szeged, Hungary;
| | - Aditya M. Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22903, USA;
| | - Sanjay Saxena
- Department of CSE, International Institute of Information Technology, Bhubaneswar 751003, India;
| | - Gavino Faa
- Department of Pathology, A.O.U., di Cagliari-Polo di Monserrato s.s., 09045 Cagliari, Italy;
| | - John R. Laird
- Cardiology Department, St. Helena Hospital, St. Helena, CA 94574, USA;
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Manudeep K. Kalra
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Kosmas I. Paraskevas
- Department of Vascular Surgery, Central Clinic of Athens, N. Iraklio, 14122 Athens, Greece;
| | - Luca Saba
- Department of Radiology, A.O.U., di Cagliari-Polo di Monserrato s.s., 09045 Cagliari, Italy;
| |
Collapse
|
8
|
Saba L, Chen H, Cau R, Rubeis G, Zhu G, Pisu F, Jang B, Lanzino G, Suri J, Qi Y, Wintermark M. Impact Analysis of Different CT Configurations of Carotid Artery Plaque Calcifications on Cerebrovascular Events. AJNR Am J Neuroradiol 2022; 43:272-279. [PMID: 35121588 PMCID: PMC8985662 DOI: 10.3174/ajnr.a7401] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE CT is considered the standard reference both for quantification and characterization of carotid artery calcifications. Our aim was to investigate the relationship among different types of calcium configurations detected with CT within the plaque with a novel classification and to investigate the prevalence of cerebrovascular events. MATERIALS AND METHODS Seven hundred ninety patients (men = 332; mean age, 69.7 [SD, 13] years; 508 symptomatic for cerebrovascular symptoms and 282 asymptomatic) who underwent computed tomography of the carotid arteries were retrospectively included in this institutional review board-approved study. The plaque was classified into 6 types according to the different types of calcium configurations as the following: type 1, complete absence of calcification within the plaque; type 2, intimal or superficial calcifications; type 3, deep or bulky calcifications; type 4, adventitial calcifications with internal soft plaque of <2 mm thickness; type 5, mixed patterns with intimal and bulky calcifications; and type 6, positive rim sign. RESULTS The highest prevalence of cerebrovascular events was observed for type 6, for which 89 of the 99 cases were symptomatic. Type 6 plaque had the highest degree of correlation with TIA, stroke, symptoms, and ipsilateral infarct for both sides with a higher prevalence in younger patients. The frequency of symptoms observed by configuration type significantly differed between right and left plaques, with symptoms observed more frequently in type 6 calcification on the right side (50/53; 94%) than on the left side (39/46; 85%, P < .001). CONCLUSIONS We propose a novel carotid artery plaque configuration classification that is associated with the prevalence of cerebrovascular events. If confirmed in longitudinal analysis, this classification could be used to stratify the risk of occurrence of ischemic events.
Collapse
Affiliation(s)
- L. Saba
- From the Department of Radiology (L.S., R.C., F.P.), Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - H. Chen
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
| | - R. Cau
- From the Department of Radiology (L.S., R.C., F.P.), Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - G.D. Rubeis
- Department of Radiology, UOC of Diagnostic and Interventional Neuroradiology (G.D.R.), San Camillo-Forlanini Hospital, Rome, Italy
| | - G. Zhu
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
| | - F. Pisu
- From the Department of Radiology (L.S., R.C., F.P.), Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - B. Jang
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
| | - G. Lanzino
- Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - J.S. Suri
- Stroke Monitoring and Diagnostic Division (J.S.S.), AtheroPoint, Roseville, California
| | - Y. Qi
- Department of Xuanwu Hospital (Y.Q.), Capital Medical University, Beijing, Chin
| | - M. Wintermark
- Department of Radiology (H.C., G.Z., B.J., M.W.), Division of Neuroradiology, Stanford University Hospital, Stanford, California
| |
Collapse
|
9
|
Computed Tomography Texture Analysis of Carotid Plaque as Predictor of Unfavorable Outcome after Carotid Artery Stenting: A Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11122214. [PMID: 34943451 PMCID: PMC8699962 DOI: 10.3390/diagnostics11122214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022] Open
Abstract
Novel biomarkers are advocated to manage carotid plaques. Therefore, we aimed to test the association between textural features of carotid plaque at computed tomography angiography (CTA) and unfavorable outcome after carotid artery stenting (CAS). Between January 2010 and January 2021, were selected 172 patients (median age, 77 years; 112/172, 65% men) who underwent CAS with CTA of the supra-aortic vessels performed within prior 6 months. Standard descriptors of the density histogram were derived by open-source software automated analysis obtained by CTA plaque segmentation. Multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the area under the ROC (AUC) were used to identify potential prognostic variables and to assess the model performance for predicting unfavorable outcome (periprocedural death or myocardial infarction and any ipsilateral acute neurological event). Unfavorable outcome occurred in 17/172 (10%) patients (median age, 79 years; 12/17, 70% men). Kurtosis was an independent predictor of unfavorable outcome (odds ratio, 0.79; confidence interval, 0.65-0.97; p = 0.029). The predictive model for unfavorable outcome including CTA textural features outperformed the model without textural features (AUC 0.789 vs. 0.695, p = 0.004). In patients with stenotic carotid plaque, kurtosis derived by CTA density histogram analysis is an independent predictor of unfavorable outcome after CAS.
Collapse
|
10
|
Saba L, Agarwal N, Cau R, Gerosa C, Sanfilippo R, Porcu M, Montisci R, Cerrone G, Qi Y, Balestrieri A, Lucatelli P, Politi C, Faa G, Suri JS. Review of imaging biomarkers for the vulnerable carotid plaque. JVS Vasc Sci 2021; 2:149-158. [PMID: 34617065 PMCID: PMC8489200 DOI: 10.1016/j.jvssci.2021.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/23/2021] [Indexed: 12/26/2022] Open
Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. As a result of the rapid technological evolution in medical imaging, several important steps have been taken in the field of carotid plaque imaging allowing us to visualize the carotid atherosclerotic plaque and its composition in great detail. For computed tomography, magnetic resonance imaging, positron emission tomography, and ultrasound scan, evidence has accumulated on novel imaging-based markers that confer information on carotid plaque vulnerability, such as intraplaque hemorrhage and lipid-rich necrotic cores. In terms of the imaging-based identification of individuals at high risk of stroke, routine assessments of such imaging markers are the way forward for improving current clinical practice. The current review highlights the main characteristics of the vulnerable plaque indicating their role in the etiology of ischemic stroke as identified by intensive plaque imaging.
Collapse
Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Nivedita Agarwal
- Section of Radiology, Santa Maria del Carmine Hospital, Rovereto, Italy
| | - Riccardo Cau
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Clara Gerosa
- Department of Pathology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Roberto Sanfilippo
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Michele Porcu
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Roberto Montisci
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Giulia Cerrone
- Department of Pathology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Yang Qi
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Pierleone Lucatelli
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Carola Politi
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Jasjit S. Suri
- Stroke Diagnosis and Monitoring Division, AtheroPoint™, Roseville, Calif
| |
Collapse
|
11
|
Song JW, Cao Q, Siegler JE, Thon JM, Woo JH, Cucchiara BL. Sex Differences in Carotid Plaque Composition in Patients With Embolic Stroke of Undetermined Source. J Am Heart Assoc 2021; 10:e020143. [PMID: 33904317 PMCID: PMC8200747 DOI: 10.1161/jaha.120.020143] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background We examined sex differences in nonstenotic carotid plaque composition in patients with embolic stroke of undetermined source (ESUS). Methods and Results Patients with anterior circulation ischemic stroke imaged with neck computed tomographic angiography who met criteria for ESUS or had atrial fibrillation were identified. Patients with atrial fibrillation were included as a negative control. Semiautomated plaque quantification software analyzed carotid artery bifurcations. Plaque subcomponent (calcium, intraplaque hemorrhage [IPH], and lipid rich necrotic core) volumes were compared by sex and in paired analyses of plaque ipsilateral versus contralateral to stroke. Multivariate linear regressions tested for associations. Ninety‐four patients with ESUS (55% women) and 95 patients with atrial fibrillation (47% women) were identified. Men with ESUS showed significantly higher volumes of calcified plaque (63.9 versus 19.6 mm3, P<0.001), IPH (9.4 versus 3.3 mm3, P=0.008) and a IPH/lipid rich necrotic core ratio (0.17 versus 0.07, P=0.03) in carotid plaque ipsilateral to stroke side than women. The atrial fibrillation cohort showed no significant sex differences in plaque volumes ipsilateral to stroke. Multivariate analyses of the ESUS cohort showed male sex was associated with IPHipsi (β=0.49; 95% CI, 0.11–0.87) and calciumipsi (β=0.78; 95% CI, 0.33–1.23). Paired plaque analyses in men with ESUS showed significantly higher calcified plaque (63.9 versus 34.1 mm3, P=0.03) and a trend of higher IPHipsi (9.4 versus 7.5 mm3, P=0.73) and lipid rich necrotic coreipsi (59.0 versus 48.4 mm3, P=0.94) volumes. Conclusions Sex differences in carotid plaque composition in ESUS suggest the possibility of a differential contribution of nonstenosing carotid plaque as a stroke mechanism in men versus women.
Collapse
Affiliation(s)
- Jae W Song
- Department of Radiology University of Pennsylvania Philadelphia PA
| | - Quy Cao
- Department of Biostatistics University of Pennsylvania Philadelphia PA
| | - James E Siegler
- Cooper Neurologic Institute Cooper University Hospital Camden NJ
| | - Jesse M Thon
- Cooper Neurologic Institute Cooper University Hospital Camden NJ
| | - John H Woo
- Department of Radiology University of Pennsylvania Philadelphia PA
| | | |
Collapse
|
12
|
Benson JC, Lanzino G, Nardi V, Savastano L, Lerman A, Brinjikji W. Semiautomated carotid artery plaque composition: are intraplaque CT imaging features associated with cardiovascular risk factors? Neuroradiology 2021; 63:1617-1626. [PMID: 33543361 DOI: 10.1007/s00234-021-02662-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little remains known about the connection between cardiovascular (CV) risk factors and carotid plaque morphologies. This study set out to assess for any such associations. MATERIALS AND METHODS A retrospective review was completed of consecutive patients that had CTA neck imaging prior to CEA. Body mass index (BMI), tobacco and/or alcohol use, and history of diabetes and/or hypertension were collected from patients' medical records. Lab values were dichotomized based on values: total cholesterol < 200 or ≥ 200; low-density lipoprotein (LDL) < 130 or ≥ 130, high-density lipoprotein < 35 or ≥ 35, and triglycerides < 200 or ≥ 200. A semiautomated analysis of CTA images computed maximum stenosis, intraplaque volumes of intraplaque hemorrhage, lipid-rich necrotic core (LRNC), and matrix, and intraplaque volume and proportional plaque makeup of calcifications of each carotid plaque. RESULTS Of 87 included patients, 54 (62.1%) were male. Mean age was 70.1 years old. Both diabetes and hypertension were associated with greater intraplaque calcification volume (p = 0.0009 and p = 0.01, respectively), and greater proportion of calcification within a plaque (p = 0.004 and p = 0.01, respectively). Higher BMI was associated with greater intraplaque volume of LRNC (p=0.02) and matrix (0.0007). Elevated total cholesterol was associated with both larger intraplaque calcification volume (p = 0.04) and greater proportion of calcification within a plaque (p = 0.01); elevated LDL was associated with greater intraplaque calcification volume (p = 0.005). CONCLUSION Multiple CV risk factors are associated with morphological differences in carotid artery plaques. Dysregulation of both total cholesterol and LDL and higher BMI are associated with higher volumes of intraplaque LRNC, a marker of plaque vulnerability.
Collapse
Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | | | - Valentina Nardi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| |
Collapse
|
13
|
Li Z, Wang Y, Wu X, Liu X, Huang S, He Y, Liu S, Ren L. Studying the Factors of Human Carotid Atherosclerotic Plaque Rupture, by Calculating Stress/Strain in the Plaque, Based on CEUS Images: A Numerical Study. Front Neuroinform 2020; 14:596340. [PMID: 33324188 PMCID: PMC7721669 DOI: 10.3389/fninf.2020.596340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023] Open
Abstract
Carotid plaque neovascularization is one of the major factors for the classification of vulnerable plaque, but the axial force effects of the pulsatile blood flow on the plaque with neovessel and intraplaque hemorrhage was unclear. Together with the severity of stenosis, the fibrous cap thickness, large lipid core, and the neovascularization followed by intraplaque hemorrhage (IPH) have been regarded as high-risk features of plaque rupture. In this work, the effects of these factors were evaluated on the progression and rupture of the carotid atherosclerotic plaques. Five geometries of carotid artery plaque were developed based on contrast-enhanced ultrasound (CEUS) images, which contain two types of neovessel and IPH, and geometry without neovessel and IPH. A one-way fluid-structure interaction model was applied to compute the maximum principal stress and strain in the plaque. For that hyper-elastic and non-linear material, Yeoh 3rd Order strain energy density function was used for components of the plaque. The simulation results indicated that the maximum principal stress of plaque in the carotid artery was higher when the degree of the luminal stenosis increased and the thickness of the fibrous cap decreased. The neovessels within the plaque could introduce a 2.5% increments of deformation in the plaque under the pulsatile blood flow pressure. The IPH also contributed to the increased risk of plaque rupture that a gain of stress was 8.983, 14.526, and 34.47 kPa for the plaque with 50, 65, and 75%, respectively, when comparing stress in the plaque with IPH distributed at the middle to the shoulder of the plaque. In conclusion, neovascularization in the plaque could reduce the stability of the plaque by increasing the stress within the plaque. Also, the risk of plaque rupture increased when large luminal stenosis, thin fibrous cap, and IPH were observed.
Collapse
Affiliation(s)
- Zhenzhou Li
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yongfeng Wang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Xinyin Wu
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xin Liu
- Guangdong Academy Research on Virtual Reality (VR) Industry, Foshan University, Foshan, China
| | - Shanshan Huang
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yi He
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Shuyu Liu
- School of Pharmacy, Sun Yat-sen University, Guangzhou, China
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| |
Collapse
|
14
|
Murgia A, Erta M, Suri JS, Gupta A, Wintermark M, Saba L. CT imaging features of carotid artery plaque vulnerability. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1261. [PMID: 33178793 PMCID: PMC7607080 DOI: 10.21037/atm-2020-cass-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite steady advances in medical care, cardiovascular disease remains one of the main causes of death and long-term morbidity worldwide. Up to 30% of strokes are associated with the presence of carotid atherosclerotic plaques. While the degree of stenosis has long been recognized as the main guiding factor in risk stratification and therapeutical decisions, recent evidence suggests that features of unstable, or ‘vulnerable’, plaques offer better prognostication capabilities. This paradigmatic shift has motivated researchers to explore the potentialities of non-invasive diagnostic tools to image not only the lumen, but also the vascular wall and the structural characteristics of the plaque. The present review will offer a panoramic on the imaging modalities currently available to characterize carotid atherosclerotic plaques and, in particular, it will focus on the increasingly important role covered by multidetector computed tomographic angiography.
Collapse
Affiliation(s)
- Alessandro Murgia
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato (Cagliari), Italy
| | - Marco Erta
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato (Cagliari), Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnosis Division, AtheroPoint(tm), Roseville, CA, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell University, New York, NY, USA
| | - Max Wintermark
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato (Cagliari), Italy
| |
Collapse
|
15
|
Porcu M, Mannelli L, Melis M, Suri JS, Gerosa C, Cerrone G, Defazio G, Faa G, Saba L. Carotid plaque imaging profiling in subjects with risk factors (diabetes and hypertension). Cardiovasc Diagn Ther 2020; 10:1005-1018. [PMID: 32968657 DOI: 10.21037/cdt.2020.01.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Carotid artery stenosis (CAS) due to the presence of atherosclerotic plaque (AP) is a frequent medical condition and a known risk factor for stroke, and it is also known from literature that several risk factors promote the AP development, in particular aging, smoke, male sex, hypertension, hyperlipidemia, smoke, diabetes type 1 and 2, and genetic factors. The study of carotid atherosclerosis is continuously evolving: even if the strategies of treatment still depends mainly on the degree of stenosis (DoS) determined by the plaque, in the last years the attention has moved to the study of the plaque components in order to identify the so called "vulnerable" plaque: features like the fibrous cap status and thickness, the volume of the lipid-rich necrotic core and the presence of intraplaque hemorrhage (IPH) are risk factors for plaque rupture, that can be studied with modern imaging techniques. The aim of this review is to give a general overview of the principle histological and imaging features of the subcomponent of carotid AP (CAP), focalizing in particular on the features of CAP of patients affected by hypertension and diabetes (in particular type 2 diabetes mellitus).
Collapse
Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| | | | - Marta Melis
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Jasjit S Suri
- Diagnostic and Monitoring Division, AtheroPoint, Roseville, California, USA
| | - Clara Gerosa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giulia Cerrone
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| |
Collapse
|
16
|
Murgia A, Balestrieri A, Francone M, Lucatelli P, Scapin E, Buckler A, Micheletti G, Faa G, Conti M, Suri JS, Guglielmi G, Carriero A, Saba L. Plaque imaging volume analysis: technique and application. Cardiovasc Diagn Ther 2020; 10:1032-1047. [PMID: 32968659 PMCID: PMC7487381 DOI: 10.21037/cdt.2020.03.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/15/2020] [Indexed: 12/12/2022]
Abstract
The prevention and management of atherosclerosis poses a tough challenge to public health organizations worldwide. Together with myocardial infarction, stroke represents its main manifestation, with up to 25% of all ischemic strokes being caused by thromboembolism arising from the carotid arteries. Therefore, a vast number of publications have focused on the characterization of the culprit lesion, the atherosclerotic plaque. A paradigm shift appears to be taking place at the current state of research, as the attention is gradually moving from the classically defined degree of stenosis to the identification of features of plaque vulnerability, which appear to be more reliable predictors of recurrent cerebrovascular events. The present review will offer a perspective on the present state of research in the field of carotid atherosclerotic disease, focusing on the imaging modalities currently used in the study of the carotid plaque and the impact that such diagnostic means are having in the clinical setting.
Collapse
Affiliation(s)
- Alessandro Murgia
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Elisa Scapin
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | | | - Giulio Micheletti
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo San Giovanni di Dio, Cagliari (Cagliari) 09045, Italy
| | - Maurizio Conti
- Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA
- Department of Electrical Engineering, U of Idaho (Affl.), Idaho, USA
| | - Jasjit S. Suri
- Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA
- Department of Electrical Engineering, U of Idaho (Affl.), Idaho, USA
| | | | - Alessandro Carriero
- Department of Radiology, Maggiore della Carità Hospital, Università del Piemonte Orientale, Novara, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| |
Collapse
|
17
|
Saba L, Zucca S, Gupta A, Micheletti G, Suri JS, Balestrieri A, Porcu M, Crivelli P, Lanzino G, Qi Y, Nardi V, Faa G, Montisci R. Perivascular Fat Density and Contrast Plaque Enhancement: Does a Correlation Exist? AJNR Am J Neuroradiol 2020; 41:1460-1465. [PMID: 32732275 DOI: 10.3174/ajnr.a6710] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Inflammatory changes in the fat tissue surrounding the coronary arteries have been associated with coronary artery disease and high-risk vulnerable plaques. Our aim was to investigate possible correlations between the presence and degree of perivascular fat density and a marker of vulnerable carotid plaque, namely contrast plaque enhancement on CTA. MATERIALS AND METHODS One-hundred patients (76 men, 24 women; mean age, 69 years) who underwent CT angiography for investigation of carotid artery stenosis were retrospectively analyzed. Contrast plaque enhancement and perivascular fat density were measured in 100 carotid arteries, and values were stratified according to symptomatic (ipsilateral-to-cerebrovascular symptoms)/asymptomatic status (carotid artery with the most severe degree of stenosis). Correlation coefficients (Pearson ρ product moment) were calculated between the contrast plaque enhancement and perivascular fat density. The differences among the correlation ρ values were calculated using the Fisher r-to-z transformation. Mann-Whitney analysis was also calculated to test differences between the groups. RESULTS There was a statistically significant positive correlation between contrast plaque enhancement and perivascular fat density (ρ value = 0.6582, P value = .001). The correlation was stronger for symptomatic rather than asymptomatic patients (ρ value = 0.7052, P value = .001 versus ρ value = 0.4092, P value = .001). CONCLUSIONS There was a positive association between perivascular fat density and contrast plaque enhancement on CTA. This correlation was stronger for symptomatic rather than asymptomatic patients. Our results suggest that perivascular fat density could be used as an indirect marker of plaque instability.
Collapse
Affiliation(s)
- L Saba
- From the Departments of Radiology (L.S., S.Z., G.M., A.B., M.P.), Pathology (G.F.), and Vascular Surgery (R.M.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy; Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - S Zucca
- From the Departments of Radiology (L.S., S.Z., G.M., A.B., M.P.), Pathology (G.F.), and Vascular Surgery (R.M.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy; Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - A Gupta
- Stroke Diagnosis and Monitoring Division (J.S.S.), AtheroPoint (TM), Roseville, California
| | - G Micheletti
- From the Departments of Radiology (L.S., S.Z., G.M., A.B., M.P.), Pathology (G.F.), and Vascular Surgery (R.M.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy; Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - J S Suri
- Stroke Diagnosis and Monitoring Division (J.S.S.), AtheroPoint (TM), Roseville, California
| | - A Balestrieri
- From the Departments of Radiology (L.S., S.Z., G.M., A.B., M.P.), Pathology (G.F.), and Vascular Surgery (R.M.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy; Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - M Porcu
- From the Departments of Radiology (L.S., S.Z., G.M., A.B., M.P.), Pathology (G.F.), and Vascular Surgery (R.M.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy; Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - P Crivelli
- Department of Radiology (P.C.), Azienda Ospedaliero Universitaria, Sassari, Italy
| | - G Lanzino
- Department of Neurologic Surgery (G.L., V.N.), Mayo Clinic, Rochester, Minnesota
| | - Y Qi
- Xuanwu Hospital (Y.Q.), Capital Medical University Beijing, China
| | - V Nardi
- Department of Neurologic Surgery (G.L., V.N.), Mayo Clinic, Rochester, Minnesota
| | - G Faa
- From the Departments of Radiology (L.S., S.Z., G.M., A.B., M.P.), Pathology (G.F.), and Vascular Surgery (R.M.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy; Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - R Montisci
- From the Departments of Radiology (L.S., S.Z., G.M., A.B., M.P.), Pathology (G.F.), and Vascular Surgery (R.M.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy; Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| |
Collapse
|