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Yoo SW, Yang S, Kim JE, Huh KH, Lee SS, Heo MS, Yi WJ. CACSNet for automatic robust classification and segmentation of carotid artery calcification on panoramic radiographs using a cascaded deep learning network. Sci Rep 2024; 14:13894. [PMID: 38886356 PMCID: PMC11183138 DOI: 10.1038/s41598-024-64265-4] [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: 12/05/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
Stroke is one of the major causes of death worldwide, and is closely associated with atherosclerosis of the carotid artery. Panoramic radiographs (PRs) are routinely used in dental practice, and can be used to visualize carotid artery calcification (CAC). The purpose of this study was to automatically and robustly classify and segment CACs with large variations in size, shape, and location, and those overlapping with anatomical structures based on deep learning analysis of PRs. We developed a cascaded deep learning network (CACSNet) consisting of classification and segmentation networks for CACs on PRs. This network was trained on ground truth data accurately determined with reference to CT images using the Tversky loss function with optimized weights by balancing between precision and recall. CACSNet with EfficientNet-B4 achieved an AUC of 0.996, accuracy of 0.985, sensitivity of 0.980, and specificity of 0.988 in classification for normal or abnormal PRs. Segmentation performances for CAC lesions were 0.595 for the Jaccard index, 0.722 for the Dice similarity coefficient, 0.749 for precision, and 0.756 for recall. Our network demonstrated superior classification performance to previous methods based on PRs, and had comparable segmentation performance to studies based on other imaging modalities. Therefore, CACSNet can be used for robust classification and segmentation of CAC lesions that are morphologically variable and overlap with surrounding structures over the entire posterior inferior region of the mandibular angle on PRs.
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Affiliation(s)
- Suh-Woo Yoo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Su Yang
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.
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Zhao M, Zhang L, Chen J, Gu S, Wu R, Jia C. Associations between carotid plaque shape, biomechanical parameters, and ischemic stroke in mild carotid stenosis with a single plaque. Ultrasonography 2024; 43:209-219. [PMID: 38644636 PMCID: PMC11079503 DOI: 10.14366/usg.24019] [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: 02/01/2024] [Revised: 03/17/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
PURPOSE This cross-sectional cohort-comparison observational study investigated the value of high-frame-rate vector flow (V Flow) imaging for evaluating differences in carotid plaque shape and biomechanical parameters in patients with mild stenosis according to a recent history of ipsilateral ischemic stroke. METHODS The present study included 352 patients from February 2023 to October 2023, who were categorized as symptomatic or asymptomatic based on a history of recent ischemic stroke and ipsilateral ischemic lesions detected on head computed tomography or magnetic resonance imaging. A Mindray Resona R9 system was used for B-mode ultrasonography and V Flow imaging. The upstream and downstream surfaces of the plaques were examined at the carotid bifurcation for wall shear stress (WSS), oscillatory shear index (OSI), and turbulence index, which performed peri-plaque biomechanical condition. Multivariable logistic regression models were used to determine associations between plaque shape, V Flow parameters, and ischemic stroke. RESULTS Symptomatic patients exhibited higher WSS values for the upstream and downstream surfaces of carotid plaque, as well as higher OSI and turbulence index values for the downstream surface. Type Ⅲ plaques and higher WSS and OSI values for the downstream surface of the plaque were significantly associated with ischemic stroke. Type Ⅲ plaques were more prevalent in symptomatic patients and demonstrated much higher WSS and OSI values for the downstream plaque surface in both groups. CONCLUSION High-frame-rate V Flow imaging could assess peri-plaque biomechanical forces and may provide effective imaging biomarkers for early prediction of ischemic stroke in patients with mild stenosis.
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Affiliation(s)
- Man Zhao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luni Zhang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Jing Chen
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiyao Gu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caixia Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Amarttayakong S, Amarttayakong P, Munkong W, La-up A, Chaiyamoon A, Suwannakhan A, Sangkhano S. Is low carotid bifurcation determined by vertebral level always convenient for surgical approach? PLoS One 2024; 19:e0294072. [PMID: 38300938 PMCID: PMC10833526 DOI: 10.1371/journal.pone.0294072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/24/2023] [Indexed: 02/03/2024] Open
Abstract
Although high-level carotid bifurcation (HCB) could lead to notable surgical difficulty, the definitive reference point for HCB is unclear. HCB is typically characterized as carotid bifurcation (CB) located higher than the level of the third cervical vertebra (C), however, a major obstacle regarding carotid artery surgical exposure is angle of the mandible (AM). The objective of this study was to investigate CB level, define HCB in relation to AM and vertebral levels, and measure the vertical distance from HCB to ipsilateral AM. Moreover, the percentage of surgically challenged CBs, misclassified as low CBs (LCB) based on vertebral level, was investigated. Patients who underwent neck computed tomography angiography were retrospectively studied. HCBs were classified into two categories: CBs above the C3 and either at or above the ipsilateral AM. Of 172 CBs (86 patients; 57 men, 29 women), CB was mostly found at C3 (44.19%), whereas AM was commonly located at C2 (51.16%). Based on vertebral level and AM, HCBs were detected in 10.47% and 20.35% of CBs, respectively. The association of HCBs determined by either C3 or AM between both sides in each individual was nonsignificant (p>0.05), but HCBs determined by C3 level were predominant in women (OR = 3.58, 95%CI = 1.31-9.80). Considering both C3 and AM, there was 8.72% of HCBs. The remaining 91.28% was classified as LCBs, including 11.63% of CBs located at both C3 and AM which were actually classified as HCBs if determined by AM. In cases of CBs above AM level, the mean vertical distance was as high as 6.56 ±2.41mm.
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Affiliation(s)
- Siriyakorn Amarttayakong
- Phu Wiang Hospital, Phu Wiang, Khon Kaen, Thailand
- Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Waranon Munkong
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Aroon La-up
- Mahidol University, Nakhonsawan Campus, Nakhonsawan, Thailand
| | - Arada Chaiyamoon
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Sukrit Sangkhano
- School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
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Liu X, Song P, Gao Q, Dai M, Rao J, Wen J. Impact on hemodynamics in carotid arteries with carotid webs at different locations: A Numerical Study Integrating Thrombus Growth Model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107926. [PMID: 37984097 DOI: 10.1016/j.cmpb.2023.107926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Carotid webs (CWs), lesions in the carotid arteries, are gaining research interest due to the unclear link to ischemic stroke. Similarity to atherosclerosis in lesion location adds the complexity. The main purpose of study is to investigate the hemodynamic effects of CWs at different locations in carotid arteries. METHODS Three types of models with CWs were reconstructed from the CTA dataset of 8 healthy carotid arteries (Models A: CWs at the common carotid artery; B: at the origin of internal carotid artery; C: at the carotid sinus). Wall shear stress (WSS)-based parameters, including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and endothelial cell activation potential (ECAP) were analyzed. A thrombus growth model was also incorporated to assess long-term thrombus formation across different carotid webs locations. RESULTS Models A exhibited helical flow, whereas models B and C showed disturbed flow in the carotid sinus. Recirculation in Models A and B was mainly downstream of CWs, while Models C had both upstream and downstream recirculation. In addition, models A had higher overall TAWSS levels, with the smallest region of TAWSS < 0.4 pa (7.78 ± 8.35%). In contrast, Models C had larger areas with TAWSS < 0.4 pa, RRT > 100, and ECAP > 1.5, accounting for 14.18 ± 5.28%, 1.51 ± 1.17%, and 10.36 ± 4.10%, respectively. Noting that thrombus volume was highest in Models C (7.20 ± 3.95%). CONCLUSIONS Numerical simulations indicate that: 1) CWs have less hemodynamic impact when located in the CCA, but may increase flow resistance leading to distal branch ischemia; 2) CWs contribute to thrombus formation, primarily downstream in the common carotid artery and internal carotid artery origin, and both upstream and downstream in the sinus; 3) CWs at the origin of the ICA are more likely to result in disturbed blood flow patterns and thrombus aggregation than the other two locations, which may increase the risk of ischemic stroke in distal cerebral arteries.
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Affiliation(s)
- Xinhui Liu
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Pan Song
- Department of Cardiology, Mianyang Central Hospital, Mianyang 621000, China
| | - Qi Gao
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, Mianyang 621000, China
| | - Junjie Rao
- Office of the Commission for Discipline Inspection, Mianyang Central Hospital, Mianyang 621000, China
| | - Jun Wen
- Department of Computer Science and Technology, Southwest University of Science and Technology, Mianyang 621010, China.
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Ren L, Xu R, Zhao C, Li W, Wang S, Cao C, Gong Y, Zhu J, Feng X, Ren B, Xia S. Tortuosity and Proximal-Specific Hemodynamics Associated with Plaque Location in the Carotid Bulb Stenosis. J Vasc Res 2023; 60:160-171. [PMID: 37499638 DOI: 10.1159/000531584] [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: 12/02/2022] [Accepted: 03/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Atherosclerotic plaque locations in the carotid bulb increasingly have been found to be associated with patterns of ischemic lesions and plaque progression. However, the occurrence of carotid bulb plaque is a complex process. We aimed to investigate plaque characteristics and geometric and hemodynamic parameters among patients with body and apical plaques of the carotid bulb and to identify the mechanism of bulb plaque formation and location. METHODS Consecutive patients with single carotid bulb stenosis (50-99%) were enrolled retrospectively. Patients were divided into body and apical plaque groups based on plaque location. Plaque location and characteristics were identified and measured on high-resolution vessel wall magnetic resonance imaging. Geometric parameters were derived from time-of-flight magnetic resonance imaging. Computational fluid dynamics simulations were performed to quantify wall shear stress (WSS) and four associated WSS-based metrics on the plaque side, on the non-plaque side, and in different parts of the lesion. Plaque characteristics and geometric and hemodynamic parameters were compared, and their associations with the plaque location were determined. RESULTS Seventy patients were recruited (41 body plaques and 29 apical plaques). WSSplaque values were lower than WSSnon-plaque values for all plaques (median [interquartile range], 12.59 [9.83-22.14] vs. 17.27 [11.63-27.63] Pa, p = 0.001). In a multivariate binary logistic regression, the tortuosity of the stenosed region, the magnitudes of the mean relative residence time, and the minimum transverse WSS in the proximal part of the lesion were the key factors independently associated with plaque location (p = 0.022, 0.013, and 0.012, respectively). CONCLUSIONS Plaque formation was associated with the local flow pattern, and the tortuosity and proximal-specific hemodynamics were significantly associated with plaque location in the carotid bulb.
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Affiliation(s)
- Lei Ren
- Department of Radiology, First Central Clinical School, Tianjin Medical University, Tianjin, China
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Rongjie Xu
- College of Computer Science, Nankai University, Tianjin, China
| | - Chenxi Zhao
- Department of Radiology, First Central Clinical School, Tianjin Medical University, Tianjin, China
| | - Wenfei Li
- Department of Radiology, First Central Clinical School, Tianjin Medical University, Tianjin, China
- Department of Radiology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Shu Wang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chen Cao
- Department of Radiology, Tianjin University Huanhu Hospital, Tianjin, China
| | - Yan Gong
- Department of Radiology, Tianjin Nankai Hospital, Tianjin, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Xuequan Feng
- Department of Neurosurgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Bo Ren
- College of Computer Science, Nankai University, Tianjin, China
| | - Shuang Xia
- Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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Strecker C, Kopczak A, Saam T, Sepp D, Hennemuth A, Mayerhofer E, Poli S, Ziemann U, Poppert H, Schindler A, Harloff A. Carotid geometry is independently associated with complicated carotid artery plaques. Front Cardiovasc Med 2023; 10:1177998. [PMID: 37378412 PMCID: PMC10291134 DOI: 10.3389/fcvm.2023.1177998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Complicated carotid artery plaques (cCAPs) are associated with an increased risk of rupture and subsequent stroke. The geometry of the carotid bifurcation determines the distribution of local hemodynamics and could thus contribute to the development and composition of these plaques. Therefore, we studied the role of carotid bifurcation geometry in the presence of cCAPs. Methods We investigated the association of individual vessel geometry with carotid artery plaque types in the Carotid Plaque Imaging in Acute Stroke (CAPIAS) study. After excluding arteries without plaque or with insufficient MRI quality, 354 carotid arteries from 182 patients were analyzed. Individual parameters of carotid geometry [i.e., internal carotid artery (ICA)/common carotid artery (CCA) ratio, bifurcation angle, and tortuosity) were derived from time-of-flight MR images. The lesion types of carotid artery plaques were determined according to the American Heart Association classification of lesions by multi-contrast 3T-MRI. The association between carotid geometry and a cCAP was studied using logistic regression after adjusting for age, sex, wall area, and cardiovascular risk factors. Results Low ICA/CCA ratios (OR per SD increase 0.60 [95%CI: 0.42-0.85]; p = 0.004) and low bifurcation angles (OR 0.61 [95%CI: 0.42-0.90]; p = 0.012) were significantly associated with the presence of cCAPs after adjusting for age, sex, cardiovascular risk factors, and wall area. Tortuosity had no significant association with cCAPs. Only ICA/CCA ratio remained significant in a model containing all three geometric parameters (OR per SD increase 0.65 [95%CI: 0.45-0.94]; p = 0.023). Conclusions A steep tapering of the ICA relative to the CCA and, to a lesser extent, a low angle of the carotid bifurcation were associated with the presence of cCAPs. Our findings highlight the contribution of bifurcation geometry to plaque vulnerability. Thus, assessment of carotid geometry could be helpful in identifying patients at risk of cCAPs.
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Affiliation(s)
- Christoph Strecker
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | | | - Dominik Sepp
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Anja Hennemuth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ernst Mayerhofer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Sven Poli
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Poppert
- Department of Neurology, Helios Klinikum München West, Munich, Germany
| | - Andreas Schindler
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bilateral vertebral artery dissection extending to the left posterior cerebral artery: A case report. Radiol Case Rep 2023; 18:1686-1690. [PMID: 36895896 PMCID: PMC9989296 DOI: 10.1016/j.radcr.2023.01.099] [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: 01/16/2023] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 03/02/2023] Open
Abstract
Intracranial artery dissection accounts for a small percentage (1%-2%) of all ischemic strokes. Vertebral artery dissection sometimes extends to the basilar artery but very rarely to the posterior cerebral artery. We report a case of bilateral vertebral artery dissection extending to the left posterior cerebral artery with the characteristic distribution of intramural hematoma. A 51-year-old woman presented with right hemiparesis and dysarthria 3 days after sudden neck pain. Magnetic resonance imaging on admission revealed infarcts in the left thalamus and temporo-occipital lobe and findings suggestive of bilateral vertebral artery dissection. No infarct was detected in the brainstem. The patient was treated conservatively. Initially, we suspected that infarction in the left posterior cerebral artery territory had been caused by artery-to-artery embolism from the dissected vertebral arteries. However, T1-weighted imaging on day 15 of admission revealed intramural hematoma extending from the left vertebral artery to the left posterior cerebral artery. Therefore, we diagnosed bilateral vertebral artery dissection extending to the basilar artery and the left posterior cerebral artery. The patient's symptoms subsequently improved with conservative treatment, and she was discharged with a modified Rankin Scale score of 1 on day 62 of admission. In this case, intramural hematoma of the basilar artery was found in the anterior vessel wall. Brainstem infarction is less likely when intramural hematoma is located in the anterior vessel wall of the basilar artery in vertebrobasilar artery dissection. T1-weighted imaging is useful for the diagnosis of this rare condition and can predict potentially impaired branches and possible symptoms.
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Tang Y, Zhang J, Liu W, Jin W, Li S, Qian Z, Kong X, Zhang R, Hu J, Li B, Yuan W, Zhang Y. Analysis of carotid vulnerable plaque MRI high-risk features and clinical risk factors associated with concomitant acute cerebral infarction. BMC Cardiovasc Disord 2023; 23:173. [PMID: 36997869 PMCID: PMC10064680 DOI: 10.1186/s12872-023-03199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND This study aimed to investigate the correlation between the high-risk characteristics of high-resolution MRI carotid vulnerable plaques and the clinical risk factors and concomitant acute cerebral infarction (ACI). METHODS Forty-five patients diagnosed with a single vulnerable carotid plaque by MRI were divided into two groups based on whether they had ipsilateral ACI. The clinical risk factors and the observation values or frequency of occurrence of high-risk MRI phenotypes of plaque volume, LRNC, IPH and ulcer were statistically compared between the two groups. RESULTS A total of 45 vulnerable carotid artery plaques were found in 45 patients, 23 patients with ACI and 22 patients without ACI. There were no significant differences in age, sex, smoking, serum TC, TG and LDL between the two groups (all P > 0.05), but the ACI group had significantly more patients with hypertension (P < 0.05) and the without ACI group coronary heart disease (P < 0.05). The volume of vulnerable carotid plaque in the group with ACI (1004.19 ± 663.57 mm3) was significantly larger than that in the group without ACI (487.21 ± 238.64 mm3) (P < 0.05). The phenotype of vulnerable carotid artery plaque was 13 cases of LRNC, 8 cases of LRNC + IPH, 5 cases of LRNC + Ulcer, and 19 cases of LRNC + IPH + Ulcer. There was no significant difference in this distribution between the two groups (all P > 0.05) with the exception of LRNC + IPH + Ulcer. The 14 cases of LRNC + IPH + LRNC + IPH + Ulcer (60.87%) in the group with ACI and was significantly greater than the 5 (22.73%) in patients without ACI (P < 0.05). CONCLUSION It is preliminarily thought that hypertension is the main clinical risk factor for vulnerable carotid plaques with ACI and the combination of plaque volume with vulnerable carotid plaque and LRNC + IPH + Ulcer is a high-risk factor for complicated ACI. It has high clinical therapeutic value due to the accurate diagnosis of responsible vessels and plaques with high-resolution MRI.
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Affiliation(s)
- Yongxiang Tang
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Jinping Zhang
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China.
| | - Weizhou Liu
- Department of Neurology, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Wei Jin
- Department of Neurology, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Shijian Li
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Zhen Qian
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Xiaoquan Kong
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Ran Zhang
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Juanjuan Hu
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Baolin Li
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Weiming Yuan
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
| | - Yifan Zhang
- Department of Medical Image Center, Tongling People's Hospital, Bijiashan Road 468, Tongling, 244000, Anhui, China
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Han N, Ma Y, Li Y, Zheng Y, Wu C, Gan T, Li M, Ma L, Zhang J. Imaging and Hemodynamic Characteristics of Vulnerable Carotid Plaques and Artificial Intelligence Applications in Plaque Classification and Segmentation. Brain Sci 2023; 13:brainsci13010143. [PMID: 36672124 PMCID: PMC9856903 DOI: 10.3390/brainsci13010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Stroke is a massive public health problem. The rupture of vulnerable carotid atherosclerotic plaques is the most common cause of acute ischemic stroke (AIS) across the world. Currently, vessel wall high-resolution magnetic resonance imaging (VW-HRMRI) is the most appropriate and cost-effective imaging technique to characterize carotid plaque vulnerability and plays an important role in promoting early diagnosis and guiding aggressive clinical therapy to reduce the risk of plaque rupture and AIS. In recent years, great progress has been made in imaging research on vulnerable carotid plaques. This review summarizes developments in the imaging and hemodynamic characteristics of vulnerable carotid plaques on the basis of VW-HRMRI and four-dimensional (4D) flow MRI, and it discusses the relationship between these characteristics and ischemic stroke. In addition, the applications of artificial intelligence in plaque classification and segmentation are reviewed.
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Affiliation(s)
- Na Han
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
| | - Yurong Ma
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Yan Li
- School of Mathematics and Statistics, Lanzhou University, Lanzhou 730030, China
| | - Yu Zheng
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
| | - Chuang Wu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Tiejun Gan
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Min Li
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Laiyang Ma
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Correspondence: ; Tel.: +86-139-1999-2479
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HR-MRI findings of intracranial artery stenosis and distribution of atherosclerotic plaques caused by different etiologies. Neurol Sci 2022; 43:5421-5430. [DOI: 10.1007/s10072-022-06132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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11
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Identification Markers of Carotid Vulnerable Plaques: An Update. Biomolecules 2022; 12:biom12091192. [PMID: 36139031 PMCID: PMC9496377 DOI: 10.3390/biom12091192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Vulnerable plaques have been a hot topic in the field of stroke and carotid atherosclerosis. Currently, risk stratification and intervention of carotid plaques are guided by the degree of luminal stenosis. Recently, it has been recognized that the vulnerability of plaques may contribute to the risk of stroke. Some classical interventions, such as carotid endarterectomy, significantly reduce the risk of stroke in symptomatic patients with severe carotid stenosis, while for asymptomatic patients, clinically silent plaques with rupture tendency may expose them to the risk of cerebrovascular events. Early identification of vulnerable plaques contributes to lowering the risk of cerebrovascular events. Previously, the identification of vulnerable plaques was commonly based on imaging technologies at the macroscopic level. Recently, some microscopic molecules pertaining to vulnerable plaques have emerged, and could be potential biomarkers or therapeutic targets. This review aimed to update the previous summarization of vulnerable plaques and identify vulnerable plaques at the microscopic and macroscopic levels.
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12
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Mingming L, Peng P, Lichen Z, Shaohua L, Fei Y, Hongtao Z, Shitong L, Yao H, Xihai Z, Jianming C. Predictors of Progression in Intraplaque Hemorrhage Volume in Patients With Carotid Atherosclerosis: A Serial Magnetic Resonance Imaging Study. Front Neurol 2022; 13:815150. [PMID: 35911916 PMCID: PMC9334903 DOI: 10.3389/fneur.2022.815150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeThis study aimed to investigate the arterial disease risk factors for the progression of intraplaque hemorrhage (IPH) in patients with carotid atherosclerosis using serial high-resolution magnetic resonance (MR) imaging.MethodsConsecutive symptomatic patients who had MRI evidence of intraplaque hemorrhage present in the ipsilateral carotid artery with respect to the side of the brain affected by stroke or TIA were recruited in the study. All the patients underwent follow-up MR imaging at least 6 months after baseline. The annual change in IPH and other carotid plaque morphology was calculated, and a tertile method was used to classify the plaques as progressed or not with respect to IPH volume using the software CASCADE. Logistic regression and receiver operating characteristic (ROC) curve were conducted to evaluate the risk factors for the progression of IPH.ResultsA total of thirty-four symptomatic patients (mean age: 67.1 years, standard deviation [SD]: 9.8 years, 27 men) were eligible for the final analysis, and contralateral plaques containing IPH were seen in 11 of these patients (making 45 plaques with IPH in total). During mean 16.6-month (SD: 11.0 months) follow-up, the overall annual change in IPH volume in 45 plaques with IPH was mean −10.9 mm3 (SD: 49.1 mm3). Carotid plaques were significantly more likely to be classified in progressed IPH group if the patient was taking antiplatelet agent at baseline (OR: 9.76; 95%CI: 1.05 to 90.56; p = 0.045), had a baseline history of current or past smoking (OR: 9.28; 95%CI: 1.26 to 68.31; p = 0.029), or had a larger baseline carotid plaque-containing vessel wall volume (OR: 1.36 per 10 mm3; 95%CI: 1.02 to 1.81; p = 0.032) after adjustments for confounding factors. ROC analysis indicated that the combination of these three risk factors in the final model produced good discriminatory value for the progressed IPH group (area under the curve: 0.887).ConclusionsTaking an antiplatelet agent at baseline, a baseline history of current or past smoking and larger baseline carotid plaque-containing vessel wall volume were independently predictive of plaques being in the progressed IPH group. Our findings indicate that awareness and management of such risk factors may reduce the risk of intraplaque hemorrhage progression.
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Affiliation(s)
- Lu Mingming
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Zhang Lichen
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Liu Shaohua
- State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center of PLA General Hospital, Institute of Geriatrics, Beijing, China
| | - Yuan Fei
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Zhang Hongtao
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Liu Shitong
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - He Yao
- State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center of PLA General Hospital, Institute of Geriatrics, Beijing, China
- He Yao
| | - Zhao Xihai
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Zhao Xihai
| | - Cai Jianming
- Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Cai Jianming
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13
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Li X, Guo D, Zhou W, Hu Y, Zhou H, Chen Y. Oxidative Stress and Inflammation Markers Associated with Multiple Peripheral Artery Occlusions in Elderly Patients. Angiology 2022; 74:472-487. [PMID: 35786005 DOI: 10.1177/00033197221111860] [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] [Indexed: 11/16/2022]
Abstract
Background: Pro-oxidative stress and pro-inflammatory responses can influence each other in the development of atherosclerosis. This study evaluated the relationship between oxidative stress, inflammation, and multiple peripheral artery occlusions in elderly patients (age mean 71.2 ± 8.1 years). Methods: A total of 723 participants were enrolled: 67 healthy subjects, 214 patients with common iliac artery occlusions, 224 patients with popliteal artery occlusions, and 218 patients with femoral artery occlusions. We measured oxidative stress biomarkers (malondialdehyde [MDA], F2-isoprostane [F2-isoP], total oxidant status [TOS], and ischemia-modified albumin [IMA]) and the expressions of molecules in mimecan (MIME)/nuclear factor kappa B (NF-κB)/P53/Toll-like receptor 4 (TLR4) signaling pathway in older patients with multiple peripheral artery occlusions. Results: The levels of MDA, F2-isoP, TOS, IMA, MIME, NF-κB, P53, and TLR4 were increased in the single-site peripheral artery occlusive group when compared with healthy controls (P < .001) and were further increased in the multiple-site peripheral artery occlusive group compared with the single-site peripheral artery occlusive group (P < .001). Conclusion: Oxidative stress may promote inflammatory signaling pathways and lead to multiple peripheral artery occlusions in elderly patients.
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Affiliation(s)
- Xia Li
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Dianxuan Guo
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Wenhang Zhou
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Youdong Hu
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Hualan Zhou
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Ying Chen
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
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14
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Benson JC, Nardi V, Hunt CH, Lerman A, Lanzino G, Brinjikji W. Cardiovascular risk factors and cervical carotid plaque features on CT angiography. Neuroradiol J 2021; 35:346-351. [PMID: 34569868 DOI: 10.1177/19714009211047450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about the impact that cardiovascular (CV) risk factors have on the formation of various carotid atherosclerotic plaque features. This study set out to assess the association between CV risk factors and plaque characteristics on computed tomography (CT) angiography (CTA). MATERIALS AND METHODS A retrospective review was completed of consecutive patients that underwent a carotid endarterectomy and had CTA imaging of the head and neck vasculature. Atherosclerotic plaques of both carotid arteries were evaluated for calcification(s), low-density plaque (LDP) components, ulceration(s), and degree of stenosis. Various clinical CV risk factors were assessed using medical records. Last recorded laboratory levels were dichotomized into categories: total cholesterol <200 or ≥200 mg/dL, low-density lipoprotein (LDL) <130 or ≥130 mg/dL, high-density lipoprotein <35 or ≥35 mg/dL, and triglyceride <200 or ≥200 mg/dL. RESULTS Of 97 included patients, 62 were male (63.9%); the average age was 72.7 (standard deviation = 9.5). Calcifications were in 95/97 (97.9%) of patients (one or both carotid plaques); LDP components were in 73/97 (75.3%), and ulcerations were in 21/97 (21.6%). Elevated total cholesterol and elevated LDL levels were both associated with a higher likelihood of LDP components (p = 0.004 and p = 0.02, respectively). There were no other statistically significant associations between individual plaque features or severity of arterial stenosis and CV risk factors. CONCLUSION In carotid atherosclerotic plaques, LDP components are more frequently present in one or both carotid arteries in patients with elevated total cholesterol and/or LDL levels. Such findings raise the possibility that cholesterol levels may be directly related to the formation of specific high-risk plaque features.
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Affiliation(s)
| | - Valentina Nardi
- Department of Cardiovascular Medicine, 6915Mayo Clinic, Mayo Clinic, USA
| | - Christopher H Hunt
- Department of Cardiovascular Medicine, 6915Mayo Clinic, Mayo Clinic, USA
| | | | | | - Waleed Brinjikji
- Department of Cardiovascular Medicine, 6915Mayo Clinic, Mayo Clinic, USA
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15
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Deng F, Mu C, Yang L, Yi R, Gu M, Li K. The Differentiation in Image Post-processing and 3D Reconstruction During Evaluation of Carotid Plaques From MR and CT Data Sources. Front Physiol 2021; 12:645438. [PMID: 33935800 PMCID: PMC8085352 DOI: 10.3389/fphys.2021.645438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Carotid plaque morphology and tissue composition help assess risk stratification of stroke events. Many post-processing image techniques based on CT and MR images have been widely used in related research, such as image segmentation, 3D reconstruction, and computer fluid dynamics. However, the criteria for the 3D numerical model of carotid plaque established by CT and MR angiographic image data remain open to questioning. Method: We accurately duplicated the geometry and simulated it using computer software to make a 3D numerical model. The initial images were obtained by CTA and TOF-MRA. MIMICS (Materialize’s interactive medical image control system) software was used to process the images to generate three-dimensional solid models of blood vessels and plaques. The subsequent output was exported to the ANSYS software to generate finite element simulation results for the further hemodynamic study. Results: The 3D models of carotid plaque of TOF-MRA and CTA were simulated by using computer software. CTA has a high-density resolution for carotid plaque, the boundary of the CTA image is obvious, and the main component of which is a calcified tissue. However, the density resolution of TOF-MRA for the carotid plaque and carotid artery was not as good as that of CTA. The results show that there is a large deviation between the TOF-MRA and CTA 3D model of plaque in the carotid artery due to the unclear recognition of plaque boundary during 3D reconstruction, and this can further affect the simulation results of hemodynamics. Conclusion: In this study, two-dimensional images and three-dimensional models of carotid plaques obtained by two angiographic techniques were compared. The potential of these two imaging methods in clinical diagnosis and fluid dynamics of carotid plaque was evaluated, and the selectivity of image post-processing analysis to original medical image acquisition was revealed.
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Affiliation(s)
| | - Changping Mu
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Ling Yang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Rongqi Yi
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Min Gu
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Kang Li
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
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Lee JH, Chen Z, He S, Zhou JK, Tsai A, Truskey GA, Leong KW. Emulating Early Atherosclerosis in a Vascular Microphysiological System Using Branched Tissue-Engineered Blood Vessels. Adv Biol (Weinh) 2021; 5:e2000428. [PMID: 33852179 PMCID: PMC9951769 DOI: 10.1002/adbi.202000428] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/26/2021] [Indexed: 02/04/2023]
Abstract
Atherosclerosis begins with the accumulation of cholesterol-carrying lipoproteins on blood vessel walls and progresses to endothelial cell dysfunction, monocyte adhesion, and foam cell formation. Endothelialized tissue-engineered blood vessels (TEBVs) have previously been fabricated to recapitulate artery functionalities, including vasoconstriction, vasodilation, and endothelium activation. Here, the initiation of atherosclerosis is emulated by designing branched TEBVs (brTEBVs) of various geometries treated with enzyme-modified low-density-lipoprotein (eLDL) and TNF-α to induce endothelial cell dysfunction and adhesion of perfused human monocytes. Locations of monocyte adhesion under pulsatile flow are identified, and the hemodynamics in the brTEBVs are characterized using particle image velocimetry (PIV) and computational fluid dynamics (CFD). Monocyte adhesion is greater at the side outlets than at the main outlets or inlets, and is greatest at larger side outlet branching angles (60° or 80° vs 45°). In PIV experiments, the branched side outlets are identified as atherosclerosis-prone areas where fluorescent particles show a transient swirling motion following flow pulses; in CFD simulations, side outlets with larger branching angles show higher vorticity magnitude and greater flow disturbance than other areas. These results suggest that the branched TEBVs with eLDL/TNF-α treatment provide a physiologically relevant model of early atherosclerosis for preclinical studies.
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Affiliation(s)
- Jounghyun H. Lee
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Zaozao Chen
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Siyu He
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Joyce K. Zhou
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Alexander Tsai
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - George A. Truskey
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Kam W. Leong
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
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Lee SH, Jung JM, Kim KY, Kim BJ. Intramural Hematoma Shape and Acute Cerebral Infarction in Intracranial Artery Dissection: A High-Resolution Magnetic Resonance Imaging Study. Cerebrovasc Dis 2020; 49:269-276. [PMID: 32623427 DOI: 10.1159/000508027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial artery dissection (IAD) is gaining recognition as an important cause of stroke, but limited information is available about the morphology of the dissection. This study aimed to investigate the relationship between acute cerebral infarctions and the shape of hematoma in patients with IADs using high-resolution magnetic resonance imaging (HRMRI). METHODS We enrolled consecutive patients who presented with vascular headaches, transient ischemic attacks, or ischemic strokes with acute IAD confirmed by HRMRI using key pathognomonic radiological findings of IAD, including intimal flap, intramural hematoma (IMH), and double lumen. All patients were enrolled and HRMRI was performed, both within 7 days of symptom onset. All patients with acute ischemic infarction within 7 days were enrolled. Patients were divided into 2 groups: those with a proximal dominant intramural hematoma (PIMH) and those with a distal dominant intramural hematoma (DIMH). A PIMH was defined as when the volume of the hematoma in the proximal region was greater than that in the distal region, and a DIMH was defined as when the distal region was greater than that in the proximal region. Clinical and radiological characteristics between the 2 groups were compared using univariable and multivariable logistic regression. RESULTS The mean age of the 42 participants was 52.6 ± 12.7 years, and 24 (57.1%) were male. Twenty-seven (64.3%) had a PIMH and 15 (35.7%) had a DIMH. Thirty-six (85.7%) showed a double lumen and 27 (64.3%) showed a dissecting flap. Acute infarction was observed in 31 (73.8%) patients. Patients with PIMHs showed a higher prevalence of cerebral infarction than those with DIMHs (96.3 vs. 33.3%; p < 0.001). Univariable (odds ratio [OR] 52.00; 95% confidence interval [CI] 5.386-502.082; p = 0.001) and multivariable (OR 65.43; 95% CI 5.20-822.92; p = 0.001) analyses showed that only dissection type was independently associated with the risk of cerebral infarction. CONCLUSION In patients with cerebral artery dissections, the shape of IMHs was independently associated with cerebral infarction. PIMHs may be more closely associated with cerebral infarctions than DIMHs.
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Affiliation(s)
- Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.,Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Keon-Yeup Kim
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
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18
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Jiang P, Chen Z, Hippe DS, Watase H, Sun B, Lin R, Yang Z, Xue Y, Zhao X, Yuan C. Association Between Carotid Bifurcation Geometry and Atherosclerotic Plaque Vulnerability: A Chinese Atherosclerosis Risk Evaluation Study. Arterioscler Thromb Vasc Biol 2020; 40:1383-1391. [PMID: 32160772 DOI: 10.1161/atvbaha.119.313830] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Carotid bifurcation geometry has been believed to be a risk factor for the initiation of atherosclerosis because of its influence on hemodynamics. However, the relationships between carotid bifurcation geometry and plaque vulnerability are not fully understood. This study aimed to determine the association between carotid bifurcation geometry and plaque vulnerability using magnetic resonance vessel wall imaging. Approach and Results: A total of 501 carotid arteries with nonstenotic atherosclerosis were included from the cross-sectional, multicenter CARE II study (Chinese Atherosclerosis Risk Evaluation). Four standardized carotid bifurcation geometric parameters (bifurcation angle, internal carotid artery planarity, luminal expansion FlareA, and tortuosity Tort2D) were derived from time-of-flight magnetic resonance angiography. Presence of vulnerable plaque, which was characterized by intraplaque hemorrhage, large lipid-rich necrotic core, or disrupted luminal surface, was determined based on multicontrast carotid magnetic resonance vessel wall images. Vulnerable plaques (N=43) were found to occur at more distal locations (ie, near the level of flow divider) than stable plaques (N=458). Multivariable logistic regression showed that the luminal expansion FlareA (odds ratio, 0.45 [95% CI, 0.25-0.81]; P=0.008) was associated with plaque vulnerability after adjustment for age, sex, maximum wall thickness, plaque location, and other geometric parameters. CONCLUSIONS Smaller luminal expansion at carotid bifurcation is associated with vulnerable plaque. The finding needs to be verified with longitudinal studies and the underlying mechanism should be further explored with hemodynamics measurement in the future.
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Affiliation(s)
- Peirong Jiang
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Zhensen Chen
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Daniel S Hippe
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Department of Surgery (H.W.), University of Washington, Seattle
| | - Bin Sun
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Ruolan Lin
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Zheting Yang
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Yunjing Xue
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (P.J., B.S., R.L., Z.Y., Y.X.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (X.Z.)
| | - Chun Yuan
- Department of Radiology (Z.C., D.S.H., C.Y.), University of Washington, Seattle
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Deng F, Hao X, Tang Z, Mu C, Li K, Li H. Carotid plaque magnetic resonance imaging and recurrent stroke risk: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15410. [PMID: 31045796 PMCID: PMC6504532 DOI: 10.1097/md.0000000000015410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND & AIMS Carotid atherosclerotic plaque is an important cause of carotid artery stenosis. The features of carotid atherosclerotic plaque detected by relevant magnetic resonance imaging (MRI), such as lipid core, plaque hemorrhage, and fibrous cap rupture, have been confirmed to be associated with the occurrence of the first cerebral ischemic event. Meanwhile, the features of carotid atherosclerotic plaque can be used as biomarkers to predict the occurrence of cerebral ischemic event. However, the mechanism of recurrent stroke is still unclear. A systematic review and meta-analysis will be performed to summarize the association between features of carotid artery plaque detected by MRI and recurrent stroke, so as to find biomarkers that can predict recurrent stroke. METHODS Electronic search will be performed in PUBMED, EMBASE, Cochrane Controlled Register of Trials (CENTRAL) from inception to October 30, 2018. We will include cohort studies with an average follow-up time of >1 month in which lipid-rich/necrotic cores (LRNC), intraplaque hemorrhage (IPH), and thinned or ruptured fibrous caps (TRFC) are associated with recurrent ipsilateral stroke or ischemic events. We will perform heterogeneity assessment before carrying out meta-analysis. According to the heterogeneity, we select random effect model or fixed effect model for meta-analysis of the included cohort studies. RESULTS Review Manager 5.3 software will be used to calculate the combined hazard ratio value and 95% confidence interval (CI). This meta-analysis will provide high-quality data analysis of LRNC, IPH, and TRFC and ipsilateral recurrent stroke or ischemic events, including biomarkers as major predictors. CONCLUSION The systematic review will provide evidence to assess the association between features of carotid plaque and ipsilateral recurrent stroke or ischemic events. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019124043.
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Affiliation(s)
- Fengbin Deng
- Chongqing Hospital of the University of Chinese Academy of Sciences
| | - Xinyu Hao
- The 3 Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | | | - Changping Mu
- Chongqing Hospital of the University of Chinese Academy of Sciences
| | - Kang Li
- Chongqing Hospital of the University of Chinese Academy of Sciences
| | - Huaqiang Li
- Chongqing Hospital of the University of Chinese Academy of Sciences
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