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Balmforth C, Whittington B, Tzolos E, Bing R, Williams MC, Clark L, Corral CA, Tavares A, Dweck MR, Newby DE. Translational molecular imaging: Thrombosis imaging with positron emission tomography. J Nucl Cardiol 2024:101848. [PMID: 38499227 DOI: 10.1016/j.nuclcard.2024.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024]
Abstract
A key focus of cardiovascular medicine is the detection, treatment, and prevention of disease, with a move towards more personalized and patient-centred treatments. To achieve this goal, novel imaging approaches that allow for early and accurate detection of disease and risk stratification are needed. At present, the diagnosis, monitoring, and prognostication of thrombotic cardiovascular diseases are based on imaging techniques that measure changes in structural anatomy and biological function. Molecular imaging is emerging as a new tool for the non-invasive detection of biological processes, such as thrombosis, that can improve identification of these events above and beyond current imaging modalities. At the forefront of these evolving techniques is the use of high-sensitivity radiotracers in conjunction with positron emission tomography imaging that could revolutionise current diagnostic paradigms by improving our understanding of the role and origin of thrombosis in a range of cardiovascular diseases.
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Affiliation(s)
- Craig Balmforth
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Beth Whittington
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Laura Clark
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Carlos Alcaide Corral
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Adriana Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Marc Richard Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David Ernest Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Nash J, Debono S, Whittington B, Kaczynski J, Clark T, Macnaught G, Semple S, van Beek EJR, Tavares A, Dey D, Williams MC, Slomka PJ, Newby DE, Dweck MR, Fletcher AJ. Thoracic aortic microcalcification activity in combined positron emission tomography and magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06670-5. [PMID: 38456972 DOI: 10.1007/s00259-024-06670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Non-invasive detection of pathological changes in thoracic aortic disease remains an unmet clinical need particularly for patients with congenital heart disease. Positron emission tomography combined with magnetic resonance imaging (PET-MRI) could provide a valuable low-radiation method of aortic surveillance in high-risk groups. Quantification of aortic microcalcification activity using sodium [18F]fluoride holds promise in the assessment of thoracic aortopathies. We sought to evaluate aortic sodium [18F]fluoride uptake in PET-MRI using three methods of attenuation correction compared to positron emission tomography computed tomography (PET-CT) in patients with bicuspid aortic valve, METHODS: Thirty asymptomatic patients under surveillance for bicuspid aortic valve disease underwent sodium [18F]fluoride PET-CT and PET-MRI of the ascending thoracic aorta during a single visit. PET-MRI data were reconstructed using three iterations of attenuation correction (Dixon, radial gradient recalled echo with two [RadialVIBE-2] or four [RadialVIBE-4] tissue segmentation). Images were qualitatively and quantitatively analysed for aortic sodium [18F]fluoride uptake on PET-CT and PET-MRI. RESULTS Aortic sodium [18F]fluoride uptake on PET-MRI was visually comparable with PET-CT using each reconstruction and total aortic standardised uptake values on PET-CT strongly correlated with each PET-MRI attenuation correction method (Dixon R = 0.70; RadialVIBE-2 R = 0.63; RadialVIBE-4 R = 0.64; p < 0.001 for all). Breathing related artefact between soft tissue and lung were detected using Dixon and RadialVIBE-4 but not RadialVIBE-2 reconstructions, with the presence of this artefact adjacent to the atria leading to variations in blood pool activity estimates. Consequently, quantitative agreements between radiotracer activity on PET-CT and PET-MRI were most consistent with RadialVIBE-2. CONCLUSION Ascending aortic microcalcification analysis in PET-MRI is feasible with comparable findings to PET-CT. RadialVIBE-2 tissue attenuation correction correlates best with the reference standard of PET-CT and is less susceptible to artefact. There remain challenges in segmenting tissue types in PET-MRI reconstructions, and improved attenuation correction methods are required.
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Affiliation(s)
- Jennifer Nash
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Samuel Debono
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Beth Whittington
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jakub Kaczynski
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Tim Clark
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Gillian Macnaught
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Scott Semple
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging Facility Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging Facility Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Adriana Tavares
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Damini Dey
- Departments of Medicine, Division of Artificial Intelligence) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA
| | - Michelle C Williams
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Piotr J Slomka
- Departments of Medicine, Division of Artificial Intelligence) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA
| | - David E Newby
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Alexander J Fletcher
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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3
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Nash J, Meah MN, Whittington B, Debono S, Raftis J, Miller MR, Sorbie A, Mills NL, Nespoux J, Bruce L, Duffin R, Dhaun N, Brittan M, Chao L, Merali S, Kim M, Wang Z, Zhang Y, Jin S, Wang B, Kozinn M, Newby DE. PAR4 Antagonism in Patients With Coronary Artery Disease Receiving Antiplatelet Therapies. Arterioscler Thromb Vasc Biol 2024. [PMID: 38357820 DOI: 10.1161/atvbaha.123.320448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND BMS-986141 is a novel potent highly selective antagonist of PAR (protease-activated receptor) type 4. PAR4 antagonism has been demonstrated to reduce thrombus formation in isolation and in combination with factor Xa inhibition in high shear conditions in healthy people. We sought to determine whether PAR4 antagonism had additive antithrombotic effects in patients with coronary artery disease who were receiving antiplatelet therapy. METHODS Forty-five patients with stable coronary heart disease and 10 healthy volunteers completed a phase 2a open-label 4-arm single-center study. Patients were allocated to 1 of 3 treatment arms for 7 days: (1) ticagrelor (90 mg BID), (2) aspirin (75 mg QD), or (3) the combination of ticagrelor and aspirin. Agonist-induced platelet aggregation, platelet activation, and ex vivo thrombus formation were measured before and 2 and 24 hours after a single oral 4-mg dose of BMS-986141 on the first study visit day in all participants. RESULTS BMS-986141 demonstrated highly selective inhibition of PAR4-AP (agonist peptide)-induced platelet aggregation, P-selectin expression, and platelet-monocyte aggregate expression (P≤0.001 for all), which were unaffected by concomitant antiplatelet therapies. PAR4 antagonism reduced ex vivo thrombus area in high shear conditions in healthy volunteers (-21%; P=0.001) and in patients receiving ticagrelor alone (-28%; P=0.001), aspirin alone (-23%; P=0.018), or both in combination (-24%; P≤0.001). Plasma concentration of BMS-986141 correlated with PAR4-AP-induced platelet responses (P≤0.001 for all) and total thrombus area under high shear stress conditions (P≤0.01 for all). CONCLUSIONS PAR4 antagonism has additive antithrombotic effects when used in addition to ticagrelor, aspirin, or their combination, in patients with stable coronary heart disease. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05093790.
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Affiliation(s)
- Jennifer Nash
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Mohammed N Meah
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Beth Whittington
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Samuel Debono
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Jennifer Raftis
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Mark R Miller
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Andrew Sorbie
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Nicholas L Mills
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Josselin Nespoux
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Lorraine Bruce
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Rodger Duffin
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Mairi Brittan
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Longfei Chao
- Clinical Pharmacology and Pharmacometrics, Bristol Myers Squibb, Lawrenceville, NJ. (L.C., S.M.)
| | - Samira Merali
- Clinical Pharmacology and Pharmacometrics, Bristol Myers Squibb, Lawrenceville, NJ. (L.C., S.M.)
| | - Minji Kim
- Translational Medicine, Bristol Myers Squibb, Lawrenceville, NJ. (M.K., Z.W.)
| | - Zhaoqing Wang
- Translational Medicine, Bristol Myers Squibb, Lawrenceville, NJ. (M.K., Z.W.)
| | - Yue Zhang
- Global Biometrics and Data Sciences, Bristol Myers Squibb, Lawrenceville, NJ. (Y.Z., S.J.)
| | - Shiqiang Jin
- Global Biometrics and Data Sciences, Bristol Myers Squibb, Lawrenceville, NJ. (Y.Z., S.J.)
| | - Beqing Wang
- WorldWide Patient Safety, Bristol Myers Squibb, Lawrenceville, NJ. (B.W.)
| | - Marc Kozinn
- Early Cardiovascular Clinical Development, R&D, Bristol Myers Squibb, Lawrenceville, NJ. (M.K.)
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
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Whittington B, Tzolos E, Bing R, Andrews J, Lucatelli C, MacAskill MG, Tavares AA, Clark T, Mills NL, Nash J, Dey D, Slomka PJ, Koglin N, Stephens AW, van Beek EJ, Smith C, Dweck MR, Williams MC, Whiteley W, Wardlaw JM, Newby DE. Noninvasive In Vivo Thrombus Imaging in Patients With Ischemic Stroke or Transient Ischemic Attack-Brief Report. Arterioscler Thromb Vasc Biol 2023; 43:1729-1736. [PMID: 37439259 PMCID: PMC10443628 DOI: 10.1161/atvbaha.122.318204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND 18F-GP1 is a novel positron-emitting radiotracer that is highly specific for activated platelets and thrombus. In a proof-of-concept study, we aimed to determine its potential clinical application in establishing the role and origin of thrombus in ischemic stroke. METHODS Eleven patients with recent ischemic stroke (n=9) or transient ischemic attack (n=2) underwent 18F-GP1 positron emission tomography and computed tomography angiography at a median of 11 (range, 2-21) days from symptom onset. 18F-GP1 uptake (maximum target-to-background ratio) was assessed in the carotid arteries and brain. RESULTS 18F-GP1 uptake was identified in 10 of 11 patients: 4 in the carotid arteries only, 3 in the brain only, and 3 in both the brain and carotid arteries. In those with carotid uptake, 4 participants had >50% stenosis and 3 had nonstenotic disease. One case had bilateral stenotic disease (>70%), but only the culprit carotid artery demonstrated 18F-GP1 uptake. The average uptake was higher in the culprit (median maximum target-to-background ratio, 1.55 [interquartile range, 1.26-1.82]) compared with the contralateral nonculprit carotid artery (maximum target-to-background ratio, 1.22 [1.19-1.6]). In those with brain 18F-GP1 uptake (maximum target-to-background ratio, 6.45 [4.89-7.65]), areas of acute infarction on computed tomography correlated with brain 18F-GP1 uptake in 6 cases. Ex vivo autoradiography of postmortem infarcted brain tissue showed focal uptake corresponding to intraluminal thrombus within the culprit vessel and downstream microvasculature. There was also evidence of diffuse uptake within some of the infarcted brain tissue reflecting parenchymal petechial hemorrhage. CONCLUSIONS 18F-GP1 positron emission tomography and computed tomography angiography is a novel noninvasive method of identifying in vivo cerebrovascular thrombosis, which holds major promise in understanding the role and origin of thrombosis in stroke. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03943966.
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Affiliation(s)
- Beth Whittington
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Rong Bing
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Jack Andrews
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Christophe Lucatelli
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
| | - Mark G. MacAskill
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
| | - Adriana A.S. Tavares
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
| | - Tim Clark
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
| | - Nicholas L. Mills
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
- Usher Institute (N.L.M.), University of Edinburgh, United Kingdom
| | - Jennifer Nash
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Department of Medicine, Division of Artificial Intelligence in Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA (D.D., P.J.S.)
| | - Piotr J. Slomka
- Department of Medicine, Division of Artificial Intelligence in Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, CA (D.D., P.J.S.)
| | - Norman Koglin
- Life Molecular Imaging GmbH, Berlin, Germany (N.K., A.W.S.)
| | | | - Edwin J.R. van Beek
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
| | - Colin Smith
- Division of Pathology (C.S.), University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
| | - Michelle C. Williams
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
| | - William Whiteley
- Centre for Clinical Brain Sciences (W.W., J.M.W.), University of Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences (W.W., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute Centre (J.M.W.), University of Edinburgh, United Kingdom
| | - David E. Newby
- BHF Centre for Cardiovascular Science (B.W., E.T., R.B., J.A., M.G.M., A.A.S.T., N.L.M., J.N., E.J.R.v.B., M.R.D., M.C.W., D.E.N.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queen’s Medical Research Institute, United Kingdom (C.L., M.G.M., A.A.S.T., T.C., E.J.R.v.B., M.R.D., M.C.W., D.E.N.)
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Whittington B, Dweck MR, van Beek EJR, Newby D, Williams MC. PET-MRI of Coronary Artery Disease. J Magn Reson Imaging 2023; 57:1301-1311. [PMID: 36524452 DOI: 10.1002/jmri.28554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Simultaneous positron emission tomography and magnetic resonance imaging (PET-MRI) combines the anatomical detail and tissue characterization of MRI with the functional information from PET. Within the coronary arteries, this hybrid technique can be used to identify biological activity combined with anatomically high-risk plaque features to better understand the processes underlying coronary atherosclerosis. Furthermore, the downstream effects of coronary artery disease on the myocardium can be characterized by providing information on myocardial perfusion, viability, and function. This review will describe the current capabilities of PET-MRI in coronary artery disease and discuss the limitations and future directions of this emerging technique. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Beth Whittington
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | | | - David Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
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Whittington B, Tzolos E, Williams MC, Dweck MR, Newby DE. Imaging of intracoronary thrombus. Heart 2023; 109:740-747. [PMID: 36549679 DOI: 10.1136/heartjnl-2022-321361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
The identification of intracoronary thrombus and atherothrombosis is central to the diagnosis of acute myocardial infarction, with the differentiation between type 1 and type 2 myocardial infarction being crucial for immediate patient management. Invasive coronary angiography has remained the principal imaging modality used in the investigation of patients with myocardial infarction. More recently developed invasive intravascular imaging approaches, such as angioscopy, intravascular ultrasound and optical coherence tomography, can be used as adjunctive imaging modalities to provide more direct visualisation of coronary atheroma and the causes of myocardial infarction as well as to improve the sensitivity of thrombus detection. However, these invasive approaches have practical and logistic constraints that limit their widespread and routine application. Non-invasive angiographic techniques, such as CT and MRI, have become more widely available and have improved the non-invasive visualisation of coronary artery disease. Although they also have a limited ability to reliably identify intracoronary thrombus, this can be overcome by combining their anatomical and structural characterisation of coronary anatomy with positron emission tomography. Specific radiotracers which bind with high specificity and sensitivity to components of thrombus, such as activated platelets, fibrin and factor XIIIa, hold promise for the non-invasive detection of intracoronary thrombus. The development of these novel non-invasive approaches has the potential to inform clinical decision making and patient management as well as to provide a non-invasive technique to assess the efficacy of novel antithrombotic therapies or interventional strategies. However, these have yet to be realised in routine clinical practice.
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Affiliation(s)
- Beth Whittington
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, UK
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Hustler K, Whittington B, Martin Z. A novel hunting method for banded kōkopu. New Zealand Journal of Zoology 2015. [DOI: 10.1080/03014223.2015.1071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- K Hustler
- Biology Department, Northcote College, Kauri Glen Road, Northcote, Auckland, New Zealand
| | - B Whittington
- Biology Department, Northcote College, Kauri Glen Road, Northcote, Auckland, New Zealand
| | - Z Martin
- Biology Department, Northcote College, Kauri Glen Road, Northcote, Auckland, New Zealand
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Conn CE, Bythell-Douglas R, Neumann D, Yoshida S, Whittington B, Westwood JH, Shirasu K, Bond CS, Dyer KA, Nelson DC. Convergent evolution of strigolactone perception enabled host detection in parasitic plants. Science 2015; 349:540-3. [DOI: 10.1126/science.aab1140] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Scarlett NVY, Madsen I, Whittington B. In-situX-ray diffraction studies into pressure acid leaching of lateritic ores. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305095644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Whittington B. Vehicle exhaust catalysis: I. The relative importance of catalytic oxidation, steam reforming and water-gas shift reactions. Catal Today 1995. [DOI: 10.1016/0920-5861(95)00093-u] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Whittington B. Vehicle exhaust catalysis. II: The effect of traces of sulphur dioxide on the performance of three-way vehicle emission catalysts. Catal Today 1995. [DOI: 10.1016/0920-5861(95)00094-v] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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