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Zhou S, Qiao Y, Zhou X, Wasserman BA, Caughey MC. Detection of Dolichoectasia and Atherosclerosis by Automated MRA Tortuosity Metrics in a Population-Based Study. J Magn Reson Imaging 2024; 59:1612-1619. [PMID: 37515312 DOI: 10.1002/jmri.28923] [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: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Intracranial vessel tortuosity is a key component of dolichoectasia and has been associated with atherosclerosis and adverse neurologic outcomes. However, the evaluation of tortuosity is mainly a descriptive assessment. PURPOSE To compare the performance of three automated tortuosity metrics (angle metric [AM], distance metric [DM], and distance-to-axis metric [DTA]) for detection of dolichoectasia and presence of segment-specific plaques. STUDY TYPE Observational, cross-sectional metric assessment. POPULATION 1899 adults from the general population; mean age = 76 years, female = 59%, and black = 29%. FIELD STRENGTH/SEQUENCE 3-T, three-dimensional (3D) time-of-flight MRA and 3D vessel wall MRI. ASSESSMENT Tortuosity metrics and mean luminal area were quantified for designated segments of the internal carotid artery, middle cerebral artery, anterior cerebral artery, posterior cerebral artery, vertebral artery, and entire length of basilar artery (BA). Qualitative interpretations of BA dolichoectasia were assessed based on Smoker's visual criteria. STATISTICAL TESTS Descriptive statistics (2-sample t-tests, Pearson chi-square tests) for group comparisons. Receiver operating characteristics area under the curve (AUC) for detection of BA dolichoectasia or segment-specific plaque. Model inputs included 1) tortuosity metrics, 2) mean luminal area, and 3) demographics (age, race, and sex). RESULTS Qualitative dolichoectasia was identified in 336 (18%) participants, and atherosclerotic plaques were detected in 192 (10%) participants. AM-, DM-, and DTA-calculated tortuosity were good individual discriminators of basilar dolichoectasia (AUCs: 0.76, 0.74, and 0.75, respectively), with model performance improving with the mean lumen area: (AUCs: 0.88, 0.87, and 0.87, respectively). Combined characteristics (tortuosity and mean luminal area) identified plaques with better performance in the anterior (AUCs ranging from 0.66 to 0.78) than posterior (AUCs ranging from 0.54 to 0.65) circulation, with all models improving by the addition of demographics (AUCs ranging from 0.62 to 0.84). DATA CONCLUSION Quantitative vessel tortuosity metrics yield good diagnostic accuracy for the detection of dolichoectasia. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Shang Zhou
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Xinwei Zhou
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
- Department of Radiology, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa C Caughey
- Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA
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Xiao J, Poblete RA, Lerner A, Nguyen PL, Song JW, Sanossian N, Wilcox AG, Song SS, Lyden PD, Saver JL, Wasserman BA, Fan Z. MRI in the Evaluation of Cryptogenic Stroke and Embolic Stroke of Undetermined Source. Radiology 2024; 311:e231934. [PMID: 38652031 DOI: 10.1148/radiol.231934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Cryptogenic stroke refers to a stroke of undetermined etiology. It accounts for approximately one-fifth of ischemic strokes and has a higher prevalence in younger patients. Embolic stroke of undetermined source (ESUS) refers to a subgroup of patients with nonlacunar cryptogenic strokes in whom embolism is the suspected stroke mechanism. Under the classifications of cryptogenic stroke or ESUS, there is wide heterogeneity in possible stroke mechanisms. In the absence of a confirmed stroke etiology, there is no established treatment for secondary prevention of stroke in patients experiencing cryptogenic stroke or ESUS, despite several clinical trials, leaving physicians with a clinical dilemma. Both conventional and advanced MRI techniques are available in clinical practice to identify differentiating features and stroke patterns and to determine or infer the underlying etiologic cause, such as atherosclerotic plaques and cardiogenic or paradoxical embolism due to occult pelvic venous thrombi. The aim of this review is to highlight the diagnostic utility of various MRI techniques in patients with cryptogenic stroke or ESUS. Future trends in technological advancement for promoting the adoption of MRI in such a special clinical application are also discussed.
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Affiliation(s)
- Jiayu Xiao
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Roy A Poblete
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Alexander Lerner
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Peggy L Nguyen
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Jae W Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Nerses Sanossian
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Alison G Wilcox
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Shlee S Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Patrick D Lyden
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Jeffrey L Saver
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Bruce A Wasserman
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
| | - Zhaoyang Fan
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
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Peter-Marske KM, Meyer M, Tanaka H, Kucharska-Newton A, Wei J, Wasserman BA, Hughes T, Qiao Y, Palta P. Central arterial stiffening and intracranial atherosclerosis: the atherosclerosis risk in communities neurocognitive study (ARIC-NCS): Aortic stiffness & intracranial atherosclerosis. J Stroke Cerebrovasc Dis 2024; 33:107477. [PMID: 37966097 PMCID: PMC10843842 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107477] [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: 07/17/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Previous studies suggest an association between central arterial stiffness (CAS) and intracranial atherosclerotic disease (ICAD) among Asian participants with stroke or hypertension; this association has not been evaluated in United States populations. We assessed the cross-sectional association of CAS with ICAD presence and burden in late-life, and differences in association by age, sex, and race. MATERIALS AND METHODS We conducted a cross-sectional analysis of 1,285 Atherosclerosis Risk in Communities Study participants [mean age 75 (standard deviation: 5) years, 38 % male, 20 % Black] at Visit 5 (2011-2013). CAS was measured as carotid-femoral pulse wave velocity (cfPWV) using the Omron VP-1000 Plus. ICAD was assessed using high-resolution vessel wall MRI and MR angiography. We evaluated associations of a 1 standard deviation (SD) cfPWV (3.02 m/s) and high vs. non-high cfPWV (≥ 13.57 m/s vs. < 13.57 m/s) with presence of plaques (yes/no) and plaque number (0, 1-2, and >2) using multivariable logistic and ordinal logistic regression models adjusted for covariates. RESULTS Each one SD greater cfPWV was associated with higher odds of plaque presence (odds ratio (OR)=1.32, 95 % confidence interval (CI): 1.22, 1.43), and an incrementally higher odds of number of plaques (OR 1-2 vs. 0 plaques = 1.21, 95 % CI: 1.10, 1.33; OR >2 vs. 0 plaques = 1.51, 95 % CI: 1.33,1.71). Results suggested differences by race, with greater magnitude associations among Black participants. CONCLUSIONS CAS was positively associated with ICAD presence and burden; cfPWV may be a useful subclinical vascular measure for identification of individuals who are at high risk for cerebrovascular disease.
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Affiliation(s)
- Kennedy M Peter-Marske
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Michelle Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bruce A Wasserman
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Timothy Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Ye Qiao
- The Russel H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins, University School of Medicine, Baltimore, MD, United States
| | - Priya Palta
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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4
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Saba L, Cau R, Murgia A, Nicolaides AN, Wintermark M, Castillo M, Staub D, Kakkos SK, Yang Q, Paraskevas KI, Yuan C, Edjlali M, Sanfilippo R, Hendrikse J, Johansson E, Mossa-Basha M, Balu N, Dichgans M, Saloner D, Bos D, Jager HR, Naylor R, Faa G, Suri JS, Costello J, Auer DP, Mcnally JS, Bonati LH, Nardi V, van der Lugt A, Griffin M, Wasserman BA, Kooi ME, Gillard J, Lanzino G, Mikhailidis DP, Mandell DM, Benson JC, van Dam-Nolen DHK, Kopczak A, Song JW, Gupta A, DeMarco JK, Chaturvedi S, Virmani R, Hatsukami TS, Brown M, Moody AR, Libby P, Schindler A, Saam T. Carotid Plaque-RADS: A Novel Stroke Risk Classification System. JACC Cardiovasc Imaging 2024; 17:62-75. [PMID: 37823860 DOI: 10.1016/j.jcmg.2023.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Carotid artery atherosclerosis is highly prevalent in the general population and is a well-established risk factor for acute ischemic stroke. Although the morphological characteristics of vulnerable plaques are well recognized, there is a lack of consensus in reporting and interpreting carotid plaque features. OBJECTIVES The aim of this paper is to establish a consistent and comprehensive approach for imaging and reporting carotid plaque by introducing the Plaque-RADS (Reporting and Data System) score. METHODS A panel of experts recognized the necessity to develop a classification system for carotid plaque and its defining characteristics. Using a multimodality analysis approach, the Plaque-RADS categories were established through consensus, drawing on existing published reports. RESULTS The authors present a universal classification that is applicable to both researchers and clinicians. The Plaque-RADS score offers a morphological assessment in addition to the prevailing quantitative parameter of "stenosis." The Plaque-RADS score spans from grade 1 (indicating complete absence of plaque) to grade 4 (representing complicated plaque). Accompanying visual examples are included to facilitate a clear understanding of the Plaque-RADS categories. CONCLUSIONS Plaque-RADS is a standardized and reliable system of reporting carotid plaque composition and morphology via different imaging modalities, such as ultrasound, computed tomography, and magnetic resonance imaging. This scoring system has the potential to help in the precise identification of patients who may benefit from exclusive medical intervention and those who require alternative treatments, thereby enhancing patient care. A standardized lexicon and structured reporting promise to enhance communication between radiologists, referring clinicians, and scientists.
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Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy.
| | - Riccardo Cau
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | - Andrew N Nicolaides
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniel Staub
- Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Myriam Edjlali
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, CEA, CNRS, Inserm, Frédéric Joliot Hospital Department, Orsay, France; Department of Radiology, APHP, Paris, France
| | | | | | - Elias Johansson
- Clinical Science, Umeå University, Neurosciences, Umeå, Sweden
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Rolf Jager
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | - Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester, United Kingdom
| | - Gavino Faa
- Department of Pathology, University of Cagliari, Cagliari, Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoin, Roseville, California, USA
| | - Justin Costello
- Department of Neuroradiology, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, and NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - J Scott Mcnally
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maura Griffin
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus
| | - Bruce A Wasserman
- Department of Radiology, University of Maryland School of Medicine and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Eline Kooi
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London School, University College London, London, United Kingdom
| | - Daniel M Mandell
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - John C Benson
- Department of Radiology Mayo Clinic, Rochester, Minnesota, USA
| | - Dianne H K van Dam-Nolen
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ajay Gupta
- Department of Radiology Weill Cornell Medical College, New York, New York, USA
| | - J Kevin DeMarco
- Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, Maryland, USA
| | | | - Martin Brown
- Department of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas Schindler
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Saam
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Die Radiologie, Rosenheim, Germany
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5
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Del Brutto VJ, Khasiyev F, Liu M, Spagnolo-Allende A, Qiao Y, Melgarejo Arias JD, Guzman VA, Igwe KC, Sanchez DL, Andrews H, Morales CD, Farrell MT, Bassil DT, Seshadri S, Wagner RG, Mngomezulu V, Manly J, Elkind MS, Berkman L, Romero JR, Maestre GE, Del Brutto OH, Brickman AM, Venketasubramanian N, Chen C, Robert C, Hilal S, Rundek T, Wasserman BA, Gutierrez J. Association of brain arterial diameters with demographic and anatomical factors in a multi-national pooled analysis of cohort studies. Neuroradiol J 2023:19714009231224429. [PMID: 38148489 DOI: 10.1177/19714009231224429] [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] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Brain arterial diameters are markers of cerebrovascular disease. Demographic and anatomical factors may influence arterial diameters. We hypothesize that age, sex, height, total cranial volume (TCV), and persistent fetal posterior cerebral artery (fPCA) correlate with brain arterial diameters across populations. METHODS Participants had a time-of-flight MRA from nine international cohorts. Arterial diameters of the cavernous internal carotid arteries (ICA), middle cerebral arteries (MCA), and basilar artery (BA) were measured using LAVA software. Regression models assessed the association between exposures and brain arterial diameters. RESULTS We included 6,518 participants (mean age: 70 ± 9 years; 41% men). Unilateral fPCA was present in 13.2% and bilateral in 3.2%. Larger ICA, MCA, and BA diameters correlated with older age (Weighted average [WA] per 10 years: 0.18 mm, 0.11 mm, and 0.12 mm), male sex (WA: 0.24 mm, 0.13 mm, and 0.21 mm), and TCV (WA: for one TCV standard deviation: 0.24 mm, 0.29 mm, and 0.18 mm). Unilateral and bilateral fPCAs showed a positive correlation with ICA diameters (WA: 0.39 mm and 0.73 mm) and negative correlation with BA diameters (WA: -0.88 mm and -1.73 mm). Regression models including age, sex, TCV, and fPCA explained on average 15%, 13%, and 25% of the ICA, MCA, and BA diameter interindividual variation, respectively. Using height instead of TCV as a surrogate of head size decreased the R-squared by 3% on average. CONCLUSION Brain arterial diameters correlated with age, sex, TCV, and fPCA. These factors should be considered when defining abnormal diameter cutoffs across populations.
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Affiliation(s)
| | | | | | | | - Ye Qiao
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | - Meagan T Farrell
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Darina T Bassil
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | | | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Lisa Berkman
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | | | - Gladys E Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
- Institute of Neuroscience, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | | | | | | | - Christopher Chen
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
| | - Caroline Robert
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Bruce A Wasserman
- Johns Hopkins University, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
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Liu M, Khasiyev F, Sariya S, Spagnolo‐Allende A, Sanchez DL, Andrews H, Yang Q, Beiser A, Qiao Y, Thomas EA, Romero JR, Rundek T, Brickman AM, Manly JJ, Elkind MSV, Seshadri S, Chen C, Hilal S, Wasserman BA, Tosto G, Fornage M, Gutierrez J. Chromosome 10q24.32 Variants Associate With Brain Arterial Diameters in Diverse Populations: A Genome-Wide Association Study. J Am Heart Assoc 2023; 12:e030935. [PMID: 38038215 PMCID: PMC10727334 DOI: 10.1161/jaha.123.030935] [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: 05/19/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Brain arterial diameters (BADs) are novel imaging biomarkers of cerebrovascular disease, cognitive decline, and dementia. Traditional vascular risk factors have been associated with BADs, but whether there may be genetic determinants of BADs is unknown. METHODS AND RESULTS The authors studied 4150 participants from 6 geographically diverse population-based cohorts (40% European, 14% African, 22% Hispanic, 24% Asian ancestries). Brain arterial diameters for 13 segments were measured and averaged to obtain a global measure of BADs as well as the posterior and anterior circulations. A genome-wide association study revealed 14 variants at one locus associated with global BAD at genome-wide significance (P<5×10-8) (top single-nucleotide polymorphism, rs7921574; β=0.06 [P=1.54×10-8]). This locus mapped to an intron of CNNM2. A trans-ancestry genome-wide association study meta-analysis identified 2 more loci at NT5C2 (rs10748839; P=2.54×10-8) and AS3MT (rs10786721; P=4.97×10-8), associated with global BAD. In addition, 2 single-nucleotide polymorphisms colocalized with expression of CNNM2 (rs7897654; β=0.12 [P=6.17×10-7]) and AL356608.1 (rs10786719; β=-0.17 [P=6.60×10-6]) in brain tissue. For the posterior BAD, 2 variants at one locus mapped to an intron of TCF25 were identified (top single-nucleotide polymorphism, rs35994878; β=0.11 [P=2.94×10-8]). For the anterior BAD, one locus at ADAP1 was identified in trans-ancestry genome-wide association analysis (rs34217249; P=3.11×10-8). CONCLUSIONS The current study reveals 3 novel risk loci (CNNM2, NT5C2, and AS3MT) associated with BADs. These findings may help elucidate the mechanism by which BADs may influence cerebrovascular health.
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Affiliation(s)
- Minghua Liu
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Farid Khasiyev
- Department of NeurologySaint Louis University School of MedicineSt. LouisMOUSA
| | - Sanjeev Sariya
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Antonio Spagnolo‐Allende
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Danurys L Sanchez
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Howard Andrews
- Biostatistics Department, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Qiong Yang
- Department of Biostatistics, School of Public HealthBoston UniversityBostonMAUSA
| | - Alexa Beiser
- Department of Biostatistics, School of Public HealthBoston UniversityBostonMAUSA
| | - Ye Qiao
- Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Emy A Thomas
- Brown Foundation Institute of Molecular Medicine, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | | | - Tatjana Rundek
- Department of NeurologyUniversity of Miami Miller School of MedicineMiamiFLUSA
- Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFLUSA
- Evelyn F. McKnight Brain InstituteUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Adam M Brickman
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Jennifer J Manly
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Mitchell SV Elkind
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Sudha Seshadri
- Department of NeurologyBoston University School of MedicineBostonMAUSA
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUniversity of Texas Health Sciences CenterSan AntonioTXUSA
| | - Christopher Chen
- Memory Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Saima Hilal
- Memory Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Bruce A Wasserman
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- University of Maryland School of MedicineBaltimoreMDUSA
| | - Giuseppe Tosto
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTXUSA
- Human Genetics Center, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
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Yang W, Sam K, Qiao Y, Huang Z, Steinman DA, Wasserman BA. A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro-Occipital Venous Plexus. J Am Heart Assoc 2023; 12:e031832. [PMID: 37830353 PMCID: PMC10757507 DOI: 10.1161/jaha.123.031832] [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: 07/20/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
Background Adaptive arterial remodeling caused by flow reduction from downstream stenosis has been demonstrated in animal studies. The authors sought to determine whether inward remodeling from downstream stenosis also occurs in humans and is detectable by ex vacuo expansion of the Rektorzik venous plexus (RVP) surrounding the petrous internal carotid artery. Methods and Results The authors analyzed 214 intracranial magnetic resonance imaging examinations that included contrast-enhanced vessel wall imaging. RVP symmetry was qualitatively assessed on vessel wall imaging. RVP thickness (RVPT) was measured on the thicker side if asymmetric or randomly assigned side if symmetric. Maximum stenosis (M1 or intracranial internal carotid artery) was measured. Posterior communicating artery and A1 diameters (>1.0 mm and 1.5 mm, respectively) defined adequate collateral outflow when proximal to the stenosis. Seventy-two patients had stenosis downstream from RVPT measurements. For those without adequate outflow (38 of 72), 95.0% with RVPT ≥1.0 mm had ≥50% stenosis compared with only 5.6% with RVPT <1.0 mm. For these 72 patients, higher RVPT (RVPT ≥1.0 mm versus <1.0 mm) and absent adequate outflow were associated with greater downstream stenosis (P<0.001) using multivariate regression. For patients with downstream stenosis without adequate outflow, asymmetric RVP thickening was associated with greater ipsilateral stenosis (P<0.001, all had ≥46% stenosis) when stenosis was unilateral and greater differences in stenosis between sides (P=0.005) when stenosis was bilateral. Conclusions Inward internal carotid artery remodeling measured by RVPT or RVP asymmetry occurs as downstream stenosis approaches 50%, unless flow is preserved through a sufficiently sized posterior communicating artery or A1, and may serve as a functional measure of substantial flow reduction from downstream stenosis.
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Affiliation(s)
- Wenjie Yang
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Kevin Sam
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Ye Qiao
- Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins School of MedicineBaltimoreMD
| | - Zhongqing Huang
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - David A. Steinman
- Department of Mechanical & Industrial EngineeringUniversity of TorontoCanada
| | - Bruce A. Wasserman
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
- Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins School of MedicineBaltimoreMD
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8
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Liu M, Khasiyev F, Sariya S, Spagnolo-Allende A, Sanchez DL, Andrews H, Yang Q, Beiser A, Qiao Y, Thomas EA, Romero JR, Rundek T, Brickman AM, Manly JJ, Elkind MSV, Seshadri S, Chen C, Sacco RL, Hilal S, Wasserman BA, Tosto G, Fornage M, Gutierrez J. Chromosome 10q24.32 Variants Associate with Brain Arterial Diameters in Diverse Populations: A Genome-Wide Association Study. medRxiv 2023:2023.01.31.23285251. [PMID: 36778463 PMCID: PMC9915818 DOI: 10.1101/2023.01.31.23285251] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Brain arterial diameters are novel imaging biomarkers of cerebrovascular disease, cognitive decline and dementia. Traditional vascular risk factors have been associated with brain arterial diameters but whether there may be genetic determinants of brain arterial diameters is unknown. Results We studied 4150 participants from six geographically diverse population-based cohorts (40% European, 14% African, 22% Hispanic, 24% Asian ancestries). We measured brain arterial diameters for 13 segments and averaged them to obtain a global measure of brain arterial diameters as well as the posterior and anterior circulations. A genome-wide association study (GWAS) revealed 14 variants at one locus associated with global brain arterial diameter at genome-wide significance (P<5×10-8) (top SNP, rs7921574; β =0.06, P=1.54×10-8). This locus mapped to an intron of CNNM2. A trans-ancestry GWAS meta-analysis identified two more loci at NT5C2 (rs10748839; P=2.54×10-8) and at AS3MT (rs10786721; P=4.97×10-8), associated with global brain arterial diameter. In addition, two SNPs co-localized with expression of CNNM2 (rs7897654, β=0.12, P=6.17×10-7) and AL356608.1 (rs10786719, β =-0.17, P=6.60×10-6) in brain tissue. For the posterior brain arterial diameter, two variants at one locus mapped to an intron of TCF25 were identified (top SNP, rs35994878; β =0.11, P=2.94×10-8). For the anterior brain arterial diameter, one locus at ADAP1 was identified in trans-ancestry genome-wide association analysis (rs34217249; P=3.11×10-8). Conclusion Our study reveals three novel risk loci (CNNM2, NT5C2 and AS3MT) associated with brain arterial diameters. Our finding may elucidate the mechanisms by which brain arterial diameters influence the risk of stroke and dementia.
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Affiliation(s)
- Minghua Liu
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Sanjeev Sariya
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Antonio Spagnolo-Allende
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Danurys L Sanchez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Howard Andrews
- Biostatistics Department, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Qiong Yang
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Alexa Beiser
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Ye Qiao
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emy A Thomas
- Brown Foundation Institute of Molecular Medicine, Mc Govern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jose Rafael Romero
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adam M Brickman
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jennifer J Manly
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mitchell SV Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sudha Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Christopher Chen
- Memory Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Saima Hilal
- Memory Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bruce A Wasserman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Giuseppe Tosto
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, Mc Govern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Logue M, McCain C, Martin C, Suri F, Wasserman BA, Gottesman RF, Rosamond WD, Sen S. Abstract 135: Adiponectin: Potential Mediator Between Central Obesity And Intracranial Atherosclerosis? Stroke 2023. [DOI: 10.1161/str.54.suppl_1.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Prior studies have identified a significant association between Waist-to-Hip Ratio (WHR) and intracranial atherosclerosis (ICAS). Adiponectin, a hormone that improves insulin sensitivity, has been hypothesized to have a protective effect against atherosclerosis. We assessed the association between central obesity-ICAS, and its potential mediation by Adiponectin.
Methods:
In the ARIC cohort a stratified subset of subjects were assessed for adiposity, adiponectin level and ICAS during visit 5 (2011-2013). Adiposity was assessed by body mass index (BMI) and waist to hip ratio (WHR). Central obesity was defined as WHR ≥0.90 for men and ≥0.85 for women. Plasma total and total adiponectin were measured by ELISA. ICAS was assessed for by 3D time-of-flight magnetic resonance angiogram (MRA). Subjects were stratified as those with any ICAS and those without. Multivariable analysis was conducted using multiple logistic regression to test the central obesity-ICAS association.
Results:
A total of 1641 subjects underwent evaluations (age 76.3±5.3, 41% Male, 71% white). Of these subjects 506 (31%) had ICAS detected on MRA. Those with ICAS were older (77±5 vs. 76±5, p<0.001), likely to be male (47% vs. 39%, p=0.001), African American (33% vs. 27%, p=0.006) and hypertensive (72% vs. 64%, p=0.004). Those with ICAS had similar BMI (28.5±5.7 vs. 28.1±5.3, p=0.26) although the WHR was higher (0.94±0.08 vs. 0.92±0.08, p<0.001). Adiponectin levels were lower (10.6±6.7 vs. 12.0±7.5, p<0.001) compared with those without ICAS. Those with central obesity had a lower level of Adiponectin (10.6±6.5 vs. 15.3±8.7, p<0.001). Central obesity was significantly (p=0.01) associated with ICAS (Odds Ratio 1.43, 95%) CI 1.08-1.91) adjusted for age, race, gender, and hypertension, however lost its significance (p=0.06) when Adiponectin is added to the model (Odds Ratio 1.33, 95% CI 0.99-1.80).
Conclusion:
We report a significant inverse association between central obesity, as well as ICAS, with Adiponectin levels. We also report a significant association between central obesity with ICAS that loses its significance after adding Adiponectin to the multivariate model. This result suggests that central obesity effect on ICAS may possibly be mediated by Adiponectin.
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Affiliation(s)
| | | | | | - Fareed Suri
- CentraCare Neurosciences Stroke Cntr, Saint Cloud, MN
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Mossa-Basha M, Yuan C, Wasserman BA, Mikulis DJ, Hatsukami TS, Balu N, Gupta A, Zhu C, Saba L, Li D, DeMarco JK, Lehman VT, Qiao Y, Jager HR, Wintermark M, Brinjikji W, Hess CP, Saloner DA. Survey of the American Society of Neuroradiology Membership on the Use and Value of Extracranial Carotid Vessel Wall MRI. AJNR Am J Neuroradiol 2022; 43:1756-1761. [PMID: 36423951 DOI: 10.3174/ajnr.a7720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Extracranial vessel wall MRI (EC-VWI) contributes to vasculopathy characterization. This survey study investigated EC-VWI adoption by American Society of Neuroradiology (ASNR) members and indications and barriers to implementation. MATERIALS AND METHODS The ASNR Vessel Wall Imaging Study Group survey on EC-VWI use, frequency, applications, MR imaging systems and field strength used, protocol development approaches, vendor engagement, reasons for not using EC-VWI, ordering provider interest, and impact on clinical care was distributed to the ASNR membership between April 2, 2019, to August 30, 2019. RESULTS There were 532 responses; 79 were excluded due to minimal, incomplete response and 42 due to redundant institutional responses, leaving 411 responses. Twenty-six percent indicated that their institution performed EC-VWI, with 66.3% performing it ≤1-2 times per month, most frequently on 3T MR imaging, with most using combined 3D and 2D protocols. Protocols most commonly included pre- and postcontrast T1-weighted imaging, TOF-MRA, and contrast-enhanced MRA. Inflammatory vasculopathy (63.3%), plaque vulnerability assessments (61.1%), intraplaque hemorrhage (61.1%), and dissection-detection/characterization (51.1%) were the most frequent applications. For those not performing EC-VWI, the reasons were a lack of ordering provider interest (63.9%), lack of radiologist time/interest (47.5%) or technical support (41.4%) for protocol development, and limited interpretation experience (44.9%) and knowledge of clinical applications (43.7%). Reasons given by 46.9% were that no providers approached radiology with interest in EC-VWI. If barriers were overcome, 51.1% of those not performing EC-VWI indicated they would perform it, and 40.6% were unsure; 48.6% did not think that EC-VWI had impacted patient management at their institution. CONCLUSIONS Only 26% of neuroradiology groups performed EC-VWI, most commonly due to limited clinician interest. Improved provider and radiologist education, protocols, processing techniques, technical support, and validation trials could increase adoption.
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Affiliation(s)
- M Mossa-Basha
- From the Department of Radiology (M.M.-B.), University of North Carolina, Chapel Hill, North Carolina .,Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - C Yuan
- Department of Radiology (C.Y.), University of Utah, Salt Lake City, Utah
| | - B A Wasserman
- Department of Radiology (B.A.W.), University of Maryland, Baltimore, Maryland.,Department of Radiology (B.A.W., Y.Q.), Johns Hopkins University, Baltimore, Maryland
| | - D J Mikulis
- Joint Department of Medical Imaging (D.J.M.), The University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - A Gupta
- Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - C Zhu
- Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - L Saba
- Department of Radiology (L.S.), University of Cagliari, Cagliari, Sardinia, Italy
| | - D Li
- Biomedical Imaging Research Institute (D.L.), Cedars-Sinai Medical Center, Los Angeles, California
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - V T Lehman
- Department of Radiology (V.T.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - Y Qiao
- Department of Radiology (B.A.W., Y.Q.), Johns Hopkins University, Baltimore, Maryland
| | - H R Jager
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London, Queen Square Institute of Neurology, London, UK
| | - M Wintermark
- Department of Neuroradiology (M.W.), MD Anderson Cancer Institute, Houston, Texas
| | - W Brinjikji
- Department of Radiology (V.T.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - C P Hess
- Department of Radiology and Biomedical Imaging (C.P.H., D.A.S.), University of California, San Francisco, San Francisco, California
| | - D A Saloner
- Department of Radiology and Biomedical Imaging (C.P.H., D.A.S.), University of California, San Francisco, San Francisco, California
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11
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Mossa-Basha M, Zhu C, Yuan C, Saba L, Saloner DA, Edjlali M, Stence NV, Mandell DM, Romero JM, Qiao Y, Mikulis DJ, Wasserman BA. Survey of the American Society of Neuroradiology Membership on the Use and Value of Intracranial Vessel Wall MRI. AJNR Am J Neuroradiol 2022; 43:951-957. [PMID: 35710122 DOI: 10.3174/ajnr.a7541] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/22/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial vessel wall MR imaging is an emerging technique for intracranial vasculopathy assessment. Our aim was to investigate intracranial vessel wall MR imaging use by the American Society of Neuroradiology (ASNR) members at their home institutions, including indications and barriers to implementation. MATERIALS AND METHODS The ASNR Vessel Wall Imaging Study Group survey on vessel wall MR imaging use, frequency, applications, MR imaging systems and field strength used, protocol development approaches, vendor engagement, reasons for not using vessel wall MR imaging, ordering-provider interest, and impact on clinical care, was distributed to the ASNR membership between April 2 and August 30, 2019. RESULTS There were 532 responses; 79 were excluded due to nonresponse and 42 due to redundant institutional responses, leaving 411 responses. Fifty-two percent indicated that their institution performs vessel wall MR imaging, with 71.5% performed at least 1-2 times/month, most frequently on 3T MR imaging, and 87.7% using 3D sequences. Protocols most commonly included were T1-weighted pre- and postcontrast and TOF-MRA; 60.6% had limited contributions from vendors or were still in protocol development. Vasculopathy differentiation (94.4%), cryptogenic stroke (41.3%), aneurysm (38.0%), and atherosclerosis (37.6%) evaluation were the most common indications. For those not performing vessel wall MR imaging, interpretation (53.1%) or technical (46.4%) expertise, knowledge of applications (50.5%), or limitations of clinician (56.7%) or radiologist (49.0%) interest were the most common reasons. If technical/expertise obstacles were overcome, 56.4% of those not performing vessel wall MR imaging indicated that they would perform it. Ordering providers most frequently inquiring about vessel wall MR imaging were from stroke neurology (56.5%) and neurosurgery (25.1%), while 34.3% indicated that no providers had inquired. CONCLUSIONS More than 50% of neuroradiology groups use vessel wall MR imaging for intracranial vasculopathy characterization and differentiation, emphasizing the need for additional technical and educational support, especially as clinical vessel wall MR imaging implementation continues to grow.
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Affiliation(s)
- M Mossa-Basha
- From the Department of Radiology (M.M.-B.), University of North Carolina, Chapel Hill, North Carolina .,Department of Radiology (M.M.-B., C.Z.), University of Washington, Seattle, Washington
| | - C Zhu
- Department of Radiology (M.M.-B., C.Z.), University of Washington, Seattle, Washington
| | - C Yuan
- Department of Radiology (C.Y.), University of Utah, Salt Lake City, Utah
| | - L Saba
- University of Cagliari (L.S.), Cagliari, Sardinia, Italy
| | - D A Saloner
- Department of Radiology and Biomedical Imaging (D.A.S.), University of California San Francisco, San Francisco, California
| | - M Edjlali
- Department of Radiology (M.E.), AP-HP, Laboratoire d'imagerie Biomédicale Multimodale (BioMaps), Paris-Saclay University, Paris, France
| | - N V Stence
- Department of Radiology (N.V.S.), Children's Hospital of Colorado, Aurora, Colorado
| | - D M Mandell
- Joint Department of Medical Imaging (D.M.M., D.J.M.), University Health Network, Toronto, Ontario, Canada
| | - J M Romero
- Department of Radiology (J.M.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - Y Qiao
- Department of Radiology (Y.Q., B.A.W.), Johns Hopkins University, Baltimore, Maryland
| | - D J Mikulis
- Joint Department of Medical Imaging (D.M.M., D.J.M.), University Health Network, Toronto, Ontario, Canada
| | - B A Wasserman
- Department of Radiology (Y.Q., B.A.W.), Johns Hopkins University, Baltimore, Maryland.,Department of Radiology (B.A.W.), University of Maryland, Baltimore, Maryland
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12
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Liu M, Khasiyev F, Wasserman BA, Qiao Y, Thomas EA, Elkind MS, Sacco RL, Rundek T, Tosto G, Sariya S, Hilal S, Seshadri S, Romero JR, Yang Q, Fornage M, Gutierrez J. Abstract WP205: Trans-ethnic Genome-wide Association Studies Meta-analysis Of Large Brain Arterial Diameters Identifies Two Novel Genetic Loci. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Larger brain arterial diameters, which may be a consequence of connective tissue disorders or hypertension, are associated with mortality, cognitive decline and risk of dementia. Whether there may be genetic determinants of large brain arterial diameters is unknown, but identifying such traits may shed light into possible mechanistic links between large brain arterial diameters and the observed outcomes.
Methods:
We studied 3654 participants from four ethnically diverse population-based cohorts: The Atherosclerosis Risk in Communities study (n=1565: 74.3% white, 25.7% black), The Northern Manhattan Study (n=1092: 13.8% white, 16.6% black, 69.6% Hispanic), Epidemiology of Dementia in Singapore (n=647: 31.7% Chinese, 35.7% Malay, 32.6% Indian), and Memory Clinic Cohort in Singapore (n=350: 84.9% Chinese, 7.8% Malay, 7.3% Indian). We measured brain arterial diameters for 13 segments and normalized the averaged diameter per participant to obtain global brain arterial diameter as dependent variable. Genome-wide association studies (GWAS) was performed in each study using linear regression, adjusted for sex, age, head size, number of missing arteries and population substructure. Meta-analysis of association statistics was performed using the METAL to generate combined trait-specific effect estimates. We also performed trans-ethnic meta-regression by MR-MEGA to account for the heterogeneity in allelic effect that is correlated with ancestry.
Results:
Genome-wide significant (P<5x10
-8
) associations were observed for global brain arterial diameter with three SNPs: rs7921574(P=1.2x10
-8
) mapping to an intron of CNNM2; rs2075858(P=2.47x10
-8
) and rs2075857 (P=2.37x10
-8
) mapping to introns of MUC5B. MR-MEGA analysis showed suggestive evidence of association (P=5.05x10
-8
) for rs7921574. These loci comprise genes involved in response to magnesium transport, neuronal transmission, hypertension, mucociliary clearance and host defense.
Conclusion:
Our study reveals two novel risk loci for large brain arterial diameters. We have begun to replicate these associations and to identify functional causal variants in independent studies. Identifying these loci may help us to elucidate underlying disease mechanisms.
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Affiliation(s)
- Minghua Liu
- Dept of Neurology, Columbia Univ, New York City, NY
| | | | | | - Ye Qiao
- JOHNS HOPKINS UNIVERISITY, Baltimore, MD
| | | | | | | | | | - Giuseppe Tosto
- Taub Institute for Rsch on Alzheimer's Disease and the Aging Brain, Columbia Univ, New York City, NY
| | - Sanjeev Sariya
- Taub Institute for Rsch on Alzheimer's Disease and the Aging Brain, Columbia Univ, New York City, NY
| | - Saima Hilal
- National Univ of Singapore, Singapore, Singapore
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13
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Zeiler SR, Wasserman BA. Vessel Wall Imaging: A Powerful Diagnostic Tool but Not a Substitute for Biopsies. AJNR Am J Neuroradiol 2021; 42:E79. [PMID: 34531191 DOI: 10.3174/ajnr.a7277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S R Zeiler
- Department of NeurologyJohns Hopkins UniversityBaltimore, Maryland
| | - B A Wasserman
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of Medicine and The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins UniversityBaltimore, Maryland
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14
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Heit JJ, Muthusami P, Chandra RV, Hui F, Negrotto M, Lee S, Wasserman BA, Abruzzo TA. Reperfusion Therapies for Children With Arterial Ischemic Stroke. Top Magn Reson Imaging 2021; 30:231-243. [PMID: 34613946 DOI: 10.1097/rmr.0000000000000273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Modern hyperacute reperfusion therapies including intravenous thrombolysis and mechanical thrombectomy have transformed the management of arterial ischemic stroke (AIS) in adults. Multiple randomized clinical trials have demonstrated that these therapies enable remarkable improvements in clinical outcome for properly selected patients with AIS. Because pediatric patients were excluded from predicate clinical trials, there is a conspicuous lack of data to guide selection of therapies and inform age-adjusted and pathology-oriented treatment modifications for children. Specifically, technical guidance concerning treatment eligibility, drug dosing, and device implementation is lacking. This review aims to outline important features that differentiate pediatric AIS from adult AIS and provide practical strategies that will assist the stroke specialist with therapeutic decision making.
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Affiliation(s)
- Jeremy J Heit
- Department of Radiology, Stanford University Medical Center, Stanford, CA.,Department of Neurosurgery, Stanford University Medical Center, Stanford, CA
| | | | - Ronil V Chandra
- Monash University Medical Center, Monash University, Melbourne, Australia
| | - Ferdinand Hui
- Johns Hopkins University Medical Center, Baltimore, MD
| | | | - Sarah Lee
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA
| | | | - Todd A Abruzzo
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ.,University of Arizona School of Medicine, Phoenix, AZ.,Mayo Clinic College of Medicine, Phoenix, AZ
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15
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Bathla G, Abdel-Wahed L, Agarwal A, Cho TA, Gupta S, Jones KA, Priya S, Soni N, Wasserman BA. Vascular Involvement in Neurosarcoidosis: Early Experiences From Intracranial Vessel Wall Imaging. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/6/e1063. [PMID: 34349028 PMCID: PMC8340434 DOI: 10.1212/nxi.0000000000001063] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Cerebrovascular manifestations in neurosarcoidosis (NS) were previously considered rare but are being increasingly recognized. We report our preliminary experience in patients with NS who underwent high-resolution vessel wall imaging (VWI). METHODS A total of 13 consecutive patients with NS underwent VWI. Images were analyzed by 2 neuroradiologists in consensus. The assessment included segment-wise evaluation of larger- and medium-sized vessels (internal carotid artery, M1-M3 middle cerebral artery; A1-A3 anterior cerebral artery; V4 segments of vertebral arteries; basilar artery; and P1-P3 posterior cerebral artery), lenticulostriate perforator vessels, and medullary and deep cerebral veins. Cortical veins were not assessed due to flow-related artifacts. Brain biopsy findings were available in 6 cases and were also reviewed. RESULTS Mean patient age was 54.9 years (33-71 years) with an M:F of 8:5. Mean duration between initial diagnosis and VWI study was 18 months. Overall, 9/13 (69%) patients had vascular abnormalities. Circumferential large vessel enhancement was seen in 3/13 (23%) patients, whereas perforator vessel involvement was seen in 6/13 (46%) patients. Medullary and deep vein involvement was also seen in 6/13 patients. In addition, 7/13 (54%) patients had microhemorrhages in susceptibility-weighted imaging, and 4/13 (31%) had chronic infarcts. On biopsy, 5/6 cases showed perivascular granulomas with vessel wall involvement in all 5 cases. DISCUSSION Our preliminary findings suggest that involvement of intracranial vascular structures may be a common finding in patients with NS and should be routinely looked for. These findings appear concordant with previously reported autopsy literature and need to be validated on a larger scale.
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Affiliation(s)
- Girish Bathla
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD.
| | - Lama Abdel-Wahed
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Amit Agarwal
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Tracey A Cho
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Sarika Gupta
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Karra A Jones
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Sarv Priya
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Neetu Soni
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Bruce A Wasserman
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
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16
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Saba L, Brinjikji W, Spence JD, Wintermark M, Castillo M, Borst GJD, Yang Q, Yuan C, Buckler A, Edjlali M, Saam T, Saloner D, Lal BK, Capodanno D, Sun J, Balu N, Naylor R, Lugt AVD, Wasserman BA, Kooi ME, Wardlaw J, Gillard J, Lanzino G, Hedin U, Mikulis D, Gupta A, DeMarco JK, Hess C, Goethem JV, Hatsukami T, Rothwell P, Brown MM, Moody AR. Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement. AJNR Am J Neuroradiol 2021; 42:1566-1575. [PMID: 34326105 DOI: 10.3174/ajnr.a7223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/26/2021] [Indexed: 12/19/2022]
Abstract
Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.
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Affiliation(s)
- L Saba
- From the Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy
| | | | - J D Spence
- Stroke Prevention and Atherosclerosis Research Centre (J.D.S.), Robarts Research Institute, Western University, London, Ontario, Canada
| | - M Wintermark
- Department of Neuroradiology (M.W.), Stanford University and Healthcare System, Stanford, California
| | - M Castillo
- Department of Radiology (M.C.), University of North Carolina, Chapel Hill, North Carolina
| | - G J D Borst
- Department of Vascular Surgery (G.J.D.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Q Yang
- Department of Radiology (Q.Y.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - C Yuan
- Departments of Radiology (C.Y., J.S., N.B.)
| | - A Buckler
- Elucid Bioimaging (A.B.), Boston, Massachusetts
| | - M Edjlali
- Department of Neuroradiology (M.E.), Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - T Saam
- Department of Radiology (T.S.), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Radiologisches Zentrum (T.S.), Rosenheim, Germany
| | - D Saloner
- Departments of Radiology and Biomedical Imaging (D.S., C.H.), University of California San Francisco, San Francisco, California
| | - B K Lal
- Department of Vascular Surgery (B.K.L.), University of Maryland School of Medicine, Baltimore, Maryland
| | - D Capodanno
- Division of Cardiology (D.C.), A.O.U. Policlinico "G. Rodolico-San Marco," University of Catania, Italy
| | - J Sun
- Departments of Radiology (C.Y., J.S., N.B.)
| | - N Balu
- Departments of Radiology (C.Y., J.S., N.B.)
| | - R Naylor
- The Leicester Vascular Institute (R.N.), Glenfield Hospital, Leicester, UK
| | - A V D Lugt
- Department of Radiology and Nuclear Medicine (A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science (B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - M E Kooi
- Department of Radiology and Nuclear Medicine (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Wardlaw
- Centre for Clinical Brain Sciences (J.W.), United Kingdom Dementia Research Institute and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - J Gillard
- Christ's College (J.G.), Cambridge, UK
| | - G Lanzino
- Neurosurgery (G.L.) Mayo Clinic, Rochester, Minnesota
| | - U Hedin
- Department of Molecular Medicine and Surgery (U.H.), Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery (U.H.), Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - D Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory (D.M.), University Health Network, Toronto, Ontario, Canada
| | - A Gupta
- Department of Radiology (A.G.), Weill Cornell Medical College, New York, New York
| | - J K DeMarco
- Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences (J.K.D.), Bethesda, Maryland
| | - C Hess
- Departments of Radiology and Biomedical Imaging (D.S., C.H.), University of California San Francisco, San Francisco, California
| | - J V Goethem
- Faculty of Biomedical Sciences (J.V.G.), University of Antwerp, Antwerp, Belgium
| | - T Hatsukami
- Surgery (T.H.), University of Washington, Seattle, Washington
| | - P Rothwell
- Centre for Prevention of Stroke and Dementia (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - M M Brown
- Stroke Research Centre (M.M.B.), Department of Brain Repair and Rehabilitation, University College of London Queen Square Institute of Neurology, University College London, UK
| | - A R Moody
- Department of Medical Imaging (A.R.M.), University of Toronto, Toronto, Ontario, Canada
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17
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Abstract
Intracranial vessel wall (VW) MRI has become widely available in clinical practice, providing multiple uses for evaluation of neurovascular diseases. The Vessel Wall Imaging Study Group of the American Society of Neuroradiology has recently reported expert consensus recommendations for the clinical implementation of this technique. However, the complexity of the neurovascular system and caveats to the technique may challenge its application in clinical practice. The purpose of this article is to review concepts essential for accurate interpretation of intracranial VW MRI results. This knowledge is intended to improve diagnostic confidence and performance in the interpretation of VW MRI scans. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Ningdong Kang
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
| | - Ye Qiao
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
| | - Bruce A Wasserman
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
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18
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Caughey MC, Qiao Y, Meyer ML, Palta P, Matsushita K, Tanaka H, Wasserman BA, Heiss G. Relationship Between Central Artery Stiffness, Brain Arterial Dilation, and White Matter Hyperintensities in Older Adults: The ARIC Study-Brief Report. Arterioscler Thromb Vasc Biol 2021; 41:2109-2116. [PMID: 33882687 PMCID: PMC8478115 DOI: 10.1161/atvbaha.120.315692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Melissa C. Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University; Chapel Hill, NC
| | - Ye Qiao
- Department of Radiology, Johns Hopkins School of Medicine; Baltimore, MD
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine; Chapel Hill, NC
| | - Priya Palta
- Department of Medicine, Columbia University School of Medicine; New York, NY
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | | | - Bruce A. Wasserman
- Department of Radiology, Johns Hopkins School of Medicine; Baltimore, MD
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health; Chapel Hill, NC
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19
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Yahyavi-Firouz-Abadi N, Kiczek M, Zeiler SR, Wasserman BA. Imaging Features of Susac Syndrome on High-Resolution Intracranial Vessel Wall MRI. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/4/e994. [PMID: 33863793 PMCID: PMC8105894 DOI: 10.1212/nxi.0000000000000994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/15/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Noushin Yahyavi-Firouz-Abadi
- From the Division of Neuoradiology (N.Y.-F.-A., B.A.W.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD; Department of Radiology (M.K.), Clevelend Clinic Foundation, Cleveland, OH; and Department of Neurology (S.R.Z.), Johns Hopkins University, Baltimore, MD.
| | - Matthew Kiczek
- From the Division of Neuoradiology (N.Y.-F.-A., B.A.W.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD; Department of Radiology (M.K.), Clevelend Clinic Foundation, Cleveland, OH; and Department of Neurology (S.R.Z.), Johns Hopkins University, Baltimore, MD
| | - Steven R Zeiler
- From the Division of Neuoradiology (N.Y.-F.-A., B.A.W.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD; Department of Radiology (M.K.), Clevelend Clinic Foundation, Cleveland, OH; and Department of Neurology (S.R.Z.), Johns Hopkins University, Baltimore, MD
| | - Bruce A Wasserman
- From the Division of Neuoradiology (N.Y.-F.-A., B.A.W.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD; Department of Radiology (M.K.), Clevelend Clinic Foundation, Cleveland, OH; and Department of Neurology (S.R.Z.), Johns Hopkins University, Baltimore, MD
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20
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Lowe F, Sen S, Adam HS, Demmer R, Wasserman BA, Rosamond WD, Moss K, Beck JD, Gottesman RF. Abstract P626: Periodontal Disease is Independently Associated With Cerebral Small Vessel Disease. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Prior studies have shown the association between periodontal disease, lacunar strokes and cognitive impairment. Using the Atherosclerosis Risk in Communities (ARIC) cohort study we investigated the relationship between periodontal disease (PD) and the development of MRI verified small vessel disease.
Methods:
Using the ARIC database data we extracted data for 1143 (mean age 77 years, 76% white, 24% African-American and 45% male) participants assessed for PD (N=800) versus periodontal health (N=343). These participants were assessed for small vessel disease on 3T MRI as measured by the log of white matter hyperintensity volume (WMHV). WMHV were derived from a semiautomated segmentation of FLAIR images. Student t-test was then used to evaluate the relationship between small vessel disease as the log of WMHV in subjects with PD or periodontal health. Based on WMHV the patients were grouped into quartiles and the association of PD with WMHV were tested using the group in periodontal health and lowest quartile of WMHV as the reference groups. Multinomial logistic regression was used to compute crude and adjusted odds ratio (OR) for the higher quartiles of WMHV compared to the reference quartile.
Results:
There was a significant increase in the presence of small vessel disease measured as log WMHV in the PD cohort as compared to periodontal health cohort with p= 0.023 on Independent Sample t-est. Based on WMHV the subjects were grouped into quartiles 0-6.41, >6.41-11.56, >11.56-21.36 and >21.36 cu mm3). PD was associated with only the highest quartile of WMHV on univariate (crude OR 1.77, 95% CI 1.23-2.56) and multivariable (adjusted OR 1.61, 95% CI 1.06-2.44) analyses. The later was adjusted for age, race, gender, hypertension, diabetes and smoking.
Conclusion:
Based on this prospective cohort there is data to suggest that PD may be associated with cerebral small vessel disease. Maintaining proper dental health may decrease future risk for the associated lacunar strokes and vascular cognitive impairment.
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Affiliation(s)
| | | | | | | | | | | | - Kevin Moss
- Univ of North Carolina at CH, Chapel Hill, NC
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21
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Kodumuri N, Sen S, La Valley EA, Suri F, Wasserman BA, Gottesman RF, Rosamond WD, Moss K, Beck JD. Abstract MP43: Paradoxical Response to Antibodies in Periodontal Microbes in Subjects With Intracranial Atherosclerotic Stenosis. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.mp43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Previously we have shown that periodontal disease and systemic inflammation are related to intracranial atherosclerosis (ICAS) in Atherosclerosis Risk In Communities study (ARIC). In this study we evaluated the relationship between serum antibodies against periodontal pathogens and ICAS.
Methods:
In this ongoing, prospective, longitudinal community-based cohort study, participants were assessed for antibodies to periodontal organisms including Porphyrmonas
gingivalis
(PG), Prevotella
intermedia
(PI), Prevotella
nigrescens
(PN), Bacteriodes
forsythensis
(BF), Treponema
denticola
(TD), Actinobacillus
actinomycetemcomitans
(AA), Campylobacter
rectus
(CR), Eikenella
corrodens
(EC), Fusobacterium
nucleatum
(FN), Peptostreptococcus
micros
(PM), Selenomonas
noxia
(SN), Capnocytophaga
ochracea
(CO), Veillonella
parvula
(VP), Streptococcus
sanguinis
(SS), Streptococcus
intermedius
(SI), Streptococcus
oralis
(SO), Actinomycosis
viscosis
(AV) and Helicobacter
pylori
(HP). These participants underwent 3D time-of-flight magnetic resonance angiography (MRA) to evaluate ICAS. Log mean antibody (IgG), CRP and IL-6 levels were compared using t-test between groups with and without ≥50% ICAS.
Results:
In this ARIC cohort, 1066 participants were assessed by MRA for ICAS. Serum CRP and IL-6 data were available for all and IgG levels were available for 772 participants. The log mean IgG level was significantly lower for patients with ≥50% ICAS versus patients with <50% ICAS in four organisms: PN (1.69 vs 1.80,
p= 0.03
), BF (1.30 vs 1.38,
p=0.05
), CO (1.23 vs 1.33,
p= 0.04
), FN (0.87 vs 1.01,
p=0.02
). The log mean IgG was also lower for CR, EC, SN, VP, SI, SO and AV though not significant. Log mean CRP was higher in the ≥50% ICAS group versus the <50% ICAS group (0.58 vs. 0.47,
p < 0.001
). Log mean IL-6 levels were also higher but not significant (0. 17 vs. 0.11,
p= 0.07
).
Conclusion:
Higher levels of systemic inflammatory markers (CRP, IL-6) are associated with significant ICAS, but we report a significantly lower level of IgG antibodies to specific periodontal pathogens (PN, BF, CO and FN) in patients with ≥50% ICAS. This paradoxical finding may represent the effect of systemic inflammation and oxidative stress on IgG levels to periodontal bacteria.
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Affiliation(s)
| | | | | | | | | | | | | | - Kevin Moss
- Univ of North Carolina at CH, Chapel Hill, NC
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22
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Gottesman RF, Mosley TH, Knopman DS, Hao Q, Wong D, Wagenknecht LE, Hughes TM, Qiao Y, Dearborn J, Wasserman BA. Association of Intracranial Atherosclerotic Disease With Brain β-Amyloid Deposition: Secondary Analysis of the ARIC Study. JAMA Neurol 2021; 77:350-357. [PMID: 31860001 DOI: 10.1001/jamaneurol.2019.4339] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Intracranial atherosclerotic disease (ICAD) is an important cause of stroke and has also been recently identified as an important risk factor for all-cause dementia, but the mechanism of its association with cognitive performance is not fully understood. Objective To test the hypothesis that ICAD is associated with cerebral β-amyloid deposition as a marker of Alzheimer disease. Design, Setting, and Participants This cross-sectional analysis of data collected from August 2011 through November 2014 was a community-based cohort study conducted in 3 US communities. Of 346 adults without dementia aged 70 to 90 years who were sequentially recruited from 3 of 4 sites of the larger Atherosclerosis Risk in Communities study into a study of brain florbetapir positron emission tomography (ARIC-PET), 300 met inclusion criteria. A total of 589 were approached about recruitment, of whom 346 (58.7%) consented (the remainder either met exclusion criteria for ARIC-PET or refused to participate). Data were analyzed from July 2017 through October 2019. Exposures Intracranial atherosclerotic disease presence, frequency, and extent of stenosis, by high-resolution vessel wall magnetic resonance imaging. Main Outcomes and Measures Global cortical standardized uptake value ratio (SUVR) of greater than 1.2 as measured by florbetapir PET. Models were conducted using logistic regression methods. In secondary analyses, we tested effect modifications by apolipoprotein E ε4 genotype with interaction terms and in stratified models and evaluated regional patterns of associations. Results In 300 participants (mean [SD] age, 76 [5] years; 132 African American individuals [44%], 167 women [56%], and 94 carriers of at least 1 apolipoprotein E ε4 allele [31%]), ICAD was found in 105 participants (35%) and mean (SD) SUVR was higher in individuals with vs without intracranial plaques (1.34 [0.29] vs 1.27 [0.23]; P = .03). In adjusted models, ICAD presence (plaque presence [adjusted odds ratio (aOR), 1.20; 95% CI, 0.69-2.07] and frequency [aOR, 1.10; 95% CI, 0.96-1.26]) was not associated significantly with elevated SUVR in the total sample. Furthermore, modest stenosis of the intracranial vessels (defined as >50% stenosis) was not associated with elevated SUVR (aOR, 2.33; 95% CI, 0.82-6.60). Conclusions and Relevance In this community-based cohort of adults without dementia, intracranial atherosclerotic plaque or stenosis was not associated with brain β-amyloid deposition.
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Affiliation(s)
- Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | | | - Qing Hao
- Department of Neurology, Mount Sinai Medical Center, New York, New York
| | - Dean Wong
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ye Qiao
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer Dearborn
- Department of Neurology, Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bruce A Wasserman
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
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23
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Yang WJ, Wasserman BA, Zheng L, Huang ZQ, Li J, Abrigo J, Wong SSM, Ying MTC, Chu WCW, Wong LKS, Leung TWH, Chen XY. Understanding the Clinical Implications of Intracranial Arterial Calcification Using Brain CT and Vessel Wall Imaging. Front Neurol 2021; 12:619233. [PMID: 34335434 PMCID: PMC8319500 DOI: 10.3389/fneur.2021.619233] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: Intracranial arterial calcification (IAC) has been the focus of much attention by clinicians and researchers as an indicator of intracranial atherosclerosis, but correlations of IAC patterns (intimal or medial) with the presence of atherosclerotic plaques and plaque stability are still a matter of debate. Our study aimed to assess the associations of IAC patterns identified on computed tomography (CT) with the presence of plaque detected on vessel wall magnetic resonance imaging and plaque stability. Materials and Methods: Patients with stroke or transient ischemic attack and intracranial artery stenosis were recruited. IAC was detected and localized (intima or media) on non-contrast CT images. Intracranial atherosclerotic plaques were identified using vessel wall magnetic resonance imaging and matched to corresponding CT images. Associations between IAC patterns and culprit atherosclerotic plaques were assessed by using multivariate regression. Results: Seventy-five patients (mean age, 63.4 ± 11.6 years; males, 46) were included. Two hundred and twenty-one segments with IAC were identified on CT in 66 patients, including 86 (38.9%) predominantly intimal calcifications and 135 (61.1%) predominantly medial calcifications. A total of 72.0% of intimal calcifications coexisted with atherosclerotic plaques, whereas only 10.2% of medial calcifications coexisted with plaques. Intimal calcification was more commonly shown in non-culprit plaques than culprit plaques (25.9 vs. 9.4%, P = 0.008). The multivariate mixed logistic regression adjusted for the degree of stenosis showed that intimal calcification was significantly associated with non-culprit plaques (OR, 2.971; 95% CI, 1.036-8.517; P = 0.043). Conclusion: Our findings suggest that intimal calcification may indicate the existence of a stable form of atherosclerotic plaque, but plaques can exist in the absence of intimal calcification especially in the middle cerebral artery.
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Affiliation(s)
- Wen-Jie Yang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Bruce A. Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Lu Zheng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhong-Qing Huang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, United States
- Department of Medical Image Center, Yuebei People's Hospital, Shantou University Medical College, Shantou, China
| | - Jia Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Sin-man Wong
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Michael Tin-cheung Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lawrence Ka-sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Thomas Wai-Hong Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiang-Yan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- *Correspondence: Xiang-Yan Chen ;
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24
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Brunner G, Virani SS, Sun W, Liu L, Dodge RC, Nambi V, Coresh J, Mosley TH, Sharrett AR, Boerwinkle E, Ballantyne CM, Wasserman BA. Associations Between Carotid Artery Plaque Burden, Plaque Characteristics, and Cardiovascular Events: The ARIC Carotid Magnetic Resonance Imaging Study. JAMA Cardiol 2020; 6:79-86. [PMID: 33206125 DOI: 10.1001/jamacardio.2020.5573] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance It remains unknown whether in an asymptomatic community-based cohort magnetic resonance imaging (MRI) measures of plaque characteristics are independently associated with incident cardiovascular disease (CVD) events when adjusted for carotid artery (CA) wall thickness, a measure of plaque burden. Objective To assess associations of CA MRI plaque characteristics with incident CVD events. Design, Setting, and Participants The Atherosclerosis Risk in Communities (ARIC) study is a prospective epidemiologic study of the incidence of CVD in 15 792 adults of which 2066 women and men were enrolled in the ARIC Carotid MRI substudy. ARIC participants were enrolled from 1987 to 1989, and the substudy was conducted between January 2004 and December 2005. Analysis began January 2017 and ended August 2020. Exposures Incident CVD events during a median (interquartile range [IQR]) follow-up time of 10.5 (8.1-10.9) years were assessed. Main Outcomes and Measures Proportional hazards Cox analyses were performed to ascertain associations between MRI variables of CA plaque burden and plaque characteristics. Results Of 15 792 ARIC participants, 2066 were enrolled in the substudy, of whom 1256 (701 women [55.8%]) had complete data and were eligible for incident CVD analyses. Carotid artery plaques in participants with incident CVD events (172 [13.7%]) compared with those without (1084 [86.3%]) had a higher normalized wall index (median [IQR], 0.48 [0.36-0.62] vs 0.43 [0.34-0.55]; P = .001), maximum CA wall thickness (median [IQR], 2.22 [1.37-3.52] mm vs 1.96 [1.29-2.85] mm; P = .01), maximum CA stenosis (median [IQR], 5% [0%-22%] vs 0% [0%-13%]; P < .001), and when present, a larger lipid core volume (median [IQR], 0.05 [0.02-0.11] mL vs 0.03 [0.01-0.07] mL; P = .03), respectively. The presence of a lipid core was independently associated with incident CVD events when adjusted for traditional CVD risk factors and maximum CA wall thickness (hazard ratio, 2.48 [95% CI, 1.36-4.51]; P = .003), whereas the presence of calcification was not. The frequency of intraplaque hemorrhage presence in this population of individuals free of CVD at baseline who were not recruited for carotid stenosis was too small to draw any meaningful conclusions (intraplaque hemorrhage presence: 68 of 1256 participants [5.4%]). Carotid artery lumen area and maximum stenosis, which were overall low, were independently associated with incident CVD events when adjusted for traditional CVD risk factors, as anticipated. Conclusions and Relevance The presence of a CA lipid core on MRI is associated with incident CVD events independent of maximum CA wall thickness in asymptomatic participants.
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Affiliation(s)
- Gerd Brunner
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey
| | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Wensheng Sun
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Li Liu
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rhiannon C Dodge
- The University of Texas Health Science Center School of Public Health, Houston
| | - Vijay Nambi
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas H Mosley
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Boerwinkle
- The University of Texas Health Science Center School of Public Health, Houston
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Fujiyoshi A, Suri MFK, Alonso A, Selvin E, Chu H, Guallar E, Qiao Y, Zhang Y, Wasserman BA, Folsom AR. Hyperglycemia, duration of diabetes, and intracranial atherosclerotic stenosis by magnetic resonance angiography: The ARIC-NCS study. J Diabetes Complications 2020; 34:107605. [PMID: 32600893 PMCID: PMC8285273 DOI: 10.1016/j.jdiacomp.2020.107605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/12/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/31/2023]
Abstract
AIMS The association of hyperglycemia and duration of diabetes with intracranial atherosclerotic stenosis (ICAS) in the general population is not well documented. We examined whether elevated glucose and longer diabetes duration is independently associated with ICAS in a community-based sample. METHODS We cross-sectionally analyzed 1644 participants (age 67-90 years) of the Atherosclerosis Risk in Communities Study who underwent cerebrovascular magnetic resonance angiography in 2011-13. We applied multivariable ordinal logistic regression to evaluate the association of ICAS category ("no stenosis", "stenosis <50%", or "stenosis ≥50%") with glucose or diabetes duration (<10, 10 to 20, and ≥20 years). We also obtained the corresponding odds ratios applying inverse-probability weighting to account for potential selection bias due to attrition. RESULTS Compared to non-diabetic participants in the lowest glucose quartile, the weighted odds ratios (95% confidence interval) of higher ICAS category were 1.88 (1.18, 3.00) and 2.01 (1.08, 3.72) for non-diabetic and diabetic participants in the corresponding highest glucose quartile, respectively. We observed significant positive trends of ICAS across diabetes duration categories in unweighted, but not in weighted, analyses. CONCLUSIONS Hyperglycemia and longer duration of diabetes were independently associated with ICAS, suggesting the importance of maintaining glycemic control to prevent stroke.
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Affiliation(s)
- Akira Fujiyoshi
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan.
| | - M Fareed K Suri
- Department of Neurology, University of Minnesota, MN, United States of America
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Elizabeth Selvin
- Departments of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Eliseo Guallar
- Departments of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Yiyi Zhang
- Departments of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
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26
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Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Along with high recurrent stroke risk from ICAD, its association with cognitive decline and dementia leads to a substantial decrease in quality of life and a high economic burden. Atherosclerotic lesions can range from slight wall thickening with plaques that are angiographically occult to severely stenotic lesions. Recent advances in intracranial high resolution vessel wall MR (VW-MR) imaging have enabled imaging beyond the lumen to characterize the vessel wall and its pathology. This technique has opened new avenues of research for identifying vulnerable plaque in the setting of acute ischemic stroke as well as assessing ICAD burden and its associations with its sequela, such as dementia. We now understand more about the intracranial arterial wall, its ability to remodel with disease and how we can use VW-MR to identify angiographically occult lesions and assess medical treatment responses, for example, to statin therapy. Our growing understanding of ICAD with intracranial VW-MR imaging can profoundly impact diagnosis, therapy, and prognosis for ischemic stroke with the possibility of lesion-based risk models to tailor and personalize treatment. In this review, we discuss the advantages of intracranial VW-MR imaging for ICAD, the potential of bioimaging markers to identify vulnerable intracranial plaque, and future directions of artificial intelligence and its utility for lesion scoring and assessment.
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Affiliation(s)
- Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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27
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Hao Q, Gottesman RF, Qiao Y, Liu L, Sharma R, Selvin E, Matsushita K, Coresh J, Wasserman BA. Association between kidney disease measures and intracranial atherosclerosis: The ARIC study. Neurology 2020; 94:e2361-e2372. [PMID: 32303651 PMCID: PMC7357292 DOI: 10.1212/wnl.0000000000009311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the association between reduced kidney function (assessed by estimated glomerular filtration rate [eGFR] and cystatin C [CysC]) and kidney damage (assessed by urinary albumin-to-creatinine ratio [ACR]) and intracranial atherosclerotic disease (ICAD) by high-resolution vessel wall MRI (VWMRI) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS We conducted a cross-sectional analysis of ARIC participants with data on kidney measures and VWMRI in 2011 to 2013. The main outcomes were presence of intracranial plaques and luminal stenosis. Multivariable models were adjusted for demographics, cardiovascular risk factors, and use of antithrombotic medications. RESULTS A total of 1,762 participants (mean ± SD age, 76.3 ± 5.3) were included. eGFR based on CysC (eGFRcysc) <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) was associated with plaque presence (adjusted odds ratio [OR] 1.29, 95% confidence interval [CI] 1.04-1.60), any detectable stenosis (adjusted OR 1.31, 95% CI 1.04-1.63), and >70% stenosis or occlusion (adjusted OR 2.15, 95% CI 1.32-3.50). Neither ACR nor CysC showed statistically significant associations with ICAD features in adjusted models. In adjusted multinomial models, participants with eGFRcysc <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) had an increased OR of 1.41 (95% CI 1.06-1.87) for having 1 plaque (vs none) but no significant increase for multiple plaques; ACR ≥30 was associated with moderate (50%-70%) stenosis (OR 2.01, 95% CI 1.14-3.55) vs absent or less than 50% stenosis. CONCLUSION In community-dwelling older adults, reduced kidney function or elevated kidney damage was associated with ICAD measured by VWMRI. This finding may help to better identify a population at high risk for ICAD.
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Affiliation(s)
- Qing Hao
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Rebecca F Gottesman
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ye Qiao
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Li Liu
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Richa Sharma
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Elizabeth Selvin
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Kunihiro Matsushita
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Josef Coresh
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Bruce A Wasserman
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD.
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Qiao Y, Suri FK, Zhang Y, Liu L, Gottesman R, Alonso A, Guallar E, Wasserman BA. Racial Differences in Prevalence and Risk for Intracranial Atherosclerosis in a US Community-Based Population. JAMA Cardiol 2019; 2:1341-1348. [PMID: 29094154 DOI: 10.1001/jamacardio.2017.4041] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Intracranial atherosclerotic disease (ICAD) is an important cause of stroke; however, little is known about racial differences in ICAD prevalence and its risk factors. Objective To determine racial differences in ICAD prevalence and the risk factors (both midlife and concurrent) associated with its development in a large, US community-based cohort. Design, Setting, and Participants Analysis of 1752 black and white participants recruited from the Atherosclerosis Risk in Communities (ARIC) cohort study who underwent 3-dimensional intracranial vessel wall magnetic resonance imaging from October 18, 2011 to December 30, 2013; data analysis was performed from October 18, 2011 to May 13, 2015. Exposures Midlife and concurrent cardiovascular risk factors. Main Outcomes and Measures Intracranial plaque presence, size (maximum normalized wall index) and number were assessed by vessel wall magnetic resonance imaging. Midlife and concurrent vascular risk factor associations were determined by Poisson regression (plaque presence), negative binominal regression (plaque number), and linear regression (plaque size), and compared between races. Results Of the 1752 study participants (mean [SD] age, 77.6 [5.3] years; range, 67-90 years), 1023 (58.4%) were women and 518 (29.6%) were black. Black men had the highest prevalence (50.9% vs 35.9% for black women, 35.5% for white men, and 30.2% for white women; P < .001) and the highest frequency (22.4% vs 12.1% for black women, 10.7% for white men, and 8.7% for white women; P < .01) of multiple plaques. Prevalence increased with age, reaching 50% before ages 68, 84, and 88 years in black men, white men, and white women, respectively (ICAD prevalence remained <50% in black women). Midlife hypertension and hyperlipidemia were associated with 29% (prevalence ratio [PR], 1.29; 95% CI, 1.08-1.55) and 18% (PR, 1.18; 95% CI, 0.98-1.42), respectively, increased ICAD prevalence with no significant differences between races. Midlife hypertension was also associated with larger plaques (1.11 higher mean maximum normalized wall index; 95% CI, 0.21-2.01). Midlife smoking and diabetes were associated with increased risk of ICAD in black individuals (102% [PR, 2.02; 95% CI, 1.12-3.63] and 57% [PR, 1.57; 95% CI, 1.13- 2.19], respectively), but not in white participants (P < .05 interaction by race). Conclusions and Relevance The prevalence of ICAD was highest in black men. Midlife smoking and diabetes were strongly associated with late-life ICAD in blacks only, whereas midlife hypertension and hyperlipidemia were associated with late-life ICAD in both races. These associations may help to explain racial differences in US stroke rates and offer insight into preventive risk-factor management strategies.
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Affiliation(s)
- Ye Qiao
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fareed K Suri
- Department of Neurology, CentraCare Clinic, St Cloud, Minnesota
| | - Yiyi Zhang
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Li Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Gottesman
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Porcu M, Anzidei M, Suri JS, A Wasserman B, Anzalone N, Lucatelli P, Loi F, Montisci R, Sanfilippo R, Rafailidis V, Saba L. Carotid artery imaging: The study of intra-plaque vascularization and hemorrhage in the era of the "vulnerable" plaque. J Neuroradiol 2019; 47:464-472. [PMID: 30954549 DOI: 10.1016/j.neurad.2019.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/04/2019] [Accepted: 03/04/2019] [Indexed: 01/01/2023]
Abstract
Intraplaque hemorrhage (IPH) is one of the main factors involved in atherosclerotic plaque (AP) instability. Its recognition is crucial for the correct staging and management of patients with carotid artery plaques to limit ischemic stroke. Imaging plays a crucial role in identifying IPH, even if the great variability of intraplaque vascularization and the limitations of our current imaging technologies make it difficult. The intent of this review is to give a general overview of the main features of intraplaque vascularization and IPH on Ultrasound (US), Computed Tomography (CT), Magnetic Resonance (MR) and Nuclear Medicine, and a brief description on the future prospectives.
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Affiliation(s)
- Michele Porcu
- Department of Medical Imaging, AOU of Cagliari, University of Cagliari, Cagliari, Italy.
| | - Michele Anzidei
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jasjit S Suri
- Monitoring and Diagnostic Division, AtheroPoint, Roseville, CA, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicoletta Anzalone
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Italy
| | - Pierleone Lucatelli
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Loi
- Department of Biomedial Sciences, Unit of Oncology and Molecular Pathology, University of Cagliari, Cagliari, Italy
| | - Roberto Montisci
- Department of Vascular Surgery, AOU of Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Sanfilippo
- Department of Vascular Surgery, AOU of Cagliari, University of Cagliari, Cagliari, Italy
| | - Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloníki, Greece
| | - Luca Saba
- Department of Medical Imaging, AOU of Cagliari, University of Cagliari, Cagliari, Italy
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Saba L, Saam T, Jäger HR, Yuan C, Hatsukami TS, Saloner D, Wasserman BA, Bonati LH, Wintermark M. Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol 2019; 18:559-572. [PMID: 30954372 DOI: 10.1016/s1474-4422(19)30035-3] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/15/2023]
Abstract
Stroke represents a massive public health problem. Carotid atherosclerosis plays a fundamental part in the occurence of ischaemic stroke. European and US guidelines for prevention of stroke in patients with carotid plaques are based on quantification of the percentage reduction in luminal diameter due to the atherosclerotic process to select the best therapeutic approach. However, better strategies for prevention of stroke are needed because some subtypes of carotid plaques (eg, vulnerable plaques) can predict the occurrence of stroke independent of the degree of stenosis. Advances in imaging techniques have enabled routine characterisation and detection of the features of carotid plaque vulnerability. Intraplaque haemorrhage is accepted by neurologists and radiologists as one of the features of vulnerable plaques, but other characteristics-eg, plaque volume, neovascularisation, and inflammation-are promising as biomarkers of carotid plaque vulnerability. These biomarkers could change current management strategies based merely on the degree of stenosis.
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Affiliation(s)
- Luca Saba
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy.
| | - Tobias Saam
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany; Radiologisches Zentrum Rosenheim, Rosenheim, Germany
| | - H Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Bruce A Wasserman
- The Russell H Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
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31
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Kwee RM, Qiao Y, Liu L, Zeiler SR, Wasserman BA. Temporal course and implications of intracranial atherosclerotic plaque enhancement on high-resolution vessel wall MRI. Neuroradiology 2019; 61:651-657. [PMID: 30834465 DOI: 10.1007/s00234-019-02190-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 01/17/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known about the natural history of intracranial atherosclerotic plaque enhancement and its clinical implications. Our objective was to investigate the value of follow-up high-resolution contrast-enhanced vessel wall MRI (VWMRI) for classifying culprit plaques in patients with intracranial atherosclerotic disease (ICAD). METHODS Fourteen patients with symptomatic ICAD (50% females; median age 48 years) underwent serial 3T VWMRI. Fifty-five plaques were identified and graded based on the likelihood of having caused the ischemic event (non-culprit, indeterminate, culprit) and degree of enhancement (0, 1, 2) at baseline and follow-up (median follow-up, 140 days). For accuracy analysis, plaque enhancement at baseline and stable or increasing plaque enhancement at follow-up was tested to identify a culprit plaque, and areas under the receiver operating characteristic curves (AUCs) were compared. RESULTS In 37/55 (67.3%) plaques, enhancement grade remained unchanged. Lack of enhancement was only seen in non-culprit plaques at baseline, and none developed enhancement over time. Enhancement never changed more than one grade. Thirty-seven percent (10/27) of non-culprit plaques that enhanced decreased in enhancement grade at follow-up, but no culprit plaques decreased in enhancement. AUC of baseline and follow-up plaque enhancement combined was significantly larger than AUC of baseline plaque enhancement alone to identify culprit plaques (0.733 vs. 0.567, p = 0.0001). CONCLUSION Contrast enhancement of ICAD can persist months after the ischemic event. Lack of enhancement at baseline or a decrease in enhancement at follow-up suggests that the plaque is not culprit. Persistent enhancement from baseline to follow-up improves accuracy in identifying culprit plaques.
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Affiliation(s)
- Robert M Kwee
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA.,Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Li Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Steven R Zeiler
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA.
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Hao Q, Qiao Y, Williams N, Johnson B, Wasserman BA, Gottesman R. Abstract TP157: Ethnic Difference in Stroke Recurrence for Patients With Intracranial Atherosclerotic Stenosis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Intracranial atherosclerotic stenosis (ICAS), one of most common stroke subtypes worldwide, carries high risk of stroke recurrence despite maximal medical treatment. ICAS more commonly affects non-white populations including Asian, African-American and Hispanic individuals. It is plausible that non-white stroke patients with ICAS might also have more active disease, and thus higher risks of stroke recurrence. We aim to compare the rate of stroke recurrence in stroke patients with ICAS in white and non-white population. Method: We retrospectively reviewed a consecutive series of patients with ischemic stroke due to ICAS in major vessels (MCA, ACA, PCA, intracranial segment of ICA and VA, BA) with >50% stenosis identified on MRA or CTA. The clinical characteristics, risk factors and rate of stroke recurrence were compared in white and non-white patients, using Chi-square (for categorical variables) test and t-test (for continuous variables).
Results:
A total of 183 patients [66.3% non-white, mean (SD) age, 63 (±14) years] who were hospitalized between January 2005 and December 2010 and satisfied the inclusion criteria were included in the analysis. Compared with white patients, non-white patients had a higher rate of HTN, DM and drug abuse (Table 1), as well a nonsignificantly higher stroke recurrence rate (3 months: OR 1.29, 95% CI 0.59-2.82; long term: OR 1.63, 95% CI 0.84 - 3.18). History of CKD was the only factor associated with 3-month stroke recurrence (OR 3.73, 965 CI 1.13-12.31).
Conclusion:
White and non-white ischemic stroke patients with ICAS have distinct risk factor profiles and possibly distinct stroke recurrence rates. Analysis with a larger sample size is ongoing to verify this finding.
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Affiliation(s)
- Qing Hao
- Icahn Sch of Medicine at Mount Sinai, New York, NY
| | - Ye Qiao
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
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Steinman DA, Gallo D, Morbiducci U, Wasserman BA. Letter by Steinman et al Regarding Article, "Wall Shear Stress and T1 Contrast Ratio Are Associated With Embolic Signals During Carotid Exposure in Endarterectomy". Stroke 2018; 49:e341. [PMID: 30571448 DOI: 10.1161/strokeaha.118.023197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David A Steinman
- Department of Mechanical and Industrial Engineering, University of Toronto, Canada
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | - Umberto Morbiducci
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | - Bruce A Wasserman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD
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34
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Gallo D, Bijari PB, Morbiducci U, Qiao Y, Xie YJ, Etesami M, Habets D, Lakatta EG, Wasserman BA, Steinman DA. Segment-specific associations between local haemodynamic and imaging markers of early atherosclerosis at the carotid artery: an in vivo human study. J R Soc Interface 2018; 15:rsif.2018.0352. [PMID: 30305419 DOI: 10.1098/rsif.2018.0352] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 05/16/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022] Open
Abstract
Low and oscillatory wall shear stress (WSS) has long been hypothesized as a risk factor for atherosclerosis; however, evidence has been inferred primarily from model and post-mortem studies, or clinical studies of patients with already-developed plaques. This study aimed to identify associations between local haemodynamic and imaging markers of early atherosclerosis. Comprehensive magnetic resonance imaging allowed quantification of contrast enhancement (CE) (a marker of endothelial dysfunction) and vessel wall thickness at two distinct segments: the internal carotid artery bulb and the common carotid artery (CCA). Strict criteria were applied to a large dataset to exclude inward remodelling, resulting in 41 cases for which personalized computational fluid dynamic simulations were performed. After controlling for cardiovascular risk factors, bulb wall thickening was found to be weakly, but not significantly, associated with oscillatory WSS. CE at the bulb was significantly associated with low WSS (p < 0.001) and low flow helicity (p < 0.05). No significant associations were found for the CCA segment. Local haemodynamics at the bulb were significantly correlated with blood flow rates and heart rates, but not carotid bifurcation geometry (flare and curvature). Therefore low, but not oscillatory, WSS is an early independent marker of atherosclerotic changes preceding intimal thickening at the carotid bulb.
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Affiliation(s)
- Diego Gallo
- Biomedical Simulation Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.,PolitoMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Payam B Bijari
- Biomedical Simulation Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Umberto Morbiducci
- PolitoMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Ye Qiao
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuanyuan Joyce Xie
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maryam Etesami
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Damiaan Habets
- Biomedical Simulation Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, NIA, Baltimore, MD, USA
| | - Bruce A Wasserman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Steinman
- Biomedical Simulation Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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35
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Zhang Y, Guallar E, Malhotra S, Astor BC, Polak JF, Qiao Y, Gomes AS, Herrington DM, Sharrett AR, Bluemke DA, Wasserman BA. Carotid Artery Wall Thickness and Incident Cardiovascular Events: A Comparison between US and MRI in the Multi-Ethnic Study of Atherosclerosis (MESA). Radiology 2018; 289:649-657. [PMID: 30299234 DOI: 10.1148/radiol.2018173069] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose To compare common carotid artery (CCA) wall thickness measured manually by using US and semiautomatically by using MRI, and to examine their associations with incident coronary heart disease and stroke. Materials and Methods This prospective study enrolled 698 participants without a history of clinical cardiovascular disease (CVD) from the Multi-Ethnic Study of Atherosclerosis (MESA) from July 2000 to December 2013 (mean age, 63 years; range, 45 to 84 years; same for men and women). All participants provided written informed consent. CCA wall thickness was measured with US as well as both noncontrast proton-density-weighted and intravenous gadolinium-enhanced MRI. Cox proportional hazards models were used to assess the associations between wall thickness measurements by using US and MRI with CVD outcomes. Results The adjusted hazard ratios for coronary heart disease, stroke, and CVD associated with per standard deviation increase in intima-media thickness were 1.10, 1.08, and 1.14, respectively. The corresponding associations for mean wall thickness measured with proton-density-weighted MRI were 1.32, 1.48, and 1.37, and for mean wall thickness measured with gadolinium-enhanced MRI were 1.27, 1.58, and 1.38. When included simultaneously in the same model, MRI wall thickness, but not intima-media thickness, remained associated with outcomes. Conclusion For individuals without known cardiovascular disease at baseline, wall thickness measurements by using MRI were more consistently associated with incident cardiovascular disease, particularly stroke, than were intima-media thickness by using US. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Yiyi Zhang
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - Eliseo Guallar
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - Saurabh Malhotra
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - Brad C Astor
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - Joseph F Polak
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - Ye Qiao
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - Antoinette S Gomes
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - David M Herrington
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - A Richey Sharrett
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - David A Bluemke
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
| | - Bruce A Wasserman
- From the Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (Y.Z., E.G., A.R.S.); Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (S.M.); Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis (B.C.A.); Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.); The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, 367 East Park Building, Baltimore, Md 21287 (Y.Q., B.A.W.); Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (A.S.G.); Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (D.M.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (D.A.B.)
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Zeiler SR, Qiao Y, Pardo CA, Lim M, Wasserman BA. Vessel Wall MRI for Targeting Biopsies of Intracranial Vasculitis. AJNR Am J Neuroradiol 2018; 39:2034-2036. [PMID: 30262647 DOI: 10.3174/ajnr.a5801] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/17/2018] [Indexed: 11/07/2022]
Abstract
Central nervous system vasculitides are elusive diseases that are challenging to diagnose because brain biopsies have high false-negative rates. We sought to test the ability of contrast-enhanced, high-resolution 3D vessel wall MR imaging to identify vascular inflammation and direct open biopsies of intracranial target vessels and adjacent brain parenchyma. Eight of 9 specimens revealed vascular inflammation. We conclude that vessel wall MR imaging can identify inflamed intracranial vessels, enabling precise localization of biopsy targets.
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Affiliation(s)
- S R Zeiler
- From the Department of Neurology (S.R.Z., C.A.P.)
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.)
| | - C A Pardo
- From the Department of Neurology (S.R.Z., C.A.P.).,Departments of Pathology (C.A.P.)
| | - M Lim
- Neurosurgery (M.L.), Johns Hopkins University, Baltimore, Maryland
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.)
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Caughey MC, Qiao Y, Windham BG, Gottesman RF, Mosley TH, Wasserman BA. Carotid Intima-Media Thickness and Silent Brain Infarctions in a Biracial Cohort: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Hypertens 2018; 31:869-875. [PMID: 29425278 PMCID: PMC6049000 DOI: 10.1093/ajh/hpy022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/08/2018] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both hypertensive and atherosclerotic processes contribute to common carotid artery intima-media thickness (CCA-IMT). Elevated CCA-IMT may be indicative of subclinical cerebrovascular disease; however, its role in the absence of concomitant carotid artery plaque is uncertain, and few studies have examined associations in Black populations. MATERIALS AND METHODS At cohort visit 3 (1993-1995) a subset of stroke-free participants (641 Blacks and 702 Whites, mean age 63) from the Atherosclerosis Risk in Communities (ARIC) study was imaged by brain MRI and carotid ultrasound. A CCA-IMT >0.9 mm was considered elevated. Asymptomatic brain lesions ≥3 mm were considered silent brain infarctions (SBI). Subcortical SBI measuring 3 to <20 mm were considered lacunes. Associations between elevated CCA-IMT and SBI were analyzed with Poisson regression. RESULTS Elevated CCA-IMT was identified in 168 participants (16% of Blacks, 10% of Whites), and SBI were observed in 156 (15% of Blacks, 8% of Whites). Elevated CCA-IMT was strongly related to anterior circulation SBI, posterior circulation SBI, and lacunes. After adjustments, elevated CCA-IMT remained associated with greater number of lacunes in Blacks ([prevalence ratio, PR] = 1.60; 95% confidence interval [CI]: 1.02-2.51), but not Whites (PR = 0.85; 95% CI: 0.35-2.04); P value for interaction = 0.12. Among Black participants without concomitant carotid plaque, elevated CCA-IMT was associated with twice the number of lacunes (PR = 2.00; 95% CI: 1.05-3.82). CONCLUSIONS In older Black adults, elevated CCA-IMT is independently associated with lipohyalinosis of the cerebral small vessels, irrespective of concomitant carotid plaque and vascular risk factors.
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Affiliation(s)
- Melissa C Caughey
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ye Qiao
- Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Beverly Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Bruce A Wasserman
- Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Deal JA, Sharrett AR, Rawlings AM, Gottesman RF, Bandeen-Roche K, Albert M, Knopman D, Selvin E, Wasserman BA, Klein B, Klein R. Retinal signs and 20-year cognitive decline in the Atherosclerosis Risk in Communities Study. Neurology 2018; 90:e1158-e1166. [PMID: 29490915 PMCID: PMC5880633 DOI: 10.1212/wnl.0000000000005205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To test the hypothesis that retinal vascular signs are associated with greater cognitive decline over 20 years in 12,317 men and women 50 to 73 years of age at baseline. METHODS A composite cognitive score was created with 3 neuropsychological tests measured at 3 time points (1990-1992 to 2011-2013). Retinal signs were measured with fundus photography (1993-1995). Differences in cognitive change by retinal signs status were estimated with linear mixed models. Cognitive scores were imputed for living participants with incomplete cognitive testing. RESULTS In multivariable-adjusted analyses that controlled for attrition, loss of vascular integrity (retinopathy and its components) was associated with greater 20-year decline (difference in 20-year cognitive change for moderate/severe vs no retinopathy -0.53 SD, 95% confidence interval -0.74 to -0.33). Estimated differences were similar in participants with and without diabetes mellitus and in white and black participants. CONCLUSIONS Retinopathy was associated with accelerated rates of 20-year cognitive decline. These findings support the exploration of more sensitive measures in the eye such as optical coherence tomography angiography, which may provide surrogate indexes of microvascular lesions relevant to cognitive decline in older adults.
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Affiliation(s)
- Jennifer A Deal
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison.
| | - A Richey Sharrett
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Andreea M Rawlings
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Rebecca F Gottesman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Karen Bandeen-Roche
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Marilyn Albert
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - David Knopman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Elizabeth Selvin
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce A Wasserman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Barbara Klein
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Ronald Klein
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
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Suri MFK, Zhou J, Qiao Y, Chu H, Qureshi AI, Mosley T, Gottesman RF, Wruck L, Sharrett AR, Alonso A, Wasserman BA. Cognitive impairment and intracranial atherosclerotic stenosis in general population. Neurology 2018. [PMID: 29523643 DOI: 10.1212/wnl.0000000000005250] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the association between asymptomatic intracranial atherosclerosis and cognitive impairment in the Atherosclerosis Risk in Communities (ARIC) cohort. METHODS ARIC participants underwent high-resolution 3T magnetic resonance angiography and a neuropsychology battery and neurologic examination adjudicated by an expert panel to detect mild cognitive impairment (MCI) and dementia. We adjusted for demographic and vascular risk factors in weighted logistic regression analysis, accounting for stratified sampling design and attrition, to determine the association of intracranial atherosclerotic stenosis (ICAS) with cognitive impairment. RESULTS In 1,701 participants (mean age 76 ± 5.3, 41% men, 71% whites, 29% blacks) with adequate imaging quality and no history of stroke, MCI was identified in 578 (34%) and dementia in 79 (4.6%). In white participants, after adjustment for demographic and vascular risk factors, ICAS ≥50% (vs no ICAS) was strongly associated with dementia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7-10.0) and with any cognitive impairment (OR 1.7, 95% CI 1.1-2.8). In contrast, no association was found between ICAS ≥50% and MCI or dementia in blacks, although the sample size was limited and estimates were imprecise. CONCLUSION Our results suggest that asymptomatic ICAS is independently associated with cognitive impairment and dementia in whites.
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Affiliation(s)
- M Fareed K Suri
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge.
| | - Jincheng Zhou
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Ye Qiao
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Haitao Chu
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Adnan I Qureshi
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Tom Mosley
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Rebecca F Gottesman
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Lisa Wruck
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - A Richey Sharrett
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Alvaro Alonso
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
| | - Bruce A Wasserman
- From the Department of Neurology (M.F.K.S., A I.Q.) and School of Public Health (J.Z., H.C.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Departments of Epidemiology (R.F.G., A.R.S.) and Medicine (R.F.G.) and Welch Center for Prevention, Epidemiology, and Clinical Research (R.F.G.), Johns Hopkins Bloomberg School of Public Health; Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (L.W.), University of North Carolina at Chapel Hill; and Department of Geriatrics (T.M.), Louisiana State University, Baton Rouge
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Gottesman RF, Dearborn J, Hao Q, Knopman DS, Mosley TH, Qiao Y, Wagenknecht LE, Wong DF, Zhou Y, Wasserman BA. Abstract 151: Intracranial Atherosclerotic Disease and Brain Amyloid Deposition: The ARIC Study. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Increasing evidence points to intracranial atherosclerosis as a risk factor not only for stroke but also for dementia, but whether it is linked to Alzheimer’s disease-specific pathology itself is less understood. In the community-based Atherosclerosis Risk in Communities (ARIC) study, we evaluated the cross-sectional association between intracranial atherosclerosis and cerebral amyloid deposition, in nondemented participants.
Methods:
In 2011-2014, a subset of participants from the ARIC Neurocognitive Study underwent both a brain MRI, including high-resolution vessel wall imaging, and florbetapir PET, as a marker of amyloid deposition. We analyzed the association between elevated amyloid (defined as a global cortical florbetapir standardized uptake value ratio (SUVR)>1.2) and intracranial arterial plaque presence, frequency, and extent of stenosis, with adjustment for demographic and vascular risk factors. We tested effect modification by APOE ε4 genotype.
Results:
In 300 participants (mean age of 76y, 44% African-American, 56% female, 31% carriers of at least one APOE ε4 allele), intracranial plaque was found in 105 (35%) participants. Mean SUVR was higher in individuals with vs without plaque (1.34 ± 0.29 vs 1.27 ± 0.23, p=0.03). In adjusted models, plaque presence was not associated significantly with elevated SUVR in the total sample, nor was number of plaques. Associations between plaque presence and extent were generally stronger in APOE ε4 carriers than noncarriers (p<0.05 for interaction for some plaque features; see Table).
Conclusions:
Although intracranial arterial plaque or stenosis was not definitively associated with brain amyloid in this sample of nondemented older adults, associations with brain amyloid appeared stronger in carriers of an APOE ε4 allele, consistent with studies demonstrating a similar relationship as that seen with other more traditionally measured vascular risk factors.
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Affiliation(s)
| | | | - Qing Hao
- Mt Sinai Sch of Medicine, New York, NY
| | | | | | - Ye Qiao
- Johns Hopkins Univ, Baltimore, MD
| | | | | | - Yun Zhou
- Johns Hopkins Univ, Baltimore, MD
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HAO Q, Gottesman R, Qiao Y, Sharma R, Liu L, Selvin E, Matsushita K, Coresh J, Wasserman BA. Abstract TMP52: Association of Chronic Kidney Disease and Intracranial Atherosclerotic Disease by High Resolution Vessel Wall MRI: The ARIC Study. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tmp52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Chronic kidney disease (CKD) is associated with high risk of cardiovascular disease (CVD), independent of established cardiovascular risk factors, with cystatin C (cysC) demonstrating associations with CVD independent of creatinine-based kidney function. We tested the association between reduced kidney function (eGFR, cysC) and kidney damage (albuminuria) and intracranial atherosclerotic disease (ICAD) by vessel wall MRI (VWMRI) in the ARIC-Neurocognitive (ARIC-NCS) study.
Methods:
In this cross-sectional analysis, we sampled ARIC participants with kidney function measurements who completed intracranial VWMRI/MRA. eGFR was estimated by both creatinine and cysC(eGFRcr-cys). Albuminuria was assessed as urinary albumin-creatinine ratio (ACR). Presence and number of intracranial plaques and presence of ≥50% stenosis for individuals with plaques were considered as outcomes in separate multivariable binomial and multinomial logistic models, with adjustment for sociodemographic features, established cardiovascular risk factors, C-reactive protein, and use of antithrombotic and lipid lowering agents.
Results:
1762 participants (age 76.5±5.3) with interpretable MRI and kidney function measurements were included. eGFRcr-cys<60 ml/min/1.73 m
2
(vs≥ 60) was associated with plaque presence(adjusted OR 1.33, 95%CI 1.05-1.68). A similar association between ACR or cysC and plaque presence lost significance in adjusted models (ACR≥30 vs <10: OR 1.19, 95% CI 0.89-1.60; CysC: OR 1.19 for increase by 1 mg/L, 95% CI 0.78-1.82). In adjusted models, compared with eGFRcr-cys≥60 ml/min/1.73 m
2
, participants with eGFRcr-cys<60 had an OR of 1.47 (95% CI 1.1-1.96) for having 1 vs zero plaque, and an OR of 1.23 (95% CI 0.93-1.63) for having ≥2 vs zero plaques. eGFRcr-cys, CysC or ACR were not associated with ≥50% stenosis among those with plaques.
Conclusion:
In older adults in the ARIC study, reduced kidney function measured by eGFRcr-cys was independently associated with ICAD burden. The potential mechanism is unknown but may be mediated by decreased clearance of metabolic toxins or proinflammatory cytokines that may play roles in the pathogenesis of atherosclerosis. This finding may help to better identify a high risk population for ICAD.
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Affiliation(s)
- Qing HAO
- Neurology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | | | - Ye Qiao
- Radiology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Richa Sharma
- Neurology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Li Liu
- Radiology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Elizabeth Selvin
- Epidemiology, Johns Hopkins Bloomberg Sch of Public Health, Baltimore, MD
| | | | - Josef Coresh
- Epidemiology, Johns Hopkins Bloomberg Sch of Public Health, Baltimore, MD
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Hao Q, Qiao Y, Gottesman R, Sam K, Shahriari M, Johnson B, Williams N, Wasserman BA. Abstract TP116: Racial Difference in Intracranial Atherosclerotic Plaque Features by High-resolution Vessel Wall MRI. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Intracranial atherosclerotic stenosis (ICAS), the most common cause of stroke worldwide, is more prevalent in non-white populations including Asian, African-American and Hispanic individuals. We studied the racial difference (white vs non-white) in the plaque features of stroke patients with ICAS using vessel wall MRI (VWMRI).
Methods:
We retrospectively included stroke patients with etiology being intracranial atherosclerosis who received VWMRI. VWMRI was read by experienced neuroradiologists blinded to other clinic information. Culprit plaque was defined as a plaque in a relevant vessel responsible for the downstream ischemic lesion. In addition to plaque number and degree of the stenosis, other plaques features were analyzed, including degree of plaque enhancement(minimal, moderate and strong), plaque calcification and eccentricity. The association between race, cardiovascular risk factors and plaque features was tested in multivariable models.
Results:
In 64 stroke patients (mean age 55.6±13.4 y, 62.5% male, 43.8% non-whites), the median number of plaque was 3 (range 0-11). Compared with whites, non-whites have a higher number of plaques (median, 4 vs 3, p=0.029). Smoking was associated with presence of extensive plaque (defined as ≥3 plaques) and remained significant after adjustment for other risks factors (non-white race, hypertension, age≥55 and HbA1C≥6.5; adjusted OR 6.9, 95% CI 1.27-37.66). For culprit plaques, presence of ≥50% stenosis, strong plaque enhancement, eccentric pattern and calcification did not differ by race. LDL >100 mg/dl, history of hyperlipidemia and eGFR<60 mL/min/1.73 m
2
were each associated with presence of strong plaque enhancement, eccentric pattern and calcification respectively (OR 1.5, 95% CI 1.5-19.6; OR 9.9, 95% CI 1.1-85.6; OR 24, 95% CI 2.3-247.4; respectively).
Conclusion:
A higher number of intracranial atherosclerotic plaques was revealed by VWMRI in non-white stroke patients with stroke etiology being intracranial atherosclerosis, while the features of their culprit plaque were similar compared with white patients. History of smoking was significantly associated with presence of ≥3 plaques. Studies with larger sample size are needed to validate the above findings.
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Affiliation(s)
- Qing Hao
- Neurology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Ye Qiao
- Radiology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | | | - Kevin Sam
- Radiology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Mona Shahriari
- Radiology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Brenda Johnson
- Neurology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Nicole Williams
- Neurology, Johns Hopkins Univ Sch of Medicine, Baltimore, MD
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Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA. Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2018; 39:E9-E31. [PMID: 29326139 DOI: 10.3174/ajnr.a5488] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
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Affiliation(s)
- L Saba
- From the Department of Medical Imaging (L.S.), University of Cagliari, Cagliari, Italy
| | - C Yuan
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - T Saam
- Department of Radiology (T.S.), Ludwig-Maximilian University Hospital, Munich, Germany
| | - A R Moody
- Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D Li
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - C C Matouk
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - H R Jäger
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | | | - M E Kooi
- Department of Radiology (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Z Fan
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - D Saloner
- Department of Radiology and Biomedical Imaging (D.S.), University of California, San Francisco, California
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - D J Mikulis
- Division of Neuroradiology (D.J.M.), Department of Medical Imaging, University Health Network
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
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Otsuka F, Zhao X, Trout HH, Qiao Y, Wasserman BA, Nakano M, Macphee CH, Brandt M, Krug-Gourley S, Guo L, Ladich ER, Cheng Q, Davis HR, Finn AV, Virmani R, Kolodgie FD. Community-based statins and advanced carotid plaque: Role of CD163 positive macrophages in lipoprotein-associated phospholipase A 2 activity in atherosclerotic plaque. Atherosclerosis 2017; 267:78-89. [PMID: 29101839 DOI: 10.1016/j.atherosclerosis.2017.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Lipoprotein-associated phospholipase A2 (Lp-PLA2), an enzymatic inflammatory biomarker primarily bound to low-density lipoprotein cholesterol, is associated with an approximate twofold increased risk of cardiovascular disease and stroke. Despite indications that circulating Lp-PLA2 is sensitive to statins, it remains largely unknown whether statin usage exerts local effects on Lp-PLA2 expression at the site of atheromatous plaque. METHODS Carotid plaques (n = 38) were prospectively collected from symptomatic (n = 18) and asymptomatic (n = 20) patients with (n = 20) or without (n = 18) documented statin history. In all cases, endarterectomy was performed where the primary stenosis was removed in an undisturbed manner. Serial cryosections of the presenting lesion were assessed histologically for macrophages, Lp-PLA2, and cell death (apoptotic index). RESULTS Symptomatic lesions exhibited less calcification, with greater inflammation characterized by increased expression of CD68+ and CD163+ macrophage subsets, and Lp-PLA2. Symptomatic plaques also exhibited greater necrotic core area and increased apoptosis, as compared with asymptomatic lesions. In contrast, statin treatment did not appear to influence any of these parameters, except for the extent of apoptosis, which was less in statin treated as compared with statin naïve lesions. Overall, Lp-PLA2 expression correlated positively with necrotic core area, CD68+ and CD163+ macrophage area, and cell death. Finally, in vitro assays and dual immunofluorescence staining confirmed CD163-expressing monocytes/macrophages are also a major source of Lp-PLA2. CONCLUSIONS Statin treatment has no effect on local atherosclerotic lesion Lp-PLA2 activity, therefore, the addition of anti-inflammatory treatments to further decrease macrophage Lp-PLA2 expression in atherosclerotic lesions may reduce lesional inflammation and cell death, and prevent necrotic core expansion and lesion progression.
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Affiliation(s)
| | | | - Hugh H Trout
- Department of Surgery, Suburban Hospital, Bethesda, MD, USA
| | - Ye Qiao
- Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Bruce A Wasserman
- Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | | - Liang Guo
- CVPath Institute, Inc., Gaithersburg, MD, USA
| | | | - Qi Cheng
- CVPath Institute, Inc., Gaithersburg, MD, USA
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45
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Li W, Xu F, Schär M, Liu J, Shin T, Zhao Y, van Zijl PCM, Wasserman BA, Qiao Y, Qin Q. Whole-brain arteriography and venography: Using improved velocity-selective saturation pulse trains. Magn Reson Med 2017; 79:2014-2023. [PMID: 28799210 DOI: 10.1002/mrm.26864] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 03/14/2017] [Revised: 06/21/2017] [Accepted: 07/15/2017] [Indexed: 11/07/2022]
Abstract
PURPOSE To develop velocity-selective (VS) MR angiography (MRA) protocols for arteriography and venography with whole-brain coverage. METHODS Tissue suppression using velocity-selective saturation (VSS) pulse trains is sensitive to radiofrequency field (B1 +) inhomogeneity. To reduce its sensitivity, we replaced the low-flip-angle hard pulses in the VSS pulse train with optimal composite (OCP) pulses. Additionally, new pulse sequences for arteriography and venography were developed by placing spatially selective inversion pulses with a delay to null signals from either venous or arterial blood. The VS MRA techniques were compared to the time-of-flight (TOF) MRA in six healthy subjects and two patients at 3T. RESULTS More uniform suppression of stationary tissue was observed when the hard pulses were replaced by OCP pulses in the VSS pulse trains, which improved contrast ratios between blood vessels and tissue background for both arteries (0.87 vs. 0.77) and veins (0.80 vs. 0.59). Both arteriograms and venograms depicted all major cervical and intracranial arteries and veins, respectively. Compared to TOF MRA, VS MRA not only offers larger spatial coverage but also depicts more small vessels. Initial clinical feasibility was shown in two patients with comparisons to TOF protocols. CONCLUSION Noncontrast-enhanced whole-brain arteriography and venography can be obtained without losing sensitivity to small vessel detection. Magn Reson Med 79:2014-2023, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Wenbo Li
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Feng Xu
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Developing Brain Research Lab, Children's National Medical Center, Washington, DC, USA
| | - Michael Schär
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jing Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Radiology, Guizhou Medical University Affiliated Hospital, Guiyang, Guizhou Province, China
| | - Taehoon Shin
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea.,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Maryland, USA
| | | | - Peter C M van Zijl
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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Dearborn JL, Zhang Y, Qiao Y, Suri MFK, Liu L, Gottesman RF, Rawlings AM, Mosley TH, Alonso A, Knopman DS, Guallar E, Wasserman BA. Intracranial atherosclerosis and dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2017; 88:1556-1563. [PMID: 28330958 DOI: 10.1212/wnl.0000000000003837] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/24/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To explore the association of intracranial atherosclerotic disease (ICAD) with mild cognitive impairment (MCI) and dementia. METHODS From 2011 to 2013, 1,744 participants completed high-resolution vessel wall MRI from the population-based Atherosclerosis Risk in Communities Study by a sampling strategy that allowed weighting back to the cohort. We defined ICAD by plaque features (presence, territory, stenosis, number). Trained clinicians used an algorithm incorporating information from interviews and neuropsychological and neurologic examinations to adjudicate for MCI and dementia. We determined the relative prevalence ratio (RPR) of MCI or dementia after adjusting for risk factors at midlife using multinomial logistic regression. RESULTS A total of 601 (34.5%) participants had MCI (mean age ± SD, 76.6 ± 5.2 years), 83 (4.8%) had dementia (79.1 ± 5.3 years), and 857 (49.1%) were current or former smokers. Anterior cerebral artery (ACA) plaque (adjusted RPR 3.81, 95% confidence interval [CI] 1.57-9.23), >2 territories with plaque (adjusted RPR 2.12, 95% CI 1.00-4.49), and presence of stenosis >50% (adjusted RPR 1.92, 95% CI 1.01-3.65) were associated with increased prevalence of dementia in separate models. Posterior cerebral artery plaque was associated with MCI but did not reach statistical significance for dementia (adjusted RPR MCI 1.43, 95% CI 1.04-1.98; adjusted RPR dementia 1.58, 95% CI 0.79-2.85). There were no associations with middle cerebral artery atherosclerotic lesions or cognitive impairment. Many participants had plaque in >1 territory (n = 291, 46%) and participants with ACA plaques (n = 69) had the greatest number of plaques in other territories (mean 6.0, SD 4.4). CONCLUSIONS This study demonstrates associations between ICAD and clinical MCI and dementia.
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Affiliation(s)
- Jennifer L Dearborn
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Yiyi Zhang
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Ye Qiao
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Muhammad Fareed K Suri
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Li Liu
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Rebecca F Gottesman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Andreea M Rawlings
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Thomas H Mosley
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Alvaro Alonso
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Eliseo Guallar
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN
| | - Bruce A Wasserman
- From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
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47
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Mandell DM, Mossa-Basha M, Qiao Y, Hess CP, Hui F, Matouk C, Johnson MH, Daemen MJAP, Vossough A, Edjlali M, Saloner D, Ansari SA, Wasserman BA, Mikulis DJ. Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2016; 38:218-229. [PMID: 27469212 DOI: 10.3174/ajnr.a4893] [Citation(s) in RCA: 397] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial vessel wall MR imaging is an adjunct to conventional angiographic imaging with CTA, MRA, or DSA. The technique has multiple potential uses in the context of ischemic stroke and intracranial hemorrhage. There remain gaps in our understanding of intracranial vessel wall MR imaging findings and research is ongoing, but the technique is already used on a clinical basis at many centers. This article, on behalf of the Vessel Wall Imaging Study Group of the American Society of Neuroradiology, provides expert consensus recommendations for current clinical practice.
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Affiliation(s)
- D M Mandell
- From the Division of Neuroradiology (D.M.M., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - M Mossa-Basha
- Department of Radiology (M.M.-B.), University of Washington, Seattle, Washington
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - C P Hess
- Department of Radiology and Biomedical Imaging (C.P.H., D.S.), University of California, San Francisco, San Francisco, California
| | - F Hui
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - C Matouk
- Departments of Neurosurgery (C.M., M.H.J.).,Radiology and Biomedical Imaging (C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery (C.M., M.H.J.).,Radiology and Biomedical Imaging (C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - M J A P Daemen
- Department of Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, the Netherlands
| | - A Vossough
- Departments of Surgery (A.V.).,Radiology (A.V.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Edjlali
- Department of Radiology (M.E.), Université Paris Descartes Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - D Saloner
- Department of Radiology and Biomedical Imaging (C.P.H., D.S.), University of California, San Francisco, San Francisco, California
| | - S A Ansari
- Departments of Radiology (S.A.A.).,Neurology (S.A.A.).,Neurological Surgery (S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - D J Mikulis
- From the Division of Neuroradiology (D.M.M., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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48
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Dearborn JL, Qiao Y, Guallar E, Steffen LM, Gottesman RF, Zhang Y, Wasserman BA. Polyunsaturated fats, carbohydrates and carotid disease: The Atherosclerosis Risk in Communities (ARIC) Carotid MRI study. Atherosclerosis 2016; 251:361-366. [PMID: 27234460 DOI: 10.1016/j.atherosclerosis.2016.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/21/2016] [Accepted: 05/13/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Carbohydrates and fat intake have both been linked to development of atherosclerosis. We examined associations between glycemic index (GI) and fat intake with carotid atherosclerosis. METHODS The Atherosclerosis Risk in Communities (ARIC) cohort enrolled participants during the period 1987-1989 and the Carotid MRI sub-study occurred between 2004 and 2006 (1672 participants attending both visits). Measures of carbohydrate quality (usual GI), fat intake (total, polyunsaturated and saturated) and overall dietary quality index (DASH Diet Score) were derived from a 66-item food frequency questionnaire administered at baseline. Trained readers measured lipid core presence and maximum wall thickness. Using multivariate logistic regression, we determined the odds of lipid core presence by quintile (Q) of energy-adjusted dietary components. Restricted cubic spline models were used to examine non-linear associations between dietary components and maximum wall thickness. RESULTS Mean daily polyunsaturated fat intake was 5 g (SD 1.4). GI and polyunsaturated fat intake had a nonlinear relationship with maximum wall thickness. Low (1-4 g) and high (6-12 g) polyunsaturated fat intake were associated with a statistically significant decreased odds of lipid core presence compared to intake in a majority of participants (OR Q5 vs. Q2-4: 0.64, 95% CI 0.42 to 0.98; OR Q1 vs. Q2-4: 0.64, 95% CI 0.42, 0.96), however, the association with lipid core was attenuated by adjustment for maximum wall thickness, hypertension, hyperlipidemia, and diabetes. CONCLUSIONS GI and polyunsaturated fat intake were not associated with high-risk plaque features, such as lipid core presence, independent of traditional vascular risk factors.
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Affiliation(s)
- Jennifer L Dearborn
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rebecca F Gottesman
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yiyi Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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49
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Suri MFK, Qiao Y, Ma X, Guallar E, Zhou J, Zhang Y, Liu L, Chu H, Qureshi AI, Alonso A, Folsom AR, Wasserman BA. Prevalence of Intracranial Atherosclerotic Stenosis Using High-Resolution Magnetic Resonance Angiography in the General Population: The Atherosclerosis Risk in Communities Study. Stroke 2016; 47:1187-93. [PMID: 27056984 PMCID: PMC5319392 DOI: 10.1161/strokeaha.115.011292] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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: 08/31/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke, but little is known about its epidemiology. We studied the prevalence of ICAS and its association with vascular risk factors using high-resolution magnetic resonance angiography in a US cardiovascular cohort. METHODS The Atherosclerosis Risk in Communities (ARIC) study recruited participants from 4 US communities from 1987 to 1989. Using stratified sampling, we selected 1980 participants from visit 5 (2011-2013) for high-resolution 3T-magnetic resonance angiography. All images were analyzed in a centralized laboratory, and ICAS was graded as: no stenosis, <50% stenosis, 50% to 69% stenosis, 70% to 99% stenosis, and complete occlusion. We calculated per-vessel and per-person prevalence of ICAS (weighted for n=6538 visit 5 participants) and also estimated the US prevalence. We used multivariable logistic regression to identify variables independently associated with ICAS. RESULTS Subjects who had an adequate magnetic resonance angiography (n=1765) were aged 67 to 90 years, 41% were men, 70% were white, and 29% were black. ICAS was prevalent in 31% of participants and 9% had ICAS ≥50%. Estimated US prevalence of ICAS ≥50% for 65 to 90 years old was 8% for whites and 12% for blacks. Older age, black race, higher systolic blood pressure, and higher low-density lipoprotein cholesterol levels were associated with increased odds of ICAS, whereas higher levels of high-density lipoprotein cholesterol and use of cholesterol-lowering medications were associated with decreased odds of ICAS. Body mass index and smoking were not associated with ICAS. CONCLUSIONS The prevalence of ICAS in older adults is high, and it could be a target for primary prevention of stroke and dementia in this population.
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Affiliation(s)
- Muhammad Fareed K Suri
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.).
| | - Ye Qiao
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Xiaoye Ma
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Eliseo Guallar
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Jincheng Zhou
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Yiyi Zhang
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Li Liu
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Haitao Chu
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Adnan I Qureshi
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Alvaro Alonso
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Aaron R Folsom
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
| | - Bruce A Wasserman
- From the Department of Neurology (M.F.K.S., A.I.Q.), Division of Epidemiology and Community Health, School of Public Health (A.A., A.R.F.), and Division of Biostatistics, School of Public Health (X.M., J.Z., H.C.), University of Minnesota, Minneapolis; Departments of Epidemiology (E.G., L.L.) and Medicine (E.G., L.L.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z.); and The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., B.A.W.)
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50
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Qiao Y, Guallar E, Wasserman BA. Response to Letter Regarding Article, "Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients". Stroke 2016; 47:e87. [PMID: 27079810 DOI: 10.1161/strokeaha.116.012970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD
| | - Eliseo Guallar
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD
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