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Shen M, Gao P, Chen S, Zhao X, Li R, Du W, Yuan C, Hatsukami T, Sui B. Differences in distribution and features of carotid and middle cerebral artery plaque in patients with pial infarction and perforating artery infarction: A 3D vessel wall imaging study. Eur J Radiol 2023; 167:111045. [PMID: 37586303 DOI: 10.1016/j.ejrad.2023.111045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 08/12/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Atherosclerotic plaques of carotid artery (CA) and middle cerebral artery (MCA) are important causes of acute ischemic stroke (AIS). This study was designed to jointly assess the plaque distribution and features of CA and MCA in AIS patients with pial infarction (PI) and perforating artery infarction (PAI), and to investigate the associations between plaque characteristics and ischemic infarction patterns. METHODS Imaging data of sixty-five patients from a cross-sectional study were reviewed. All the patients had acute infarction in the MCA territory on diffusion weighted imaging (DWI) and underwent CA and MCA vessel wall imaging (VWI). The CA and MCA plaque presence and high-risk features on the ipsilateral side of infarction were analyzed. The brain infarction lesions were divided into PI group vs. non-PI group, and PAI group vs. non-PAI group. Different plaque distribution types and plaque features were compared in each two groups, and their associations were investigated using binary logistic regression. RESULTS Sixty-five patients (mean age, 54.6 ± 10.1 years; 61 men) were included. The CA high-risk plaque (OR: 5.683 [1.409-22.929], P = 0.015) and MCA plaque presence (OR: 3.949 [1.397-11.162], P = 0.010) were significantly associated with PI. MCA plaques that involved the orifice of the perforating arteries were significantly associated with PAI (OR: 15.167 [1.851-124.257], P = 0.011). CONCLUSION CA and MCA plaques show distinct distribution and high-risk features in patients with PI and PAI. Combined intracranial and extracranial arteries imaging should be considered for the evaluation of the symptomatic ischemic patients.
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Affiliation(s)
- Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Beijing, China.
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Wanliang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China; Department of Radiology, University of Washington, Seattle, WA, USA
| | - Thomas Hatsukami
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Binbin Sui
- Beijing Neurosurgical Institute, Beijing, China; Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China.
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Xia S, Wang Y, Lv X, Chen C, Hui J, Wu X, Wang Z, Chen H, Ji J. The use of SNAP and T1-weighted VISTA in cervical artery dissection. Interv Neuroradiol 2023; 29:235-242. [PMID: 35234066 PMCID: PMC10369114 DOI: 10.1177/15910199221082847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Some cervical artery dissection (CAD) can't be easily confirmed by commonly used angiography techniques in clinical practice. We aimed to compare the abilities of the vessel wall magnetic resonance imaging (MRI) techniques including simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) sequence and T1-weighted volumetric isotropic turbo spin echo acquisition (T1-w VISTA) sequence alone for evaluating CAD. MATERIALS AND METHODS From July 2017 to October 2020, 59 patients underwent MRI examinations including SNAP and T1-w VISTA sequences for cervical artery pathologies. SNAP and T1-w VISTA images were retrospectively and independently reviewed to evaluate their diagnostic performances of CAD by using the final diagnosis as the reference standard which was established by clinical history, physical examination, and all available images. The agreement between T1-w VISTA and SNAP in the identification of the imaging features of CAD, including intramural hematoma (IMH), intimal flap, and double lumen, were compared. The IMH-wall contrasts by T1-w VISTA and SNAP were also compared. RESULTS CAD was confirmed in 43 of the 59 patients. T1-w VISTA and SNAP showed the same diagnostic performance, and their consistencies with the final diagnosis were good (κ = 0.776, p < 0.001). The sensitivity and specificity in CAD diagnosis were 0.978 and 0.750 for T1-w VISTA and SNAP. The IMH, intimal flap, and double lumen observed on SNAP were also determined by T1-w VISTA (κ = 1.000, p < 0.001 for all). The SNAP sequence showed higher IMH-wall contrast than T1-w VISTA (7.34 ± 4.56 vs. 3.12 ± 1.17, p < 0.001). CONCLUSIONS SNAP and T1-w VISTA sequences had the same performance in CAD diagnosis, thus they were both recommended. In addition, SNAP showed better IMH-wall contrast than T1-w VISTA.
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Affiliation(s)
- Shuiwei Xia
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chunmiao Chen
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Junguo Hui
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Xulu Wu
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Zufei Wang
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jiansong Ji
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
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Tang M, Gao J, Gao J, Yan X, Zhang X, Li L, Xia Z, Lei X, Zhang X. Evaluating intracranial artery dissection by using three-dimensional simultaneous non-contrast angiography and intra-plaque hemorrhage high-resolution magnetic resonance imaging: a retrospective study. Acta Radiol 2022; 63:401-409. [PMID: 33601894 DOI: 10.1177/0284185121992235] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND There was no previous report on the three-dimensional simultaneous non-contrast angiography and intra-plaque hemorrhage (3D-SNAP) magnetic resonance imaging (MRI) sequence to diagnose intracranial artery dissection (IAD). PURPOSE To improve the diagnostic accuracy and guide the clinical treatment for IAD by elucidating its pathological features using 3D-SNAP MRI. MATERIAL AND METHODS From January 2015 to September 2018, 113 patients with suspected IAD were analyzed. They were divided into IAD and non-IAD groups according to the spontaneous coronary artery dissection (SCAD) criteria. All patients underwent 3D-SNAP, 3D-TOF, T2W imaging, 3D-PD, 3D-T1W-VISTA, and 3D-T1WCE) using 3.0-T MRI; clinical data were collected. The IAD imaging findings (intramural hematoma, double lumen, intimal flap, aneurysmal dilatation, stenosis, or occlusion) in every sequence were analyzed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficiency of each sequence. RESULTS There was a significant difference in the probability of intramural hematoma, relative signal intensity of intramural hematoma, double lumen, stenosis, or occlusion signs on 3D-TOF, T2W, 3D-PD, 3D-T1W-VISTA, 3D-SNAP, and 3D-T1WCE sequences (P<0.05). The 3D-SNAP and 3D-T1WCE sequences were most sensitive for diagnosing intramural hematoma and displaying double-lumen signs, respectively. The diagnostic efficiency of the 3D-SNAP sequence combined with 3D-T1WCE was the highest (area under the curve [AUC] 0.966). The AUC value of the 3D-SNAP sequence (AUC 0.897) was slightly inferior to that of 3D-T1W enhancement (AUC 0.903). CONCLUSION 3D-SNAP MRI is a non-invasive and effective method and had the greatest potential among those methods tested for improving the diagnostic accuracy for IAD.
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Affiliation(s)
- Min Tang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Jinglong Gao
- Department of Neurology, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Jie Gao
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Xuejiao Yan
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Xin Zhang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Longchao Li
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Zhe Xia
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, PR China
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Cao X, Tang Y, Pan L, Yang J, Wu Y, Geng D, Zhang J. Assessment of carotid atherosclerotic plaque using 3D motion-sensitized driven-equilibrium prepared rapid gradient echo: a comparative study. Quant Imaging Med Surg 2021; 11:2744-2755. [PMID: 34079738 DOI: 10.21037/qims-20-869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background 3D motion-sensitized driven-equilibrium prepared rapid gradient echo (MERGE) can characterize carotid atherosclerotic plaque morphology and composition. The present study aimed to evaluate its performance by comparing it with reference images and assessing the inter-reader agreement. Methods Eighty-four patients were prospectively recruited and scanned with 3D MERGE. Two trained magnetic resonance imaging (MRI) readers measured and calculated the maximum wall thickness (WT), maximum vessel diameter, total vessel area, lumen area, wall area, normalized wall index, plaque volume, intraplaque hemorrhage (IPH) volume, and calcification volume independently. IPH, calcification, mixed calcification, and ulceration were identified. The intraclass correlation coefficient (ICC) with 95% confidence interval (CI) was used to assess the inter-reader agreement. MERGE performance was assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, kappa value (κ), and the results of the Bland-Altman analysis and compared with reference images. Results MERGE showed excellent inter-reader agreement (All ICCs >0.90). MERGE and simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) showed excellent agreement in detecting IPH (κ=0.938) and measuring IPH volume (ICC =0.995; 95% CI: 0.991-0.997). MERGE and computed tomography angiography (CTA) showed strong consistency in detecting calcification (κ=0.814) and mixed calcification (κ=0.972), and in measuring calcification volume (ICC =0.996; 95% CI: 0.993-0.997). MERGE and digital subtraction angiography (DSA) showed relatively strong consistency in identifying ulceration (κ=0.737). Conclusions MERGE showed excellent performance in identifying and measuring IPH and calcification in carotid atherosclerotic plaques. Therefore, MERGE can be a promising imaging approach in atherosclerotic-vulnerable plaque.
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Affiliation(s)
- Xin Cao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Ye Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Pan
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinming Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifan Wu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
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Hajhosseiny R, Prieto C, Qi H, Phinikaridou A, Botnar RM. Thrombosis and Embolism. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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6
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Histological validation of simultaneous non-contrast angiography and intraplaque hemorrhage imaging (SNAP) for characterizing carotid intraplaque hemorrhage. Eur Radiol 2020; 31:3106-3115. [PMID: 33052465 DOI: 10.1007/s00330-020-07352-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/17/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study sought to validate the performance of simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging in characterizing carotid IPH by histology. METHODS Thirty-five patients with carotid atherosclerotic disease (symptomatic 50-70% stenosis or > 70% stenosis) scheduled for carotid endarterectomy underwent 3.0-T carotid MR imaging by acquiring SNAP and magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) sequences. Presence and area of IPH were separately evaluated on SNAP and MP-RAGE images. Presence and area of IPH were also assessed on histology. Agreement between SNAP/MP-RAGE and histology was determined in identify and quantify IPH using Cohen kappa, Spearman correlation, and Bland-Altman analyses. RESULTS Of all 35 patients (mean age: 63.1 ± 8.8 years; 27 males), 128 slices with successful registration were eligible for analysis. The accuracy, sensitivity, specificity, and positive and negative predictive values were 86.7%, 85%, 89.6%, 93.2%, and 78.2% for SNAP, and 76.6%, 75%, 79.2%, 85.7%, and 65.5% for MP-RAGE in identification of IPH, respectively. In identification of IPH, the kappa value between SNAP and histology and between MP-RAGE and histology was 0.725 and 0.520, respectively. The correlation between SNAP and histology (r = 0.805, p < 0.001) was stronger than that between MP-RAGE and histology (r = 0.637, p < 0.001) in measuring IPH area. Bland-Altman analysis showed that, in measuring IPH area, the bias of SNAP (1.4 mm2, 95% CI: - 0.016 to 2.883) was smaller than that of MP-RAGE (1.7 mm2, 95% CI: - 0.039 to 3.430) compared with histology. CONCLUSIONS This validation study by histology demonstrates that SNAP sequence better identifies and quantifies carotid intraplaque hemorrhage compared with traditional MP-RAGE sequence. KEY POINTS • SNAP imaging showed better agreement with histology compared with MP-RAGE imaging, especially for the IPHs with small size. • SNAP sequence is a more effective tool to identify and quantify carotid IPH than traditional sequence of MP-RAGE that can help clinicians to optimizing the treatment strategy. • The plaque components of rich lipid pools or loose matrix and chronic/old IPH (cholesterol crystals) can lead to false positive and false negative results in SNAP and MP-RAGE imaging for identifying IPH.
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7
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Hajhosseiny R, Bahaei TS, Prieto C, Botnar RM. Molecular and Nonmolecular Magnetic Resonance Coronary and Carotid Imaging. Arterioscler Thromb Vasc Biol 2020; 39:569-582. [PMID: 30760017 DOI: 10.1161/atvbaha.118.311754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerosis is the leading cause of cardiovascular morbidity and mortality. Over the past 2 decades, increasing research attention is converging on the early detection and monitoring of atherosclerotic plaque. Among several invasive and noninvasive imaging modalities, magnetic resonance imaging (MRI) is emerging as a promising option. Advantages include its versatility, excellent soft tissue contrast for plaque characterization and lack of ionizing radiation. In this review, we will explore the recent advances in multicontrast and multiparametric imaging sequences that are bringing the aspiration of simultaneous arterial lumen, vessel wall, and plaque characterization closer to clinical feasibility. We also discuss the latest advances in molecular magnetic resonance and multimodal atherosclerosis imaging.
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Affiliation(s)
- Reza Hajhosseiny
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,National Heart and Lung Institute, Imperial College London, United Kingdom (R.H.)
| | - Tamanna S Bahaei
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.)
| | - Claudia Prieto
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
| | - René M Botnar
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
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8
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Xiong Y, Zhang Z, He L, Ma Y, Han H, Zhao X, Guo H. Intracranial simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MRA: Analyzation, optimization, and extension for dynamic MRA. Magn Reson Med 2019; 82:1646-1659. [DOI: 10.1002/mrm.27855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Yuhui Xiong
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Zhe Zhang
- China National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital, Capital Medical University Beijing People's Republic of China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Yu Ma
- Tsinghua University Yuquan Hospital Beijing People's Republic of China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine Tsinghua University Beijing People's Republic of China
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Qi H, Sun J, Qiao H, Zhao X, Guo R, Balu N, Yuan C, Chen H. Simultaneous T 1 and T 2 mapping of the carotid plaque (SIMPLE) with T 2 and inversion recovery prepared 3D radial imaging. Magn Reson Med 2018; 80:2598-2608. [PMID: 29802629 DOI: 10.1002/mrm.27361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To propose a technique that can produce different T1 and T2 contrasts in a single scan for simultaneous T1 and T2 mapping of the carotid plaque (SIMPLE). METHODS An interleaved 3D golden angle radial trajectory was used in conjunction with T2 preparation with variable duration (TEprep ) and inversion recovery pulses. Sliding window reconstruction was adopted to reconstruct images at different inversion delay time and TEprep for joint T1 and T2 fitting. In the fitting procedure, a rapid B1 correction method was presented. The accuracy of SIMPLE was investigated in phantom experiments. In vivo scans were performed on 5 healthy volunteers with 2 scans each, and on 5 patients with carotid atherosclerosis. RESULTS The phantom T1 and T2 estimations of SIMPLE agreed well with the standard methods with the percentage difference smaller than 7.1%. In vivo T1 and T2 for normal carotid vessel wall were 1213 ± 48.3 ms and 51.1 ± 1.7 ms, with good interscan repeatability. Alternations of T1 and T2 in plaque regions were in agreement with the conventional multicontrast imaging findings. CONCLUSION The proposed SIMPLE allows simultaneous T1 and T2 mapping of the carotid artery in less than 10 minutes, serving as a quantitative tool with good accuracy and reproducibility for plaque characterization.
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Affiliation(s)
- Haikun Qi
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Rui Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Cattaneo M, Wyttenbach R, Corti R, Staub D, Gallino A. The Growing Field of Imaging of Atherosclerosis in Peripheral Arteries. Angiology 2018; 70:20-34. [PMID: 29783854 DOI: 10.1177/0003319718776122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the past decades, peripheral arteries have represented a model for the comprehension of atherosclerosis as well as for the development of new diagnostic imaging modalities and therapeutic strategies. Peripheral arteries may represent a window to study atherosclerosis. Pathology has prominently contributed to move the clinical and research attention from the arterial lumen stenosis and angiography to morphological and functional imaging techniques. Evidence from large and prospective cohort or randomized controlled studies is still modest. Nevertheless, several emerging imaging investigations represent a potential tool for a comprehensive "in vivo" evaluation of the entire natural history of peripheral atherosclerosis. This constitutes a demanding assignment, as it would be desirable to obtain both single-lesion focused and extensive arterial system views to achieve the most accurate prognostic information. Our narrative review rests upon the fundamental pathological evidence, summarizing the rapidly growing field of imaging of atherosclerosis in peripheral arteries and presenting a selection of both currently available and emerging imaging techniques.
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Affiliation(s)
- Mattia Cattaneo
- 1 Cardiovascular Medicine Department, Ospedale Regionale di Bellinzona e Valli, San Giovanni, Bellinzona, Switzerland
| | - Rolf Wyttenbach
- 2 Radiology Department, Ospedale Regionale di Bellinzona e Valli, San Giovanni, Bellinzona, Switzerland.,3 University of Bern, Bern, Switzerland
| | - Roberto Corti
- 4 Cardiology Department, HerzKlinik Hirslanden, Zurich, Switzerland
| | - Daniel Staub
- 5 Angiology Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Augusto Gallino
- 1 Cardiovascular Medicine Department, Ospedale Regionale di Bellinzona e Valli, San Giovanni, Bellinzona, Switzerland.,6 University of Zurich, Zurich, Switzerland
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Fujiwara Y, Maruyama H, Toyomaru K, Nishizaka Y, Fukamatsu M. Quantitative T 1 and T 2* carotid atherosclerotic plaque imaging using a three-dimensional multi-echo phase-sensitive inversion recovery sequence: a feasibility study. Radiol Phys Technol 2018; 11:156-164. [PMID: 29512056 DOI: 10.1007/s12194-018-0449-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
Magnetic resonance imaging (MRI) is widely used to detect carotid atherosclerotic plaques. Although it is important to evaluate vulnerable carotid plaques containing lipids and intra-plaque hemorrhages (IPHs) using T1-weighted images, the image contrast changes depending on the imaging settings. Moreover, to distinguish between a thrombus and a hemorrhage, it is useful to evaluate the iron content of the plaque using both T1-weighted and T2*-weighted images. Therefore, a quantitative evaluation of carotid atherosclerotic plaques using T1 and T2* values may be necessary for the accurate evaluation of plaque components. The purpose of this study was to determine whether the multi-echo phase-sensitive inversion recovery (mPSIR) sequence can improve T1 contrast while simultaneously providing accurate T1 and T2* values of an IPH. T1 and T2* values measured using mPSIR were compared to values from conventional methods in phantom and in vivo studies. In the phantom study, the T1 and T2* values estimated using mPSIR were linearly correlated with those of conventional methods. In the in vivo study, mPSIR demonstrated higher T1 contrast between the IPH phantom and sternocleidomastoid muscle than the conventional method. Moreover, the T1 and T2* values of the blood vessel wall and sternocleidomastoid muscle estimated using mPSIR were correlated with values measured by conventional methods and with values reported previously. The mPSIR sequence improved T1 contrast while simultaneously providing accurate T1 and T2* values of the neck region. Although further study is required to evaluate the clinical utility, mPSIR may improve carotid atherosclerotic plaque detection and provide detailed information about plaque components.
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Affiliation(s)
- Yasuhiro Fujiwara
- Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto, 862-0976, Japan.
| | - Hirotoshi Maruyama
- Radiological Center, National Hospital Organization Kumamoto Saisyunsou Hospital, Kumamoto, Japan
| | - Kanako Toyomaru
- Course of Radiological Science, School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuri Nishizaka
- Course of Radiological Science, School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Masahiro Fukamatsu
- Radiological Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
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12
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Chen S, Zhao H, Li J, Zhou Z, Li R, Balu N, Yuan C, Chen H, Zhao X. Evaluation of carotid atherosclerotic plaque surface characteristics utilizing simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) technique. J Magn Reson Imaging 2018; 47:634-639. [PMID: 28766810 PMCID: PMC5796877 DOI: 10.1002/jmri.25815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the feasibility of the Simultaneous Noncontrast Angiography and intraPlaque hemorrhage (SNAP) technique in identification of carotid plaque surface characteristics compared with the conventional multicontrast vessel wall imaging protocol. MATERIALS AND METHODS Thirty symptomatic patients with carotid plaque were recruited and underwent carotid artery magnetic resonance imaging (MRI) (3.0T) using a conventional multicontrast protocol and SNAP sequence. As an intrinsic multicontrast sequence, SNAP could generate a gray blood reference (Ref) image set, a black blood corrected real (CR) image set, and a bright blood MR angiography (MRA) image set. A bright blood SNAP Ref2 image was implemented by combining Ref and MRA images for facilitating plaque surface characteristics evaluation. The presence/absence of calcification (CA), juxtaluminal calcification (JCA), and ulceration was assessed. The agreement between SNAP and multicontrast vessel wall protocol in identifying CA, JCA, and ulceration was analyzed using Cohen's kappa analysis. The interreader and intrareader reproducibility of SNAP imaging in identifying plaque surface characteristics was also assessed. RESULTS Good to excellent agreement was found between SNAP and conventional multicontrast protocol in identifying CA (κ = 0.74, 95% confidence interval [CI]: 0.54-0.93), JCA (κ = 0.81, 95% CI: 0.66-0.97), and ulceration (κ = 0.82, 95% CI: 0.65-0.99). In addition, excellent intrareader and interreader reproducibility was found for SNAP imaging in identification of CA, JCA, and ulceration. CONCLUSION SNAP imaging showed excellent agreement with multicontrast imaging and high reproducibility in identification of both JCA and ulceration, suggesting that SNAP imaging may be a time-efficient, alternative tool in identification of plaque surface characteristics in carotid arteries. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:634-639.
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Affiliation(s)
- Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Jifan Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Zechen Zhou
- Healthcare Department, Philips Research China, Shanghai, P.R. China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
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Li D, Zhao H, Chen X, Chen S, Qiao H, He L, Li R, Xu J, Yuan C, Zhao X. Identification of intraplaque haemorrhage in carotid artery by simultaneous non-contrast angiography and intraPlaque haemorrhage (SNAP) imaging: a magnetic resonance vessel wall imaging study. Eur Radiol 2017; 28:1681-1686. [PMID: 29098439 DOI: 10.1007/s00330-017-5096-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/05/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the usefulness of Simultaneous Non-contrast Angiography and intraPlaque haemorrhage (SNAP) imaging in characterising carotid intraplaque haemorrhage (IPH) compared with magnetisation-prepared rapid acquisition gradient-echo (MP-RAGE) sequence. METHODS Fifty-four symptomatic patients (mean age: 63.1 ± 5.7 years, 38 males) with carotid atherosclerosis were recruited and underwent carotid MR imaging. The presence and area of IPH on SNAP and MP-RAGE images were determined. The agreement in identifying IPH and its area between SNAP and MP-RAGE was analysed. RESULTS Of 1368 slices with acceptable image quality in 54 patients, 13% and 22.6% were found to have IPH on MP-RAGE and SNAP images, respectively. There was moderate agreement between MP-RAGE and SNAP sequences in identifying IPH (κ = 0.511, p = 0.029). The area of IPH on SNAP images was significantly larger than that on MP-RAGE images (17.9 ± 18.2 mm2 vs. 9.2 ± 10.5 mm2, p < 0.001). For IPHs detected by SNAP imaging, the area of IPHs also detected by the MP-RAGE sequence was significantly larger than that of IPHs not detected by the MP-RAGE sequence (17.9 ± 19.2 mm2 vs. 6.4 ± 6.2 mm2, p < 0.001). CONCLUSION Compared with the MP-RAGE sequence, SNAP imaging detects more IPHs, particularly for smaller IPHs, suggesting that SNAP imaging might be a more sensitive tool for identification of carotid haemorrhagic plaques. KEY POINTS • Moderate agreement was found between SNAP and MP-RAGE in identification of IPH • SNAP imaging might be a more sensitive tool to detect carotid IPHs • Compared with the MP-RAGE sequence, SNAP imaging can detect carotid IPHs with smaller size • SNAP imaging can help clinicians to optimise the treatment strategy.
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Affiliation(s)
- Dongye Li
- Centre for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyi Chen
- Centre for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Shuo Chen
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Huiyu Qiao
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Le He
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Rui Li
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chun Yuan
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Xihai Zhao
- Centre for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, Haidian District, 100084, China.
- Centre of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
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Xu X, Geng H, Zhang Q, Yu J, Chu Y, Dong G, Wu J. Investigation of 3D reduced field of view carotid atherosclerotic plaque imaging. Magn Reson Imaging 2017; 49:10-15. [PMID: 28958875 DOI: 10.1016/j.mri.2017.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/19/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022]
Abstract
To investigate the feasibility of using CUBE based reduced field of view imaging in atherosclerotic plaque imaging. Twenty-four patients were enrolled in this prospective study (13 males, 11 females, age 63±10). All patients underwent MRI exams consisting of 3D TOF, MPRAGE, iMSDE, DANTE, full FOV and reduced FOV CUBE imaging; 18 patients under went contrast enhanced imaging. The resulting images from different imaging sequences were assessed in terms of blood suppression, SNR, motion artifacts and vascular clarity. Reduced field of view CUBE outperformed MPRAGE, iMSDE and full FOV CUBE in blood suppression (P<0.05); outperformed MPRAGE, iMSDE and DANTE in SNR(P<005); outperformed MPRAGE and iMSDE in motion artifacts (P<005); outperformed MPRAGE and iMSDE in vascular clarity (P<0.05). The identifications of hemorrhage and calcification components were consistent between full FOV CUBE and reduced FOV CUBE (P<0.05). Overall, CUBE combined with reduced field of view imaging would be a promising method in atherosclerotic plaque imaging.
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Affiliation(s)
- Xueyan Xu
- Weifang People's Hospital, Weifang, Shandong, China
| | - Hai Geng
- Weifang People's Hospital, Weifang, Shandong, China
| | - Qiang Zhang
- Weifang People's Hospital, Weifang, Shandong, China
| | - Jianmin Yu
- Weifang People's Hospital, Weifang, Shandong, China
| | - Yujing Chu
- Weifang People's Hospital, Weifang, Shandong, China
| | - Guang Dong
- Weifang People's Hospital, Weifang, Shandong, China
| | - Jun Wu
- Weifang People's Hospital, Weifang, Shandong, China.
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15
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Kerwin WS, Miller Z, Yuan C. Imaging of the high-risk carotid plaque: magnetic resonance imaging. Semin Vasc Surg 2017; 30:54-61. [PMID: 28818259 DOI: 10.1053/j.semvascsurg.2017.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The emergence of the concept of high-risk atherosclerotic plaque has led to considerable interest in noninvasive imaging techniques to identify high-risk features before clinical sequelae. For plaques in the carotid arteries, magnetic resonance imaging has undergone considerable histologic validation to link imaging features to indicators of plaque instability, including plaque burden, intraplaque hemorrhage, fibrous cap disruption, lipid rich necrotic core, and calcification. Recently introduced imaging technologies, especially those focused on three-dimensional imaging sequences, are now poised for integration into the clinical workup of patients with suspected carotid atherosclerosis. The purpose of this article is to review the carotid plaque magnetic resonance imaging techniques that are most ready for integration into the clinic.
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Affiliation(s)
- William S Kerwin
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Zach Miller
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109
| | - Chun Yuan
- University of Washington Vascular Imaging Lab, Department of Radiology, 850 Republican Street, Seattle, WA 98109.
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Abstract
We proposed and assessed a modified asymmetric Fourier imaging (AFI) technique named real-based polarity-preserving AFI (RepAFI), in which the low-pass filter kernel for background phase estimation in AFI is optimized to preserve the magnetization polarity information for blood vessels and cerebrospinal fluid (CSF) even for data obtained using phase-sensitive inversion-recovery spin-echo-based (PSIR-SE) sequences with asymmetrical sampling in the k-space. Our proposed RepAFI technique achieves a practical balance of image quality and simplicity to provide better performance than conventional AFI methods.
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Affiliation(s)
- Tokunori Kimura
- Clinical Application Research and Development Department, Center for Medical Research and Development, Toshiba Medical Systems Corporation
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McNally JS, Kim SE, Mendes J, Hadley JR, Sakata A, De Havenon AH, Treiman GS, Parker DL. Magnetic Resonance Imaging Detection of Intraplaque Hemorrhage. MAGNETIC RESONANCE INSIGHTS 2017; 10:1-8. [PMID: 28469441 PMCID: PMC5348123 DOI: 10.1177/1178623x17694150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/25/2017] [Indexed: 11/16/2022]
Abstract
Carotid artery atherosclerosis is a major cause of ischemic stroke. For more than 30 years, future stroke risk and carotid stroke etiology have been determined using percent diameter stenosis based on clinical trials in the 1990s. In the past 10 years, magnetic resonance imaging (MRI) sequences have been developed to detect carotid intraplaque hemorrhage. By detecting carotid intraplaque hemorrhage, MRI identifies potential stroke sources that are often overlooked by lumen imaging. In addition, MRI can dramatically improve assessment of future stroke risk beyond lumen stenosis alone. In this review, we discuss the use of heavily T1-weighted MRI sequences used to detect carotid intraplaque hemorrhage. In addition, advances in ciné imaging, motion robust techniques, and specialized neck coils will be reviewed. Finally, the clinical use and future impact of MRI plaque hemorrhage imaging will be discussed.
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Affiliation(s)
- J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Seong-Eun Kim
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Jason Mendes
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - J Rock Hadley
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Akihiko Sakata
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Adam H De Havenon
- Department of Neurology, The University of Utah, Salt Lake City, UT, USA
| | - Gerald S Treiman
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
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Zhang N, Zhang L, Yang Q, Pei A, Tong X, Chung YC, Liu X. A fast screening protocol for carotid plaques imaging using 3D multi-contrast MRI without contrast agent. Magn Reson Imaging 2016; 39:89-97. [PMID: 27989914 DOI: 10.1016/j.mri.2016.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To implement a fast (~15min) MRI protocol for carotid plaque screening using 3D multi-contrast MRI sequences without contrast agent on a 3Tesla MRI scanner. MATERIALS AND METHODS 7 healthy volunteers and 25 patients with clinically confirmed transient ischemic attack or suspected cerebrovascular ischemia were included in this study. The proposed protocol, including 3D T1-weighted and T2-weighted SPACE (variable-flip-angle 3D turbo spin echo), and T1-weighted magnetization prepared rapid acquisition gradient echo (MPRAGE) was performed first and was followed by 2D T1-weighted and T2-weighted turbo spin echo, and post-contrast T1-weighted SPACE sequences. Image quality, number of plaques, and vessel wall thicknesses measured at the intersection of the plaques were evaluated and compared between sequences. RESULTS Average examination time of the proposed protocol was 14.6min. The average image quality scores of 3D T1-weighted, T2-weighted SPACE, and T1-weighted magnetization prepared rapid acquisition gradient echo were 3.69, 3.75, and 3.48, respectively. There was no significant difference in detecting the number of plaques and vulnerable plaques using pre-contrast 3D images with or without post-contrast T1-weighted SPACE. The 3D SPACE and 2D turbo spin echo sequences had excellent agreement (R=0.96 for T1-weighted and 0.98 for T2-weighted, p<0.001) regarding vessel wall thickness measurements. CONCLUSION The proposed protocol demonstrated the feasibility of attaining carotid plaque screening within a 15-minute scan, which provided sufficient anatomical coverage and critical diagnostic information. This protocol offers the potential for rapid and reliable screening for carotid plaques without contrast agent.
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Affiliation(s)
- Na Zhang
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China; Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Lei Zhang
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China
| | - Qi Yang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Anqi Pei
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoxin Tong
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yiu-Cho Chung
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China
| | - Xin Liu
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen Key Laboratory for MRI, Shenzhen, China.
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In Vivo Validation of Simultaneous Non-Contrast Angiography and intraPlaque Hemorrhage (SNAP) Magnetic Resonance Angiography: An Intracranial Artery Study. PLoS One 2016; 11:e0149130. [PMID: 26863432 PMCID: PMC4749283 DOI: 10.1371/journal.pone.0149130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/27/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives Simultaneous Non-contrast Angiography and intraPlaque hemorrhage (SNAP) technique was recently proposed for joint MRA and intraplaque hemorrhage (IPH) imaging. The purpose of this study is to validate SNAP’s MRA performance in patients with suspected intracranial artery disease. Methods SNAP and time-of-flight (TOF) techniques with matched field of view and resolution were applied on 15 patients with suspected intracranial artery disease. Both techniques were evaluated based on their detection of luminal stenosis of bilateral middle cerebral arteries (MCA) and the delineation of smallest visible branches (SVB) of the MCA. Statistical analysis was conducted on the artery level. Results The SNAP MRA was found to provide similar stenosis detection performance when compared with TOF (Cohen’s κ 0.79; 95% Confidence Interval: 0.56–0.99). For the SVB comparison, SNAP was found to provide significantly better small artery delineation than TOF (p = 0.017). Inter-reader reproducibility for both measurements on SNAP was over 0.7. SNAP also detected IPH lesions on 13% of the patients. Conclusions The SNAP technique’s MRA performance was optimized and compared against TOF for intracranial artery atherosclerosis imaging and was found to provide comparable stenosis detection accuracy. Along with its IPH detection capability, SNAP holds the potential to become a first-line screening tool for high risk intracranial atherosclerosis disease evaluation.
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Chen S, Ning J, Zhao X, Wang J, Zhou Z, Yuan C, Chen H. Fast simultaneous noncontrast angiography and intraplaque hemorrhage (fSNAP) sequence for carotid artery imaging. Magn Reson Med 2016; 77:753-758. [PMID: 26786908 DOI: 10.1002/mrm.26111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/23/2015] [Accepted: 12/09/2015] [Indexed: 11/10/2022]
Abstract
PURPOSE To propose a fast simultaneous noncontrast angiography and intraplaque hemorrhage (fSNAP) sequence for carotid artery imaging. METHODS The proposed fSNAP sequence uses a low-resolution reference acquisition for phase-sensitive reconstruction to speed up the scan, and an inversion recovery acquisition with arbitrary k-space filling order to generate similar contrast to conventional SNAP. Four healthy volunteers and eight patients were recruited to test the performance of fSNAP in vivo. The lumen area quantification, muscle-blood CNR, IPH-blood CNR, lumen SNR, and standard deviation and intraplaque hemorrhage (IPH) detection accuracy were compared between fSNAP and SNAP. RESULTS By using a low-resolution reference acquisition with 1/4 matrix size of the full-resolution reference scan, the scan time of fSNAP was 37.5% less than that of SNAP. A high agreement of lumen area measurement (ICC = 0.97, 95% CI: 0.96-0.99) and IPH detection (Kappa = 1) were found between fSNAP and SNAP. Also, no significant difference was found for muscle-blood CNR (P = 0.25), IPH-blood CNR (P = 0.35), lumen SNR (P = 0.60), and standard deviation (P = 0.46) between the two techniques. CONCLUSION The feasibility of fSNAP was validated. fSNAP can improve the imaging efficiency with similar performance to SNAP on carotid artery imaging. Magn Reson Med 77:753-758, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jia Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, New York, USA
| | - Zechen Zhou
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Goel S, Miller A, Agarwal C, Zakin E, Acholonu M, Gidwani U, Sharma A, Kulbak G, Shani J, Chen O. Imaging Modalities to Identity Inflammation in an Atherosclerotic Plaque. Radiol Res Pract 2015; 2015:410967. [PMID: 26798515 PMCID: PMC4699110 DOI: 10.1155/2015/410967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022] Open
Abstract
Atherosclerosis is a chronic, progressive, multifocal arterial wall disease caused by local and systemic inflammation responsible for major cardiovascular complications such as myocardial infarction and stroke. With the recent understanding that vulnerable plaque erosion and rupture, with subsequent thrombosis, rather than luminal stenosis, is the underlying cause of acute ischemic events, there has been a shift of focus to understand the mechanisms that make an atherosclerotic plaque unstable or vulnerable to rupture. The presence of inflammation in the atherosclerotic plaque has been considered as one of the initial events which convert a stable plaque into an unstable and vulnerable plaque. This paper systemically reviews the noninvasive and invasive imaging modalities that are currently available to detect this inflammatory process, at least in the intermediate stages, and discusses the ongoing studies that will help us to better understand and identify it at the molecular level.
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Affiliation(s)
- Sunny Goel
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Avraham Miller
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Chirag Agarwal
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Elina Zakin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Acholonu
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Umesh Gidwani
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY 11203, USA
| | - Guy Kulbak
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - On Chen
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Zhou Z, Li R, Zhao X, He L, Wang X, Wang J, Balu N, Yuan C. Evaluation of 3D multi-contrast joint intra- and extracranial vessel wall cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2015; 17:41. [PMID: 26013973 PMCID: PMC4446075 DOI: 10.1186/s12968-015-0143-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 05/01/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multi-contrast vessel wall cardiovascular magnetic resonance (CMR) has demonstrated its capability for atherosclerotic plaque morphology measurement and component characterization in different vasculatures. However, limited coverage and partial volume effect with conventional two-dimensional (2D) techniques might cause lesion underestimation. The aim of this work is to evaluate the performance in a) blood suppression and b) vessel wall delineation of three-dimensional (3D) multi-contrast joint intra- and extracranial vessel wall imaging at 3T. METHODS Three multi-contrast 3D black blood (BB) sequences with T1, T2 and heavy T1 weighting and a custom designed 36-channel neurovascular coil covering the entire intra- and extracranial vasculature have been used and investigated in this study. Two healthy subjects were recruited for sequence parameter optimization and twenty-five patients were consecutively scanned for image quality and blood suppression assessment. Qualitative image scores of vessel wall delineation as well as quantitative Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) were evaluated at five typical locations ranging from common carotid arteries to middle cerebral arteries. RESULTS The 3D multi-contrast images acquired within 15mins allowed the vessel wall visualization with 0.8 mm isotropic spatial resolution covering intra- and extracranial segments. Quantitative wall and lumen SNR measurements for each sequence showed effective blood suppression at all selected locations (P < 0.0001). Although the wall-lumen CNR varied across measured locations, each sequence provided good or adequate image quality in both intra- and extracranial segments. CONCLUSIONS The proposed 3D multi-contrast vessel wall technique provides isotropic resolution and time efficient solution for joint intra- and extracranial vessel wall CMR.
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Affiliation(s)
- Zechen Zhou
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Xiaole Wang
- Department of Biomedical Engineering, Tsinghua University, Beijing, China.
| | - Jinnan Wang
- Department of Radiology, University of Washington, Seattle, WA, USA.
- Philips Research North America, Briarcliff Manor, NY, USA.
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
- Department of Radiology, University of Washington, Seattle, WA, USA.
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Anderson NG, Butler AP. Clinical applications of spectral molecular imaging: potential and challenges. CONTRAST MEDIA & MOLECULAR IMAGING 2014; 9:3-12. [PMID: 24470290 DOI: 10.1002/cmmi.1550] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/20/2013] [Accepted: 05/28/2013] [Indexed: 12/22/2022]
Abstract
Spectral molecular imaging is a new X-ray-based imaging technology providing highly specific 3D imaging at high spatial resolution that has the potential to measure disease activity and response to treatment noninvasively. The ability to identify and quantify components of tissue and biomarkers of disease activity derive from the properties of the photon-processing detector. Multiple narrow sections of the energy spectrum are sampled simultaneously, providing a range of energy dependent Hounsfield units. As each material has a specific measurable X-ray spectrum, spectroscopic imaging allows for multiple materials to be quantified and differentiated from each other simultaneously. The technology, currently in its infancy, is set to grow rapidly, much as magnetic resonance did. The critical clinical applications have not yet been established, but it is likely to play a major role in identifying and directing treatment for unstable atherosclerotic plaque, assessing activity and response to treatment of a range of inflammatory diseases, and monitoring biomarkers of cancer and its treatment. If combined with Positron-emission tomography (PET), spectral molecular imaging could have a far greater effective role in cancer diagnosis and treatment monitoring than PET-CT does at present. It is currently used for small animal and specimen imaging. There are many challenges to be overcome before spectral imaging can be introduced into clinical medicine - these include technological improvements to detector design, bonding to the semiconductor layer, image reconstruction and display software, identifying which biomarkers are of most relevance to the disease in question, and accelerating drug discovery enabled by the new capabilities provided by spectral imaging.
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Affiliation(s)
- Nigel G Anderson
- Academic Radiology and Centre for Bioengineering, University of Otago, Christchurch, New Zealand; Medical Imaging, Royal Hobart Hospital, Hobart, Australia
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Fan Z, Yu W, Xie Y, Dong L, Yang L, Wang Z, Conte AH, Bi X, An J, Zhang T, Laub G, Shah PK, Zhang Z, Li D. Multi-contrast atherosclerosis characterization (MATCH) of carotid plaque with a single 5-min scan: technical development and clinical feasibility. J Cardiovasc Magn Reson 2014; 16:53. [PMID: 25184808 PMCID: PMC4222690 DOI: 10.1186/s12968-014-0053-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/08/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multi-contrast weighted imaging is a commonly used cardiovascular magnetic resonance (CMR) protocol for characterization of carotid plaque composition. However, this approach is limited in several aspects including low slice resolution, long scan time, image mis-registration, and complex image interpretation. In this work, a 3D CMR technique, named Multi-contrast Atherosclerosis Characterization (MATCH), was developed to mitigate the above limitations. METHODS MATCH employs a 3D spoiled segmented fast low angle shot readout to acquire data with three different contrast weightings in an interleaved fashion. The inherently co-registered image sets, hyper T1-weighting, gray blood, and T2-weighting, are used to detect intra-plaque hemorrhage (IPH), calcification (CA), lipid-rich necrotic core (LRNC), and loose-matrix (LM). The MATCH sequence was optimized by computer simulations and testing on four healthy volunteers and then evaluated in a pilot study of six patients with carotid plaque, using the conventional multi-contrast protocol as a reference. RESULTS On MATCH images, the major plaque components were easy to identify. Spatial co-registration between the three image sets with MATCH was particularly helpful for the reviewer to discern co-existent components in an image and appreciate their spatial relation. Based on Cohen's kappa tests, moderate to excellent agreement in the image-based or artery-based component detection between the two protocols was obtained for LRNC, IPH, CA, and LM, respectively. Compared with the conventional multi-contrast protocol, the MATCH protocol yield significantly higher signal contrast ratio for IPH (3.1±1.3 vs. 0.4±0.3, p<0.001) and CA (1.6±1.5 vs. 0.7±0.6, p=0.012) with respect to the vessel wall. CONCLUSIONS To the best of our knowledge, the proposed MATCH sequence is the first 3D CMR technique that acquires spatially co-registered multi-contrast image sets in a single scan for characterization of carotid plaque composition. Our pilot clinical study suggests that the MATCH-based protocol may outperform the conventional multi-contrast protocol in several respects. With further technical improvements and large-scale clinical validation, MATCH has the potential to become a CMR method for assessing the risk of plaque disruption in a clinical workup.
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Affiliation(s)
- Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Wei Yu
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Li Dong
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lixin Yang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhanhong Wang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA
| | - Jing An
- MR Collaborations NE Asia, Siemens Healthcare, Beijing, China
| | - Tianjing Zhang
- MR Collaborations NE Asia, Siemens Healthcare, Beijing, China
| | - Gerhard Laub
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA
| | - Prediman Krishan Shah
- Oppenheimer Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Atherosclerosis Prevention and Management Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zhaoqi Zhang
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
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Scott McNally J, Yoon HC, Kim SE, Narra KK, McLaughlin MS, Parker DL, Treiman GS. Carotid MRI Detection of Intraplaque Hemorrhage at 3T and 1.5T. J Neuroimaging 2014; 25:390-6. [PMID: 25040677 DOI: 10.1111/jon.12146] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 03/27/2014] [Accepted: 03/30/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Carotid intraplaque hemorrhage leads to plaque progression and ischemic events. Detection can be accomplished with 3T T1w sequences, but may be limited by false-positive lipid/necrosis. The purpose of this study was threefold: (1) to determine if magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) detects intraplaque hemorrhage versus lipid/necrosis; (2) if 3T MPRAGE image quality is retained at 1.5T; and (3) to determine observer agreement. METHODS MPRAGE positive areas were compared to hemorrhage and lipid/necrosis areas from 100 carotid endarterectomy slides in 12 subjects using multivariable linear regression. Image quality was determined between 3T and 1.5T in 716 carotid arteries using t-tests and multivariable linear regression. Kappa analysis was used to determine agreement. RESULTS Intraplaque hemorrhage, not lipid/necrosis, was a significant predictor of MPRAGE positive area before and after adjusting for confounders (slope = .52 vs. .51, P < .001). Image quality at 3T was slightly lower than 1.5T (mean 3.87 vs. 4.34, P < .0001). 3T image quality remained slightly decreased before and after adjusting for confounders (slope = -.46 vs. -.41, P < .001). Kappa values for inter-/intraobserver agreement were .807/.919 at 3T and .803/.871 at 1.5T. CONCLUSIONS Carotid MPRAGE detects intraplaque hemorrhage, not lipid/necrosis. 3T image quality was retained at 1.5T with very good observer agreement.
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Affiliation(s)
- J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT
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Teng Z, Sadat U, Brown AJ, Gillard JH. Plaque hemorrhage in carotid artery disease: pathogenesis, clinical and biomechanical considerations. J Biomech 2014; 47:847-58. [PMID: 24485514 PMCID: PMC3994507 DOI: 10.1016/j.jbiomech.2014.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 12/21/2022]
Abstract
Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Adam J Brown
- Department of Cardiovascular Medicine, University of Cambridge, UK
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Wang J, Chen H, Maki JH, Zhao X, Wilson GJ, Yuan C, Börnert P. Referenceless acquisition of phase-sensitive inversion-recovery with decisive reconstruction (RAPID) imaging. Magn Reson Med 2013; 72:806-15. [PMID: 24407614 DOI: 10.1002/mrm.24989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/28/2013] [Accepted: 09/15/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE To describe a referenceless reconstruction approach to generate phase-sensitive inversion recovery images without relying on the extra acquisition of reference images. METHODS The basic idea of the Referenceless Acquisition of Phase-sensitive Inversion-recovery with Decisive reconstruction, or RAPID, algorithm is to retrieve the magnetization polarity by estimating the background phase variation of a complex valued image. The theory and algorithm of RAPID is described in detail. To evaluate the performance of RAPID, seven patients were recruited then scanned in different anatomical regions (cardiac, brain, and vascular). Standard Phase Sensitive Inversion Recovery (PSIR) reconstructions using reference image information were compared with RAPID reconstructions using the same source data. RESULTS RAPID reconstructed images were found to provide very good agreement with PSIR reconstructed images on all cases, although no reference image info was used in the RAPID algorithm. For neuroimaging applications, it was found that RAPID reconstruction is more robust compared with the PSIR algorithm as RAPID can avoid potential errors introduced by the reference acquisition. CONCLUSION The RAPID technique for phase-sensitive reconstruction is promising and can improve the imaging efficiency by a factor of 2 compared with PSIR. RAPID was also shown to provide more robust reconstruction by avoiding errors caused by the reference acquisition.
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Affiliation(s)
- Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, New York, USA
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Mendes J, Parker DL, Kim SE, Treiman GS. Reduced blood flow artifact in intraplaque hemorrhage imaging using CineMPRAGE. Magn Reson Med 2013; 69:1276-84. [PMID: 22760825 PMCID: PMC3465506 DOI: 10.1002/mrm.24354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 05/01/2012] [Accepted: 05/04/2012] [Indexed: 12/21/2022]
Abstract
Magnetization prepared rapid acquisition gradient echo (3D MPRAGE) has been shown to be a sensitive method to image carotid intraplaque hemorrhage. As the MPRAGE sequence used to identify potential intraplaque hemorrhage does not utilize cardiac gating, it is difficult to optimize the inversion times due to the dynamic nature of flowing blood. As a result, a best fit inversion time is often determined experimentally and then used for in vivo clinical examination. This results in compromised blood suppression and occasional hemorrhage mimicking flow artifacts. We demonstrate that a retrospective cardiac correlated reconstruction can be applied to the conventional MPRAGE sequence (CineMPRAGE) to more accurately identify blood signal. This CineMPRAGE reconstruction uses the data from a standard nongated MPRAGE sequence to generate a full sequence of cardiac correlated images throughout the cardiac cycle and, therefore, provides a dynamic view of the carotid artery and a better ability to discern blood signal from potential intraplaque hemorrhage. In our preliminary study of 35 patients, signal from potential hemorrhage was constant over the cardiac cycle, whereas any signal from blood flow artifact was observed as an oscillating signal over the cardiac cycle.
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Affiliation(s)
- Jason Mendes
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah 84108, USA.
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Abstract
OBJECTIVE Although MRI is widely used to observe atherosclerosis impacts on the vessel lumen, MRI also depicts the size of the plaque itself, its composition, and plaque inflammation, providing information beyond simple stenosis. This article summarizes the state of evidence for a clinical role for MRI of carotid atherosclerosis. CONCLUSION MRI of carotid atherosclerosis has a proven role in pharmaceutical trials and may improve patient management once large-scale clinical trials have been completed.
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Wang J, Börnert P, Zhao H, Hippe DS, Zhao X, Balu N, Ferguson MS, Hatsukami TS, Xu J, Yuan C, Kerwin WS. Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging for carotid atherosclerotic disease evaluation. Magn Reson Med 2013; 69:337-45. [PMID: 22442116 PMCID: PMC3418400 DOI: 10.1002/mrm.24254] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 02/20/2012] [Accepted: 02/23/2012] [Indexed: 12/24/2022]
Abstract
A simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MR imaging technique is proposed to detect both luminal stenosis and hemorrhage in atherosclerosis patients in a single scan. Thirteen patients with diagnosed carotid atherosclerotic plaque were admitted after informed consent. All scans were performed on a 3T MR imaging system with SNAP, 2D time-of-flight and magnetization-prepared 3D rapid acquisition gradient echo sequences. The SNAP sequence utilized a phase sensitive acquisition, and was designed to provide positive signals corresponding to intraplaque hemorrhage and negative signals corresponding to lumen. SNAP images were compared to time-of-flight images to evaluate lumen size measurements using linear mixed models and the intraclass correlation coefficient. Intraplaque hemorrhage identification accuracy was evaluated by comparing to magnetization-prepared 3D rapid acquisition gradient echo images using Cohen's Kappa. Diagnostic quality SNAP images were generated from all subjects. Quantitatively, the lumen size measurements by SNAP were strongly correlated (intraclass correlation coefficient = 0.96, P < 0.001) with those measured by time-of-flight. For intraplaque hemorrhage detection, strong agreement (κ = 0.82, P < 0.001) was also identified between SNAP and magnetization-prepared 3D rapid acquisition gradient echo images. In conclusion, a SNAP imaging technique was proposed and shows great promise for imaging both lumen size and carotid intraplaque hemorrhage with a single scan.
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Affiliation(s)
- Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, New York, USA.
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Zhao XQ, Kerwin WS. Utilizing imaging tools in lipidology: examining the potential of MRI for monitoring cholesterol therapy. ACTA ACUST UNITED AC 2012. [PMID: 23197995 DOI: 10.2217/clp.12.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lipid abnormalities play important roles in the development of atherosclerosis. Lipid therapies result in alterations in atherosclerotic plaques including halting of progression of the plaque, lipid transport out of the plaque and reducing inflammatory activity, which lead to plaque morphologies that are less prone to disruption, the main cause of clinical events. In order to investigate and monitor plaque morphological changes during lipid therapy in vivo we need an imaging method that can provide accurate assessment of plaque tissue components and activity. MRI of atherosclerosis has been validated as a reliable assessment of the size of the vessel lumen, but also the size of the plaque, its tissue composition and plaque activity, including inflammation. The purpose of this review is to summarize the state of evidence for the direct assessment of atherosclerotic plaque and its change by MRI, and to establish the proven role of MRI of atherosclerosis in pharmaceutical trials with lipid therapy.
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Affiliation(s)
- Xue-Qiao Zhao
- University of Washington School of Medicine, Seattle, WA 98105, USA
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Yamada K, Song Y, Hippe DS, Sun J, Dong L, Xu D, Ferguson MS, Chu B, Hatsukami TS, Chen M, Zhou C, Yuan C. Quantitative evaluation of high intensity signal on MIP images of carotid atherosclerotic plaques from routine TOF-MRA reveals elevated volumes of intraplaque hemorrhage and lipid rich necrotic core. J Cardiovasc Magn Reson 2012; 14:81. [PMID: 23194180 PMCID: PMC3552725 DOI: 10.1186/1532-429x-14-81] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 11/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carotid intraplaque hemorrhage (IPH) and lipid rich necrotic core (LRNC) have been associated with accelerated plaque growth, luminal narrowing, future surface disruption and development of symptomatic events. The aim of this study was to evaluate the quantitative relationships between high intensity signals (HIS) in the plaque on TOF-MRA and IPH or LRNC volumes as measured by multicontrast weighted CMR. METHODS Seventy six patients with a suspected carotid artery stenosis or carotid plaque by ultrasonography underwent multicontrast carotid CMR. HIS presence and volume were measured from TOF-MRA MIP images while IPH and LRNC volumes were separately measured from multicontrast CMR. RESULTS For detecting IPH, HIS on MIP images overall had high specificity (100.0%, 95% CI: 93.0 - 100.0%) but relatively low sensitivity (32%, 95% CI: 20.8 - 47.9%). However, the sensitivity had a significant increasing relationship with underlying IPH volume (p = 0.033) and degree of stenosis (p = 0.022). Mean IPH volume was 2.7 times larger in those with presence of HIS than in those without (142.8 ± 97.7 mm(3) vs. 53.4 ± 56.3 mm(3), p = 0.014). Similarly, mean LRNC volume was 3.4 times larger in those with HIS present (379.8 ± 203.4 mm(3) vs. 111.3 ± 122.7 mm(3), p = 0.001). There was a strong correlation between the volume of the HIS region and the IPH volume measured from multicontrast CMR (r = 0.96, p < 0.001). CONCLUSION MIP images are easily reformatted from three minute, routine, clinical TOF sequences. High intensity signals in carotid plaque on TOF-MRA MIP images are associated with increased intraplaque hemorrhage and lipid-rich necrotic core volumes. The technique is most sensitive in patients with moderate to severe stenosis.
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Affiliation(s)
- Kiyofumi Yamada
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
| | - Yan Song
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Daniel S Hippe
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
| | - Jie Sun
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
| | - Li Dong
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
| | - Marina S Ferguson
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
| | - Baocheng Chu
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
| | | | - Min Chen
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Cheng Zhou
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, 815 Mercer St, Seattle, WA 98109-4325, USA
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Kerwin WS. Carotid artery disease and stroke: assessing risk with vessel wall MRI. ISRN CARDIOLOGY 2012; 2012:180710. [PMID: 23209940 PMCID: PMC3504380 DOI: 10.5402/2012/180710] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022]
Abstract
Although MRI is widely used to diagnose stenotic carotid arteries, it also detects characteristics of the atherosclerotic plaque itself, including its size, composition, and activity. These features are emerging as additional risk factors for stroke that can be feasibly acquired clinically. This paper summarizes the state of evidence for a clinical role for MRI of carotid atherosclerosis.
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Affiliation(s)
- William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA 98109, USA ; VPDiagnostics Incorporation, Seattle, WA 98101, USA
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Yuan C, Wang J, Balu N. High-field atherosclerotic plaque magnetic resonance imaging. Neuroimaging Clin N Am 2012; 22:271-84, xi. [PMID: 22548932 DOI: 10.1016/j.nic.2012.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Manifestations of atherosclerotic plaque in different arterial beds range from perfusion deficits to overt ischemia such as stroke and myocardial infarction. Atherosclerotic plaque composition is associated with its propensity to rupture and cause vascular events. Magnetic resonance (MR) imaging of atherosclerotic plaque using clinical 1.5 T scanners can detect plaque composition. Plaque MR imaging at higher field strengths offers both opportunities and challenges to improving the high spatial resolution and contrast required for this type of imaging. This article summarizes the technological requirements required for high-field plaque MR imaging and its application in detecting plaque components.
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Affiliation(s)
- Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA 98109, USA.
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Soloperto G, Casciaro S. Progress in atherosclerotic plaque imaging. World J Radiol 2012; 4:353-71. [PMID: 22937215 PMCID: PMC3430733 DOI: 10.4329/wjr.v4.i8.353] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are the primary cause of mortality in the industrialized world, and arterial obstruction, triggered by rupture-prone atherosclerotic plaques, lead to myocardial infarction and cerebral stroke. Vulnerable plaques do not necessarily occur with flow-limiting stenosis, thus conventional luminographic assessment of the pathology fails to identify unstable lesions. In this review we discuss the currently available imaging modalities used to investigate morphological features and biological characteristics of the atherosclerotic plaque. The different imaging modalities such as ultrasound, magnetic resonance imaging, computed tomography, nuclear imaging and their intravascular applications are illustrated, highlighting their specific diagnostic potential. Clinically available and upcoming methodologies are also reviewed along with the related challenges in their clinical translation, concerning the specific invasiveness, accuracy and cost-effectiveness of these methods.
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Peripheral arterial wall imaging using contrast-enhanced, susceptibility-weighted phase imaging. J Comput Assist Tomogr 2012; 36:77-82. [PMID: 22261774 DOI: 10.1097/rct.0b013e3182388cdf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To demonstrate improved delineation of peripheral arterial wall in susceptibility-weighted imaging (SWI) phase images by using gadolinium contrast agent. MATERIALS AND METHODS Superficial femoral arteries were imaged using high-resolution SWI in 11 healthy volunteers before and after injection of gadopentetate dimeglumine. Two postcontrast scans started 1 minute and 11 minutes after injection, respectively. Eight of the 11 volunteers also underwent double-inversion recovery turbo-spin-echo (TSE) scans. The same resolution and matrix size were used between SWI and TSE studies, and TSE locations were matched to SWI images. Arterial lumen-wall phase difference and phase contrast-to-noise ratio were measured and compared between precontrast and postcontrast SWI measurements. The lumen and wall areas measured on both TSE and matching SWI images were analyzed for agreement. Two other volunteers participated in a double-echo gradient-echo study. Results were compared to SWI. RESULTS By injecting gadolinium contrast agent, phase difference changed by 54.5% and -1.6%, and phase contrast-to-noise ratio changed by 85.7% and 27.0% for the first and second postcontrast scans, respectively. Morphological measurements showed insignificant difference between TSE and SWIs based on paired t tests; good agreements in Bland-Altman plots were achieved. The double-echo gradient-echo study had similar phase measurements as SWI. CONCLUSION Contrast-enhanced phase imaging improves arterial wall delineation in SWI of peripheral arterial wall. Contrast-enhanced SWI is a promising vessel wall imaging technique.
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Liu W, Balu N, Sun J, Zhao X, Chen H, Yuan C, Zhao H, Xu J, Wang G, Kerwin WS. Segmentation of carotid plaque using multicontrast 3D gradient echo MRI. J Magn Reson Imaging 2011; 35:812-9. [PMID: 22127812 DOI: 10.1002/jmri.22886] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 10/11/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the performance of automatic segmentation of atherosclerotic plaque components using solely multicontrast 3D gradient echo (GRE) magnetic resonance imaging (MRI). MATERIALS AND METHODS A total of 15 patients with a history of recent transient ischemic attacks or stroke underwent carotid vessel wall imaging bilaterally with a combination of 2D turbo spin echo (TSE) sequences and 3D GRE sequences. The TSE sequences included T1-weighted, T2-weighted, and contrast-enhanced T1-weighted scans. The 3D GRE sequences included time-of-flight (TOF), magnetization-prepared rapid gradient echo (MP-RAGE), and motion-sensitized driven equilibrium prepared rapid gradient echo (MERGE) scans. From these images, the previously developed morphology-enhanced probabilistic plaque segmentation (MEPPS) algorithm was retrained based solely on the 3D GRE sequences to segment necrotic core (NC), calcification (CA), and loose matrix (LM). Segmentation performance was assessed using a leave-one-out cross-validation approach via comparing the new 3D-MEPPS algorithm to the original MEPPS algorithm that was based on the traditional multicontrast protocol including 2D TSE and TOF sequences. RESULTS Twenty arteries of 15 subjects were found to exhibit significant plaques within the coverage of all imaging sequences. For these arteries, between new and original MEPPS algorithms, the areas per slice exhibited correlation coefficients of 0.86 for NC, 0.99 for CA, and 0.80 for LM; no significant area bias was observed. CONCLUSION The combination of 3D imaging sequences (TOF, MP-RAGE, and MERGE) can provide sufficient contrast to distinguish NC, CA, and LM. Automatic segmentation using 3D sequences and traditional multicontrast protocol produced highly similar results.
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Affiliation(s)
- Wenbo Liu
- Biomedical Engineering & Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Beijing, China
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Underhill HR, Yuan C. Carotid MRI: a tool for monitoring individual response to cardiovascular therapy? Expert Rev Cardiovasc Ther 2011; 9:63-80. [PMID: 21166529 DOI: 10.1586/erc.10.172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke remains a leading cause of morbidity and mortality. While stroke-related mortality has declined over the past four decades, data indicate that the mortality rate has begun to plateau. This change in trend may be attributable to variation in individual response to therapies that were derived from population-based studies. Further reductions in stroke mortality may require individualized care governed by directly monitoring the effects of cardiovascular therapy. In this article, carotid MRI is considered as a tool for monitoring in vivo carotid atherosclerotic disease, a principal etiology of stroke. Carotid MRI has been previously utilized to identify specific plaque features beyond luminal stenosis that are predictive of transient ischemic attack and stroke. To gain perspective on the possibility of monitoring plaque change within the individual, clinical trials and natural history studies that have used serial carotid MRI are considered. Data from these studies indicate that patients with a lipid-rich necrotic core with or without intraplaque hemorrhage may represent the desired phenotype for monitoring treatment effects in the individual. Advances in tissue-specific sequences, acquisition resolution, scan time, and techniques for monitoring inflammation and mechanical forces are expected to enable earlier detection of response to therapy. In so doing, cost-effective multicenter studies can be conducted to confirm the anticipated positive effects on outcomes of using carotid MRI for individualized care in patients with carotid atherosclerosis. In accordance, carotid MRI is poised to emerge as a powerful clinical tool for individualized management of carotid atherosclerotic disease to prevent stroke.
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Affiliation(s)
- Hunter R Underhill
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K253, Box 357720, Seattle, WA 98195, USA.
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Horie T, Kawakata M, Kajihara N, Takano H, Honda M, Muro I, Ogino T. [Improved visualization of long-axis black-blood imaging of the carotid arteries using phase sensitive inversion recovery combined with 3D IR-T₁TFE]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2011; 67:888-894. [PMID: 21869542 DOI: 10.6009/jjrt.67.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to improve the visualization of long-axis black-blood imaging of the carotid arteries. We experimented on phantom and in-vivo study of 3 dimension (3D) inversion recovery T(1) turbo field echo combined with phase sensitive inversion recovery (PSIR-3D IR-T(1)TFE) at 3.0 Tesla. As a result, the contrast has been improved by calculated images of PSIR-3D IR-T(1)TFE set to inversion time (TI) 350 ms that is shorter than null point of blood. This displays that the contrast between blood and tissues can be improved when the longitudinal magnetization of blood is a negative. Therefore, the visualization of long-axis black-blood imaging of the carotid arteries has been improved by the calculated images of PSIR-3D IR-T(1)TFE set to TI that is shorter than null point of blood.
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Lucignani G, Schäfers M. PET, CT and MRI characterisation of the atherosclerotic plaque. Eur J Nucl Med Mol Imaging 2010; 37:2398-402. [DOI: 10.1007/s00259-010-1634-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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