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Guimarães J, de Almeida J, Mendes PL, Ferreira MJ, Gonçalves L. Advancements in non-invasive imaging of atherosclerosis: Future perspectives. J Clin Lipidol 2024; 18:e142-e152. [PMID: 38142178 DOI: 10.1016/j.jacl.2023.11.008] [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: 07/23/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
Atherosclerosis is a chronic inflammatory disease characterized by the buildup of plaques in arterial walls, leading to cardiovascular diseases and high morbidity and mortality rates worldwide. Non-invasive imaging techniques play a crucial role in evaluating patients with suspected or established atherosclerosis. However, there is a growing body of evidence suggesting the need to visualize the underlying processes of plaque progression and rupture to enhance risk stratification. This review explores recent advancements in non-invasive assessment of atherosclerosis, focusing on computed tomography, magnetic resonance imaging, and nuclear imaging. These advancements provide valuable insights into the assessment and management of atherosclerosis, potentially leading to better risk stratification and improved patient outcomes.
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Affiliation(s)
- Joana Guimarães
- Cardiology Department, Coimbra's Hospital and University Center, Praceta Mota Pinto, 3000-561 Coimbra, Portugal.
| | - José de Almeida
- Cardiology Department, Coimbra's Hospital and University Center, Praceta Mota Pinto, 3000-561 Coimbra, Portugal
| | - Paulo Lázaro Mendes
- Cardiology Department, Coimbra's Hospital and University Center, Praceta Mota Pinto, 3000-561 Coimbra, Portugal
| | - Maria João Ferreira
- Cardiology Department, Coimbra's Hospital and University Center, Praceta Mota Pinto, 3000-561 Coimbra, Portugal; Faculty of Medicine, Coimbra's University, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Coimbra's Hospital and University Center, Praceta Mota Pinto, 3000-561 Coimbra, Portugal; Faculty of Medicine, Coimbra's University, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
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Wu J, Xin J, Yang X, Matkovic LA, Zhao X, Zheng N, Li R. Segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black blood magnetic resonance imaging with multi-task learning. Med Phys 2024; 51:1775-1797. [PMID: 37681965 DOI: 10.1002/mp.16728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Early detection of carotid atherosclerosis can prevent the progression of cardiovascular disease. Many (semi-) automatic methods have been designed for the segmentation of carotid vessel wall and the diagnosis of carotid atherosclerosis (i.e., the lumen segmentation, the outer wall segmentation, and the carotid atherosclerosis diagnosis) on black blood magnetic resonance imaging (BB-MRI). However, most of these methods ignore the intrinsic correlation among different tasks on BB-MRI, leading to limited performance. PURPOSE Thus, we model the intrinsic correlation among the lumen segmentation, the outer wall segmentation, and the carotid atherosclerosis diagnosis tasks on BB-MRI by using the multi-task learning technique and propose a gated multi-task network (GMT-Net) to perform three related tasks in a neural network (i.e., carotid artery lumen segmentation, outer wall segmentation, and carotid atherosclerosis diagnosis). METHODS In the proposed method, the GMT-Net is composed of three modules, including the sharing module, the segmentation module, and the diagnosis module, which interact with each other to achieve better learning performance. At the same time, two new adaptive layers, namely, the gated exchange layer and the gated fusion layer, are presented to exchange and merge branch features. RESULTS The proposed method is applied to the CAREII dataset (i.e., 1057 scans) for the lumen segmentation, the outer wall segmentation, and the carotid atherosclerosis diagnosis. The proposed method can achieve promising segmentation performances (0.9677 Dice for the lumen and 0.9669 Dice for the outer wall) and better diagnosis accuracy of carotid atherosclerosis (0.9516 AUC and 0.9024 Accuracy) in the "CAREII test" dataset (i.e., 106 scans). The results show that the proposed method has statistically significant accuracy and efficiency. CONCLUSIONS Even without the intervention of reviewers required for the previous works, the proposed method automatically segments the lumen and outer wall together and diagnoses carotid atherosclerosis with high performance. The proposed method can be used in clinical trials to help radiologists get rid of tedious reading tasks, such as screening review to separate normal carotid arteries from atherosclerotic arteries and to outline vessel wall contours.
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Affiliation(s)
- Jiayi Wu
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University
| | - Jingmin Xin
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Luke A Matkovic
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Nanning Zheng
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Cui E, Kersche G, Grubic N, Hétu MF, Pang SC, Sillesen H, Johri AM. Effect of pharmacologic anti-atherosclerotic therapy on carotid intraplaque neovascularization: A systematic review. J Clin Lipidol 2023; 17:315-326. [PMID: 37173161 DOI: 10.1016/j.jacl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/07/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
Intraplaque neovascularization (IPN), a key feature of vulnerable carotid plaque, is associated with adverse cardiovascular (CV) events. Statin therapy has been shown to diminish and stabilize atherosclerotic plaque, but its effect on IPN is uncertain. This review investigated the effects of common pharmacologic anti-atherosclerotic therapies on carotid IPN. Electronic databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception until July 13, 2022. Studies evaluating the effect of anti-atherosclerotic therapy on carotid IPN among adults with carotid atherosclerosis were included. Sixteen studies were eligible for inclusion. Contrast-enhanced ultrasound (CEUS) was the most common IPN assessment modality (n=8), followed by dynamic contrast-enhanced MRI (DCE-MRI) (n=4), excised plaque histology (n=3) and superb microvascular imaging (n=2). In fifteen studies, statins were the therapy of interest and one study assessed PCSK9 inhibitors. Among CEUS studies, baseline statin use was associated with a lower frequency of carotid IPN (median OR = 0.45). Prospective studies showed regression of IPN after 6-12 months of lipid-lowering therapy, with more regression observed in treated participants compared to untreated controls. Our findings suggest that lipid-lowering therapy with statins or PCSK9 inhibitors is associated with IPN regression. However, there was no correlation between change in IPN parameters and change in serum lipids and inflammatory markers in statin-treated participants, so it is unclear whether these factors are mediators in the observed IPN changes. Lastly, this review was limited by study heterogeneity and small sample sizes, so larger trials are needed to validate findings.
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Affiliation(s)
- Edward Cui
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Georgia Kersche
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Nicholas Grubic
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Marie-France Hétu
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Stephen C Pang
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada (Dr Pang)
| | - Henrik Sillesen
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Dr Sillesen); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Dr Sillesen)
| | - Amer M Johri
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri).
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Zhao XQ, Sun J, Hippe DS, Isquith DA, Canton G, Yamada K, Balu N, Crouse JR, Anderson TJ, Huston J, O’Brien KD, Hatsukami TS, Yuan C. Magnetic Resonance Imaging of Intraplaque Hemorrhage and Plaque Lipid Content With Continued Lipid-Lowering Therapy: Results of a Magnetic Resonance Imaging Substudy in AIM-HIGH. Circ Cardiovasc Imaging 2022; 15:e014229. [PMID: 36378778 PMCID: PMC9773914 DOI: 10.1161/circimaging.122.014229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intraplaque hemorrhage (IPH) is associated with plaque progression and ischemic events, and plaque lipid content (% lipid core) predicts the residual atherosclerotic cardiovascular disease risk. This study examined the impact of IPH on lipid content change in the setting of intensive lipid-lowering therapy. METHODS In total, 214 AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low High-Density Lipoprotein/High Triglycerides: Impact on Global Health Outcomes) participants with clinically established ASCVD and low high-density lipoprotein cholesterol received cartoid MRI at baseline and 2 years to assess changes in carotid morphology and composition. Patients were randomized to extended-release niacin or placebo, and all received simvastatin with optional ezetimibe as necessary to lower low-density lipoprotein cholesterol to 40 to 80 mg/dL. Changes in lipid content and carotid morphology were tested using the Wilcoxon signed-rank test. Differences between subjects with and without IPH and between subjects assigned extended-release niacin or placebo were tested using the Wilcoxon rank-sum test. Linear regression was used to test the association of IPH and lipid content changes after adjusting for clinical risk factors. RESULTS Among 156 patients (61±9 years; 81% men) with complete MRI, prior statin use: <1 year, 26%; 1 to 5 years, 37%; >5 years, 37%. Triglycerides and ApoB decreased significantly, whereas high-density lipoprotein cholesterol and ApoA1 increased significantly over time. Plaque lipid content was significantly reduced (-0.5±2.4 %/year, P = 0.017) without a significant difference between the 2 treatment groups. However, the lipid content increased in plaques with IPH but regressed in plaques without IPH (1.2±2.5 %/year versus -1.0±2.2, P = 0.006). Additionally, IPH was associated with a decrease in lumen area (-0.4±0.9 mm2/year versus 0.3±1.4, P = 0.033). IPH remained significantly associated with increase in lipid content in multivariable analysis (54.4%, 95% CI: 26.8, 88.0, P < 0.001). CONCLUSIONS Carotid plaques under continued intensive lipid-lowering therapy moved toward stabilization. However, plaques with IPH showed greater increases in lipid content and greater decreases in lumen area than plaques without IPH. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01178320.
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Affiliation(s)
- Xue-Qiao Zhao
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel A. Isquith
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | - John R. Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J. Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin D. O’Brien
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Thomas S. Hatsukami
- Department of Surgery (Division of Vascular Surgery), University of Washington, Seattle, Washington
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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Qiao H, Yang Q, Huo R, Han H, Ning Z, Shen R, Song X, Chen H, Chen S, Zhao X. Reliability and Value of 3D Sequential QUantitative T 1 -T 2 -T 2 * MAppings (SQUMA) MR Multi-Parametric Imaging in Characterizing Carotid Artery Atherosclerosis. J Magn Reson Imaging 2022; 57:1376-1389. [PMID: 36173363 DOI: 10.1002/jmri.28445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND T1 , T2 , and T2 * mappings are seldom performed in a single examination, and their values in evaluating symptomatic atherosclerosis are lacking. PURPOSE To perform three-dimensional (3D) quantitative T1 , T2 , and T2 * mappings (SQUMA) multi-parametric imaging for carotid vessel wall and evaluate its reliability and value in assessing carotid atherosclerosis. STUDY TYPE Prospective. SUBJECTS Eight healthy subjects and 20 patients with symptomatic carotid atherosclerosis. FIELD STRENGTH/SEQUENCE 3 T, SQUMA imaging T1 -, T2 -, and T2 *-mapping, multi-contrast vessel wall imaging including T1 - and T2 -weighted, time-of-flight, and SNAP sequences. ASSESSMENT SQUMA was acquired in all subjects and multi-contrast images were acquired in healthy subjects. T1 , T2 , and T2 * values and lumen area (LA), wall area (WA), mean wall thickness (MeanWT), and normalized wall index (NWI) of carotid arteries were measured. SQUMA and multi-contrast measurements were compared in healthy subjects and differences in SQUMA measurements between healthy subjects and patients were assessed. The discriminative value of SQUMA measurements for symptomatic vessel was determined. STATISTICAL TESTS Paired t or Wilcoxon signed-rank test, independent t or Mann-Whitney U test, area under the receiver operating characteristic curve (AUC), intraclass correlation coefficients, and Bland-Altman plots. Statistically significant level, P < 0.05. RESULTS There were no significant differences in LA (P = 0.340), WA (P = 0.317), MeanWT (P = 0.088), and NWI (P = 0.091) of carotid arteries between SQUMA and multi-contrast vessel wall images. The values of T2 (50.9 ± 2.9 msec vs. 44.5 ± 4.2 msec), T2 * (28.2 ± 4.3 msec vs. 24.7 ± 2.6 msec), WA (23.7 ± 4.6 mm2 vs. 36.2 ± 7.7 mm2 ), MeanWT (0.99 ± 0.05 mm vs. 1.50 ± 0.28 mm), and NWI (40.7 ± 3.0% vs. 53.8 ± 5.4%) of carotid arteries in healthy subjects were significantly different from those in atherosclerotic patients. The combination of quantitative T1 , T2 , and T2 * values and MeanWT showed greatest AUC (0.81; 95% CI: 0.65-0.92) in discriminating symptomatic vessels. DATA CONCLUSION Carotid MR 3D quantitative multi-parametric imaging of SQUMA enables acquisition of T1 , T2 , and T2 * maps, reliably measuring carotid morphology and discriminating carotid symptomatic atherosclerosis. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,School of Medicine, Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Qiansu Yang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Ran Huo
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, 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
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Bomben MA, Moody AR, Drake JM, Matsuura N. Fabrication of Customizable Intraplaque Hemorrhage Phantoms for Magnetic Resonance Imaging. Mol Imaging Biol 2022; 24:732-739. [PMID: 35486294 PMCID: PMC9581813 DOI: 10.1007/s11307-022-01722-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Abstract
Purpose Magnetic resonance (MR) imaging detection of methemoglobin, a molecular marker of intraplaque hemorrhage (IPH), in atherosclerotic plaque is a promising method of assessing stroke risk. However, the multicenter imaging studies required to further validate this technique necessitate the development of IPH phantoms to standardize images acquired across different scanners. This study developed a set of phantoms that modeled methemoglobin-laden IPH for use in MR image standardization. Procedures A time-stable material mimicking the MR properties of methemoglobin in IPH was created by doping agarose hydrogel with gadolinium and sodium alginate. This material was used to create a phantom that consisted of 9 cylindrical IPH sites (with sizes from 1 to 8 mm). Anatomical replicas of IPH-positive atherosclerosis were also created using 3D printed molds. These plaque replicas also modeled other common plaque components including a lipid core and atheroma cap. T1 mapping and a magnetization-prepared rapid acquisition gradient echo (MPRAGE) carotid imaging protocol were used to assess phantom realism and long-term stability. Results Cylindrical phantom IPH sites possessed a T1 time of 335 ± 51 ms and exhibited little change in size or MPRAGE signal intensity over 31 days; the mean (SD) magnitude of changes in size and signal were 6.4 % (2.7 %) and 7.3 % (6.7 %), respectively. IPH sites incorporated into complex anatomical plaque phantoms exhibited contrast comparable to clinical images. Conclusions The cylindrical IPH phantom accurately modeled the short T1 time characteristic of methemoglobin-laden IPH, with the IPH sites exhibiting little variation in imaging properties over 31 days. Furthermore, MPRAGE images of the anatomical atherosclerosis replicas closely matched those of clinical plaques. In combination, these phantoms will allow for IPH imaging protocol standardization and thus facilitate future multicenter IPH imaging. Supplementary Information The online version contains supplementary material available at 10.1007/s11307-022-01722-4.
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Affiliation(s)
- Matteo A Bomben
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
- The Wilfred and Joyce Posluns Centre for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Sunnybrook Hospital, Toronto, ON, Canada
| | - James M Drake
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
- The Wilfred and Joyce Posluns Centre for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, 184 College Street, Room 140, Toronto, ON, M5S 3E4, Canada
| | - Naomi Matsuura
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
- Institute of Biomedical Engineering, University of Toronto, 184 College Street, Room 140, Toronto, ON, M5S 3E4, Canada.
- Department of Materials Science and Engineering, University of Toronto, Toronto, ON, Canada.
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Semiautomated Segmentation and Volume Measurements of Cervical Carotid High-Signal Plaques Using 3D Turbo Spin-Echo T1-Weighted Black-Blood Vessel Wall Imaging: A Preliminary Study. Diagnostics (Basel) 2022; 12:diagnostics12041014. [PMID: 35454062 PMCID: PMC9026945 DOI: 10.3390/diagnostics12041014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
Unstable carotid plaques are visualized as high-signal plaques (HSPs) on 3D turbo spin-echo T1-weighted black-blood vessel wall imaging (3D TSE T1-BB VWI). The purpose of this study was to compare manual segmentation and semiautomated segmentation for the quantification of carotid HSPs using 3D TSE T1-BB VWI. Twenty cervical carotid plaque lesions in 19 patients with a plaque contrast ratio of > 1.3 compared to adjacent muscle were studied. Using the mean voxel value for the adjacent muscle multiplied by 1.3 as a threshold value, the semiautomated software exclusively segmented and measured the HSP volume. Manual and semiautomated HSP volumes were well correlated (r = 0.965). Regarding reproducibility, the inter-rater ICC was 0.959 (bias: 24.63, 95% limit of agreement: −96.07, 146.35) for the manual method and 0.998 (bias: 15.2, 95% limit of agreement: −17.83, 48.23) for the semiautomated method, indicating improved reproducibility by the semiautomated method compared to the manual method. The time required for semiautomated segmentation was significantly shorter than that of manual segmentation times (81.7 ± 7.8 s versus 189.5 ± 49.6 s; p < 0.01). The results obtained in this study demonstrate that the semiautomated segmentation method allows for reliable assessment of the HSP volume in patients with carotid plaque lesions, with reduced time and effort for the analysis.
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Zhou P, Wang Y, Sun J, Yu Y, Mossa-Basha M, Zhu C. Assessment of Therapeutic Response to Statin Therapy in Patients With Intracranial or Extracranial Carotid Atherosclerosis by Vessel Wall MRI: A Systematic Review and Updated Meta-Analysis. Front Cardiovasc Med 2021; 8:742935. [PMID: 34778404 PMCID: PMC8578267 DOI: 10.3389/fcvm.2021.742935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Statin therapy is an essential component of cardiovascular preventive care. In recent years, various vessel wall MRI (VW-MRI) techniques have been used to monitor atherosclerosis progression or regression in patients with extracranial or intracranial large-artery atherosclerosis. We aimed to perform a systematic review and meta-analysis on the effects of statin therapy on plaque evolution as assessed by VW-MRI. Materials and Methods: Prospective studies investigating carotid and intracranial atherosclerotic plaques in patients on statin therapy monitored by serial VW-MRI were systematically identified in the literature. The plaque burden and lipid-rich necrotic core (LRNC) volume of carotid plaque and the imaging features of intracranial plaques were extracted and summarized. For studies investigating carotid artery wall volume and LRNC volume, combined estimates were derived by meta-analysis. Results: The study identified 21 studies of carotid plaque and two studies of intracranial plaque. While 16 studies investigating carotid plaques that included 780 patients by High-resolution VW-MRI were included in the meta-analysis. There was no significant change in carotid wall volume from baseline to 12 months. A significant change in LRNC volume was observed at > 12 months compared with baseline (Effect = −10.69, 95% CI = −19.11, −2.28, P < 0.01), while no significant change in LRNC volume at 3–6 months or 7–12 months after statin therapy initiation in 6 studies. Increases in fibrous tissue and calcium and reduction in neovascularization density of the plaque were seen in 2/3 studies (including 48/59 patients), 1/3 studies (including 17/54 patients), and 2/2 studies (including 71 patients) after statin therapy, respectively. Two studies with 257 patients in intracranial atherosclerosis showed that statins could effectively decrease wall volume and plaque enhancement volume. Conclusions: Collective data indicated that statins could potentially stabilize carotid plaques by significantly reducing LRNC with 1 year of therapy as shown on serial carotid VW-MRI. There was no significant decrease in wall volume, which nonetheless indicated that plaque composition changes might be more sensitive to response monitoring than wall volume. It is likely that more sensitive, clinically relevant, and preferably quantitative indicators of therapeutic effects on intracranial vessel plaque morphology will be developed in the future.
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Affiliation(s)
- Pengyu Zhou
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuting Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Yannan Yu
- Internal Medicine Department, University of Massachusetts Memorial Medical Center, Worcester, MA, United States
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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A comparison of carotid atherosclerosis in symptomatic patients between 2002-2005 and 2012-2015 cohorts using multi-contrast magnetic resonance vessel wall imaging. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:623-630. [PMID: 34527028 PMCID: PMC8390937 DOI: 10.11909/j.issn.1671-5411.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the morphological and compositional characteristics of carotid plaques in two cohorts (2002−2005 and 2012−2015) of Chinese patients using magnetic resonance vessel wall imaging. METHODS Symptomatic patients with carotid atherosclerotic plaques who underwent carotid vessel wall magnetic resonance imaging between 2002−2005 and 2012−2015 were retrospectively recruited. Plaque morphology [including mean wall area, wall thickness, and maximum normalized wall index (NWI)] and composition [including calcification, intraplaque hemorrhage, and lipid-rich necrotic core (LRNC)] in symptomatic carotid arteries were evaluated and compared between patients in these two time periods. RESULTS A total of 258 patients, including 129 patients in the 2002−2005 cohort and 129 patients in the 2012−2015 cohort, were recruited. Statin use (49.6%vs. 32.6%, P = 0.004) and hypertension (76.0% vs. 62.8%, P = 0.015) were significantly more common in the 2012–2015 cohort than in the 2002−2005 cohort. Patients in the 2012−2015 cohort also exhibited significantly low plaque burden parameters (allP < 0.05), as well as a lower prevalence (68.2% vs. 89.9%, P < 0.001) and volume percentages of LRNC (11.2% ± 14.2% vs. 25.7% ± 17.7%, P < 0.001). These differences remained significant after adjustment for clinical factors. The differences in the volume percentages of LRNC also remained significant after an additional adjustment for maximum NWI ( P < 0.001).
CONCLUSIONS Patients in the 2012−2015 cohort had a lower plaque burden and volume percentages of LRNC in symptomatic carotid arteries than those in the 2002−2005 cohort. These findings indicate that carotid plaques in the recent cohort had a lower severity and vulnerability.
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Lepor NE, Sun J, Canton G, Contreras L, Hippe DS, Isquith DA, Balu N, Kedan I, Simonini AA, Yuan C, Hatsukami TS, Zhao XQ. Regression in carotid plaque lipid content and neovasculature with PCSK9 inhibition: A time course study. Atherosclerosis 2021; 327:31-38. [PMID: 34038761 DOI: 10.1016/j.atherosclerosis.2021.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce cardiovascular events, but their effects on atherosclerotic plaque remain elusive. Using serial magnetic resonance imaging (MRI), we studied changes in carotid plaque lipid content and neovasculature under PCSK9 inhibition with alirocumab. METHODS Among patients with low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dl but ineligible for high-dose statin therapy, those with lipid core on carotid MRI were identified to receive alirocumab 150 mg every 2 weeks. Follow-up MRI was performed at 3, 6, and 12 months after treatment. Pre- and post-contrast MRI were acquired to measure percent lipid core volume (% lipid core). Dynamic contrast-enhanced MRI was acquired to measure the extravasation rate of gadolinium contrast (Ktrans), a marker of plaque neovasculature. RESULTS Of 31 patients enrolled, 27 completed the study (mean age: 69 ± 9; male: 67%). From 9.8% at baseline, % lipid core was progressively reduced to 8.4% at 3 months, 7.5% at 6 months, and 7.2% at 12 months (p = 0.014 for trend), which was accompanied by a progressive increase in % fibrous tissue (p = 0.009) but not % calcification (p = 0.35). Ktrans was not reduced until 12 months (from 0.069 ± 0.019 min-1 to 0.058 ± 0.020 min-1; p = 0.029). Lumen and wall areas did not change significantly during the study period. CONCLUSIONS Regression in plaque composition and neovasculature were observed under PCSK9 inhibition on carotid MRI, which provides unique insight into the biological process of plaque stabilization with disease-modifying therapies.
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Affiliation(s)
- Norman E Lepor
- Westside Medical Associates of Los Angeles, Beverly Hills, CA, USA; Smidt Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Jie Sun
- University of Washington, Seattle, WA, USA.
| | | | - Laurn Contreras
- Westside Medical Associates of Los Angeles, Beverly Hills, CA, USA
| | | | | | | | - Ilan Kedan
- Smidt Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - Chun Yuan
- University of Washington, Seattle, WA, USA
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11
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Johnston RD, Gaul RT, Lally C. An investigation into the critical role of fibre orientation in the ultimate tensile strength and stiffness of human carotid plaque caps. Acta Biomater 2021; 124:291-300. [PMID: 33571712 DOI: 10.1016/j.actbio.2021.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 01/02/2023]
Abstract
The development and subsequent rupture of atherosclerotic plaques in human carotid arteries is a major cause of ischaemic stroke. Mechanical characterization of atherosclerotic plaques can aid our understanding of this rupture risk. Despite this however, experimental studies on human atherosclerotic carotid plaques, and fibrous plaque caps in particular, are very limited. This study aims to provide further insights into atherosclerotic plaque rupture by mechanically testing human fibrous plaque caps, the region of the atherosclerotic lesion most often attributed the highest risk of rupture. The results obtained highlight the variability in the ultimate tensile stress, strain and stiffness experienced in atherosclerotic plaque caps. By pre-screening all samples using small angle light scattering (SALS) to determine the dominant fibre direction in the tissue, along with supporting histological analysis, this work suggests that the collagen fibre alignment in the circumferential direction plays the most dominant role for determining plaque structural stability. The work presented in this study could provide the basis for new diagnostic approaches to be developed, which non-invasively identify carotid plaques at greatest risk of rupture. STATEMENT OF SIGNIFICANCE: Mechanical characterisation of the atherosclerotic plaque cap is of utmost importance for understanding the mechanisms that govern the rupture strength of this tissue in-vivo. Studies has shown that plaque tissue is heterogenous and comprises of many structural components, each of which exhibits a varying mechanical response. However, rupture generally is located to the plaque cap, whereby the stress exerted on this location exceeds its mechanical strength causing failure. This work shows, for the first time, that the underlying collagen fibre architecture of carotid plaque caps governs their strength and stiffness. This study shows that plaque caps with collagen fibres aligned in the predominately circumferential direction experience higher stresses and lower strains before failure while those with predominately axial fibres display the opposite trend. Furthermore, total collagen content was found not to play a dominant role in determining the mechanical response of the tissue. The present study provides critical insights into human atherosclerotic plaque tissue mechanics and offers clinically relevant insights for mechanically sensitive imaging techniques, such as strain-based ultrasound or MRI.
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12
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Beddhu S, Boucher RE, Sun J, Balu N, Chonchol M, Navaneethan S, Chertow GM, Townsend R, Haley W, Cheung AK, Conroy MB, Raj DS, Xu D, George T, Yunis R, Wei G, Canton G, Bates J, Chen J, Papademetriou V, Punzi H, Wiggers A, Wright JT, Greene T, Yuan C. Chronic kidney disease, atherosclerotic plaque characteristics on carotid magnetic resonance imaging, and cardiovascular outcomes. BMC Nephrol 2021; 22:69. [PMID: 33627066 PMCID: PMC7905597 DOI: 10.1186/s12882-021-02260-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background It is unclear whether faster progression of atherosclerosis explains the higher risk of cardiovascular events in CKD. The objectives of this study were to 1. Characterize the associations of CKD with presence and morphology of atherosclerotic plaques on carotid magnetic resonance imaging (MRI) and 2. Examine the associations of baseline CKD and carotid atherosclerotic plaques with subsequent cardiovascular events. Methods In a subgroup (N = 465) of Systolic Blood Pressure Intervention Trial. (SPRINT) participants, we measured carotid plaque presence and morphology at baseline and after 30-months with MRI. We examined the associations of CKD (baseline eGFR < 60 ml/min/1.73m2) with progression of carotid plaques and the SPRINT cardiovascular endpoint. Results One hundred and ninety six (42%) participants had CKD. Baseline eGFR in the non-CKD and CKD subgroups were 77 ± 14 and 49 ± 8 ml/min/1.73 m2, respectively. Lipid rich necrotic-core plaque was present in 137 (29.5%) participants. In 323 participants with both baseline and follow-up MRI measurements of maximum wall thickness, CKD was not associated with progression of maximum wall thickness (OR 0.62, 95% CI 0.36 to 1.07, p = 0.082). In 96 participants with necrotic core plaque at baseline and with a valid follow-up MRI, CKD was associated with lower odds of progression of necrotic core plaque (OR 0.41, 95% CI 0.17 to 0.95, p = 0.039). There were 28 cardiovascular events over 1764 person-years of follow-up. In separate Cox models, necrotic core plaque (HR 2.59, 95% CI 1.15 to 5.85) but not plaque defined by maximum wall thickness or presence of a plaque component (HR 1.79, 95% CI 0.73 to 4.43) was associated with cardiovascular events. Independent of necrotic core plaque, CKD (HR 3.35, 95% CI 1.40 to 7.99) was associated with cardiovascular events. Conclusions Presence of necrotic core in carotid plaque rather than the presence of plaque per se was associated with increased risk of cardiovascular events. We did not find CKD to be associated with faster progression of necrotic core plaques, although both were independently associated with cardiovascular events. Thus, CKD may contribute to cardiovascular disease principally via mechanisms other than atherosclerosis such as arterial media calcification or stiffening. Trial Registration NCT01475747, registered on November 21, 2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02260-x.
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Affiliation(s)
- Srinivasan Beddhu
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, USA. .,Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA.
| | - Robert E Boucher
- Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA
| | - Jie Sun
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Niranjan Balu
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sankar Navaneethan
- Section of Nephrology, Baylor College of Medicine, Houston, TX, USA.,Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Raymond Townsend
- Division of Nephrology, University of Pennsylvania, Philadelphia, PA, USA
| | - William Haley
- Division of Nephrology, Mayo Clinic, Jacksonville, FL, USA
| | - Alfred K Cheung
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, USA.,Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA
| | - Molly B Conroy
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dominic S Raj
- Division of Nephrology, George Washington University, Washington, DC, USA
| | - Dongxiang Xu
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Thomas George
- Division of Nephrology, Cleveland Clinic, Cleveland, OH, USA
| | - Reem Yunis
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Guo Wei
- Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA
| | - Gador Canton
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Jeffrey Bates
- Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jing Chen
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Henry Punzi
- Department of Medicine & Clinical Research, Punzi Medical Center, Carrollton, TX, USA
| | - Alan Wiggers
- Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH, USA
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH, USA
| | - Tom Greene
- Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chun Yuan
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
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13
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Evolving determinants of carotid atherosclerosis vulnerability in asymptomatic patients from the MAGNETIC observational study. Sci Rep 2021; 11:2327. [PMID: 33504842 PMCID: PMC7840938 DOI: 10.1038/s41598-021-81247-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/28/2020] [Indexed: 11/08/2022] Open
Abstract
MRI can assess plaque composition and has demonstrated an association between some atherosclerotic risk factors (RF) and markers of plaque vulnerability in naive patients. We aimed at investigating this association in medically treated asymptomatic patients. This is a cross-sectional interim analysis (August 2013-September 2016) of a single center prospective study on carotid plaque vulnerability (MAGNETIC study). We recruited patients with asymptomatic carotid atherosclerosis (US stenosis > 30%, ECST criteria), receiving medical treatments at a tertiary cardiac rehabilitation. Atherosclerotic burden and plaque composition were quantified with 3.0 T MRI. The association between baseline characteristics and extent of lipid-rich necrotic core (LRNC), fibrous cap (CAP) and intraplaque hemorrhage (IPH) was studied with multiple regression analysis. We enrolled 260 patients (198 male, 76%) with median age of 71-y (interquartile range: 65-76). Patients were on antiplatelet therapy, ACE-inhibitors/angiotensin receptor blockers and statins (196-229, 75-88%). Median LDL-cholesterol was 78 mg/dl (59-106), blood pressure 130/70 mmHg (111-140/65-80), glycosylated hemoglobin 46 mmol/mol (39-51) and BMI 25 kg/m2 (23-28); moreover, 125 out of 187 (67%) patients were ex-smokers. Multivariate analysis of a data-set of 487 (94%) carotid arteries showed that a history of hypercholesterolemia, diabetes, hypertension or smoking did not correlate with LRNC, CAP or IPH. Conversely, maximum stenosis was the strongest independent predictor of LRNC, CAP and IPH (p < 0.001). MRI assessment of plaque composition in patients on treatment for asymptomatic carotid atherosclerosis shows no correlation between plaque vulnerability and the most well-controlled modifiable RF. Conversely, maximum stenosis exhibits a strong correlation with vulnerable features despite treatment.
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14
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Sun J, Lepor NE, Cantón G, Contreras L, Hippe DS, Isquith DA, Balu N, Kedan I, Simonini AA, Yuan C, Zhao XQ, Hatsukami TS. Serial magnetic resonance imaging detects a rapid reduction in plaque lipid content under PCSK9 inhibition with alirocumab. Int J Cardiovasc Imaging 2021; 37:1415-1422. [DOI: 10.1007/s10554-020-02115-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022]
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15
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Chen L, Sun J, Canton G, Balu N, Hippe DS, Zhao X, Li R, Hatsukami TS, Hwang JN, Yuan C. Automated Artery Localization and Vessel Wall Segmentation using Tracklet Refinement and Polar Conversion. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2020; 8:217603-217614. [PMID: 33777593 PMCID: PMC7996631 DOI: 10.1109/access.2020.3040616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Quantitative analysis of blood vessel wall structures is important to study atherosclerotic diseases and assess cardiovascular event risks. To achieve this, accurate identification of vessel luminal and outer wall contours is needed. Computer-assisted tools exist, but manual preprocessing steps, such as region of interest identification and/or boundary initialization, are still needed. In addition, prior knowledge of the ring shape of vessel walls has not been fully explored in designing segmentation methods. In this work, a fully automated artery localization and vessel wall segmentation system is proposed. A tracklet refinement algorithm was adapted to robustly identify the artery of interest from a neural network-based artery centerline identification architecture. Image patches were extracted from the centerlines and converted in a polar coordinate system for vessel wall segmentation. The segmentation method used 3D polar information and overcame problems such as contour discontinuity, complex vessel geometry, and interference from neighboring vessels. Verified by a large (>32000 images) carotid artery dataset collected from multiple sites, the proposed system was shown to better automatically segment the vessel wall than traditional vessel wall segmentation methods or standard convolutional neural network approaches. In addition, a segmentation uncertainty score was estimated to effectively identify slices likely to have errors and prompt manual confirmation of the segmentation. This robust vessel wall segmentation system has applications in different vascular beds and will facilitate vessel wall feature extraction and cardiovascular risk assessment.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Daniel S. Hippe
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | | | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
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16
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Chen L, Canton G, Liu W, Hippe DS, Balu N, Watase H, Hatsukami TS, Waterton JC, Hwang JN, Yuan C. Fully automated and robust analysis technique for popliteal artery vessel wall evaluation (FRAPPE) using neural network models from standardized knee MRI. Magn Reson Med 2020; 84:2147-2160. [PMID: 32162395 PMCID: PMC8320767 DOI: 10.1002/mrm.28237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop a fully automated vessel wall (VW) analysis workflow (fully automated and robust analysis technique for popliteal artery evaluation, FRAPPE) on the popliteal artery in standardized knee MR images. METHODS Popliteal artery locations were detected from each MR slice by a deep neural network model and connected into a 3D artery centerline. Vessel wall regions around the centerline were then segmented using another neural network model for segmentation in polar coordinate system. Contours from vessel wall segmentations were used for vascular feature calculation, such as mean wall thickness and wall area. A transfer learning and active learning framework was applied in training the localization and segmentation neural network models to maintain accuracy while reducing manual annotations. This new popliteal artery analysis technique (FRAPPE) was validated against manual segmentation qualitatively and quantitatively in a series of 225 cases from the Osteoarthritis Initiative (OAI) dataset. RESULTS FRAPPE demonstrated high accuracy and robustness in locating popliteal arteries, segmenting artery walls, and quantifying arterial features. Qualitative evaluations showed 1.2% of slices had noticeable major errors, including segmenting the wrong target and irregular vessel wall contours. The mean Dice similarity coefficient with manual segmentation was 0.79, which is comparable to inter-rater variations. Repeatability evaluations show most of the vascular features have good to excellent repeatability from repeated scans of same subjects, with intra-class coefficient ranging from 0.80 to 0.98. CONCLUSION This technique can be used in large population-based studies, such as OAI, to efficiently assess the burden of atherosclerosis from routine MR knee scans.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Wenjin Liu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S. Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Hiroko Watase
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | - John C. Waterton
- Centre for Imaging Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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17
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Zheng KH, Kaiser Y, van Olden CC, Santos RD, Dasseux JL, Genest J, Gaudet D, Westerink J, Keyserling C, Verberne HJ, Leitersdorf E, Hegele RA, Descamps OS, Hopkins P, Nederveen AJ, Stroes ES. No benefit of HDL mimetic CER-001 on carotid atherosclerosis in patients with genetically determined very low HDL levels. Atherosclerosis 2020; 311:13-19. [DOI: 10.1016/j.atherosclerosis.2020.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022]
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18
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Zhu G, Hom J, Li Y, Jiang B, Rodriguez F, Fleischmann D, Saloner D, Porcu M, Zhang Y, Saba L, Wintermark M. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020; 10:1048-1067. [PMID: 32968660 DOI: 10.21037/cdt.2020.03.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Carotid artery plaque is a measure of atherosclerosis and is associated with future risk of atherosclerotic cardiovascular disease (ASCVD), which encompasses coronary, cerebrovascular, and peripheral arterial diseases. With advanced imaging techniques, computerized tomography (CT) and magnetic resonance imaging (MRI) have shown their potential superiority to routine ultrasound to detect features of carotid plaque vulnerability, such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC), and calcification. The correlation between imaging features and histological changes of carotid plaques has been investigated. Imaging of carotid features has been used to predict the risk of cardiovascular events. Other techniques such as nuclear imaging and intra-vascular ultrasound (IVUS) have also been proposed to better understand the vulnerable carotid plaque features. In this article, we review the studies of imaging specific carotid plaque components and their correlation with risk scores.
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Affiliation(s)
- Guangming Zhu
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ying Li
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA.,Clinical Medical Research Center, Luye Pharma Group Ltd., Beijing 100000, China
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Dominik Fleischmann
- Department of Radiology, Cardiovascular Imaging Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Saloner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Michele Porcu
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Yanrong Zhang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA, USA
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19
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Imaging Features of Vulnerable Carotid Atherosclerotic Plaque and the Associated Clinical Implications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00821-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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20
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Qiao H, Cai Y, Huang M, Liu Y, Zhang Q, Huang L, Chen H, Yuan C, Zhao X. Quantitative assessment of carotid artery atherosclerosis by three-dimensional magnetic resonance and two-dimensional ultrasound imaging: a comparison study. Quant Imaging Med Surg 2020; 10:1021-1032. [PMID: 32489926 DOI: 10.21037/qims-19-818] [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] [Indexed: 01/15/2023]
Abstract
Background It has been proven that magnetic resonance (MR) and ultrasound imaging are useful tools in the quantification of carotid atherosclerotic plaques. However, there are only a few pieces of evidence to illustrate the links of quantitative measurements of carotid plaques between MR and ultrasound imaging. This study looked to compare the quantitative measurements of carotid plaques and investigate their relationship between three-dimensional (3D) MR vessel wall imaging and two-dimensional (2D) ultrasound imaging. Methods Seventy-five asymptomatic elderly subjects (mean age: 73.3±5.7 years; 45 males) with carotid atherosclerotic plaques diagnosed by both ultrasound and MR imaging were included in this study. The plaque size, including the maximum wall thickness (Max WT), plaque length, and plaque area, was measured by 3D MR and ultrasound imaging on longitudinal and cross-sectional views. The quantitative assessments of carotid plaque size were compared and correlated between 3D MR and 2D ultrasound imaging. Results In total, the quantitative measurements of 101 plaques on longitudinal views or 44 plaques on cross-sectional views of both MR and ultrasound imaging were compared. The Max WT of the plaques (longitudinal: 2.9±0.8 vs. 2.4±0.9 mm; cross-sectional: 3.2±1.1 vs. 2.6±0.7 mm) and plaque areas (longitudinal: 24.3±13.4 vs. 17.0±12.7 mm2; cross-sectional: 24.9±24.6 vs. 16.8±13.3 mm2) measured by MR imaging were found to be significantly higher than those measured by ultrasound imaging (all P<0.001). Moderate to strong correlations were found in Max WT, plaque area, plaque length between 3D MR and ultrasound imaging. Conclusions The quantitative measurements of carotid plaques using 3D MR and 2D ultrasound are significantly correlated. The plaque area and Max WT measured by 3D MR imaging are more significant than these parameters measured by 2D ultrasound imaging, which might be explained by the resolution of MR imaging and the workflow of measurements.
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Affiliation(s)
- Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | - Ying Cai
- Department of Radiology, Taizhou People's Hospital, Taizhou 225400, China
| | - Manwei Huang
- Department of Ultrasound, China Meitan General Hospital, Beijing 100028, China
| | - Yang Liu
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou 225009, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | | | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Washington, Seattle, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
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21
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Wong ND. Cardiovascular risk assessment: The foundation of preventive cardiology. Am J Prev Cardiol 2020; 1:100008. [PMID: 34327451 PMCID: PMC8315480 DOI: 10.1016/j.ajpc.2020.100008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022] Open
Abstract
The foundation of preventive cardiology begins with knowing the patient's baseline cardiovascular disease (CVD) risk from which the patient-clinician risk discussion informs on the best ways to lower risk through lifestyle management, as well as a decision about the initiation and intensity of pharmacologic therapy. Global CVD risk assessment involves estimation of cardiovascular risk using a basic panel of risk factors. The Framingham Heart Study championed the first such risk scores, followed by others around the world. Most recently, the Pooled Cohort Equations (PCE) have been recommended in the United States as a starting point in CVD risk assessment. Persons at low (<5%) 10-year risk are generally recommended for lifestyle management only and those at highest (>20%) 10-year risk are recommended for both lifestyle and pharmacologic therapy to reduce risk. Assessing the presence of one or more "risk enhancing" factors is intended to inform the treatment decision in those at borderline (5-<7.5%) or intermediate (7.5-20%) risk, with the use of coronary calcium scores to further refine the treatment decision. Moreover, not all those with ASCVD are treated equal, and recent guidelines provide criteria for identifying those at very high risk. While current techniques best predict long-term risk of CVD events, biomarkers strategies are being developed to predict near-term events, and other imaging techniques such as coronary CT angiography and vascular MRI hold promise to identify vulnerable plaque. Validation and incorporating into clinical practice such state of the art techniques will be vital to moving CVD risk assessment to the next level.
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Affiliation(s)
- Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, C240 Medical Sciences, University of California, Irvine, CA, 92697-4079, USA
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22
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Han T, Paramsothy P, Hong J, Isquith D, Xu D, Bai H, Neradilek M, Gill E, Zhao XQ. High-resolution MRI assessed carotid atherosclerotic plaque characteristics comparing men and women with elevated ApoB levels. Int J Cardiovasc Imaging 2020; 36:481-489. [PMID: 32020410 DOI: 10.1007/s10554-019-01600-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/06/2019] [Indexed: 01/14/2023]
Abstract
Previous studies demonstrated that men were more likely to have plaque rupture and are at greater risk for myocardial infarction and stroke than women. We evaluated differences in carotid plaque characteristics by MRI between men and women with mild-moderate atherosclerosis and elevated ApoB levels. One hundred eighty-two subjects (104 men and 78 women) with CAD or carotid stenosis (≥ 15% by ultrasound), ApoB ≥ 120 mg/dL and carotid MRI scan were included. Percent wall volume (%WV) was calculated as (wall volume/total vessel volume) × 100%. Three major plaque compositions, fibrous tissue (FT), calcification (CA) and lipid rich necrotic core (LRNC), were identified and quantified using published MRI criteria. Adventitial and plaque neovascularization as fractional plasma volume (Vp) and permeability as transfer constant (Ktrans) were analyzed using kinetic modeling. These characteristics were compared between men and women. Men, compared to women, were younger (54 ± 8 vs. 58 ± 8 years, p = 0.01), had higher rate of previous MI (46 vs. 26%, p = 0.005) but lower proportions of metabolic syndrome (37 vs. 59%, p = 0.003). After adjusting for between-gender differences, men were significantly more likely to have LRNC (OR 2.22, 95% CI 1.04-4.89, p = 0.04) and showed significantly larger %LRNC than women (diff = 4.3%, 95% CI 1.6-6.9%, p = 0.002), while %WV, FT, and CA were similar between men and women. There were no statistically significant differences in adventitial and plaque Vp or Ktrans. Men were significantly more likely to have LRNC and had larger LRNC than women. However, men and women showed relatively similar levels of adventitial and plaque neovascularization and permeability.Trial registration: NCT00715273 at ClinicalTrials.gov. Registered 15 July 2008, retrospectively registered.
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Affiliation(s)
- Tianwen Han
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, 98104, USA
| | - Pathmaja Paramsothy
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, 98104, USA
| | - Jaekyoung Hong
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, 98104, USA
| | - Daniel Isquith
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, 98104, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, 98109, USA
| | - Hua Bai
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Beijing, 100032, China
| | - Moni Neradilek
- The Mountain-Whisper-Light Statistics, Seattle, WA, 98112, USA
| | - Edward Gill
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, 98104, USA
| | - Xue-Qiao Zhao
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, 98104, USA. .,Harborview Medical Center, University of Washington, GEC-37, 325 9th Ave, Box 359720, Seattle, WA, 98104, USA.
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Cao Y, Zhao X, Watase H, Hippe DS, Wu Y, Zhang H, Yue L, Canto GM, Song Y, Shi H, Wang G, Li R, Bao H, Yuan C. Comparison of Carotid Atherosclerosis between Patients at High Altitude and Sea Level: A Chinese Atherosclerosis Risk Evaluation Study. J Stroke Cerebrovasc Dis 2020; 29:104448. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 01/29/2023] Open
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Wüst RCI, Calcagno C, Daal MRR, Nederveen AJ, Coolen BF, Strijkers GJ. Emerging Magnetic Resonance Imaging Techniques for Atherosclerosis Imaging. Arterioscler Thromb Vasc Biol 2020; 39:841-849. [PMID: 30917678 DOI: 10.1161/atvbaha.118.311756] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis is a prevalent disease affecting a large portion of the population at one point in their lives. There is an unmet need for noninvasive diagnostics to identify and characterize at-risk plaque phenotypes noninvasively and in vivo, to improve the stratification of patients with cardiovascular disease, and for treatment evaluation. Magnetic resonance imaging is uniquely positioned to address these diagnostic needs. However, currently available magnetic resonance imaging methods for vessel wall imaging lack sufficient discriminative and predictive power to guide the individual patient needs. To address this challenge, physicists are pushing the boundaries of magnetic resonance atherosclerosis imaging to increase image resolution, provide improved quantitative evaluation of plaque constituents, and obtain readouts of disease activity such as inflammation. Here, we review some of these important developments, with specific focus on emerging applications using high-field magnetic resonance imaging, the use of quantitative relaxation parameter mapping for improved plaque characterization, and novel 19F magnetic resonance imaging technology to image plaque inflammation.
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Affiliation(s)
- Rob C I Wüst
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Claudia Calcagno
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., G.J.S.)
| | - Mariah R R Daal
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Aart J Nederveen
- Radiology and Nuclear Medicine (A.J.N.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Bram F Coolen
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Gustav J Strijkers
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands.,Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., G.J.S.)
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25
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Hippe DS, Balu N, Chen L, Canton G, Liu W, Watase H, Waterton JC, Hatsukami TS, Hwang JN, Yuan C. Confidence Weighting for Robust Automated Measurements of Popliteal Vessel Wall Magnetic Resonance Imaging. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e002870. [PMID: 31928231 DOI: 10.1161/circgen.119.002870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel S Hippe
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Niranjan Balu
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Li Chen
- Department of Electrical and Computer Engineering (L.C., J.-N.H.), University of Washington, Seattle
| | - Gador Canton
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Wenjin Liu
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Division of Vascular Surgery, Department of Surgery (H.W., T.S.H.), University of Washington, Seattle
| | - John C Waterton
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom. (J.C.W.)
| | - Thomas S Hatsukami
- Division of Vascular Surgery, Department of Surgery (H.W., T.S.H.), University of Washington, Seattle
| | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering (L.C., J.-N.H.), University of Washington, Seattle
| | - Chun Yuan
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
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Segment-specific progression of carotid artery atherosclerosis: a magnetic resonance vessel wall imaging study. Neuroradiology 2019; 62:211-220. [PMID: 31720758 DOI: 10.1007/s00234-019-02316-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aimed to investigate the segment-specific progression of atherosclerotic carotid plaques using serial multi-contrast magnetic resonance (MR) imaging. METHODS Symptomatic patients with carotid 30-70% stenosis were recruited and underwent carotid MR vessel wall imaging at baseline and follow-up time point (≥ 6 months after baseline). The location of plaques was determined according to the maximum wall thickness located above or below carotid bifurcation. The baseline and changing characteristics of carotid plaques were compared between plaques above and below carotid bifurcation, and the risk factors for segment-specific plaque progression were analyzed with logistic regression. RESULTS Ninety-six carotid plaques from 73 patients (mean age 66.5 ± 11.4 years old) were eligible for statistical analysis. Compared with plaques located below carotid bifurcation, those above bifurcation had significantly greater stenosis at baseline (57.2 ± 13.0% vs. 50.4 ± 13.5%, p = 0.016, adjusted p = 0.005) and greater progression rate of carotid wall volume (35.2 ± 68.8 mm3/year vs. 4.2 ± 65.0 mm3/year, p = 0.026, adjusted p = 0.005) before and after adjusting for all clinical risk factors and baseline stenosis and wall volume of carotid arteries. Logistic regression showed that the related risk factors were age, hypertension, and smoke for the progression of plaques located above the bifurcation and age for plaques below the bifurcation, respectively. CONCLUSION Plaques located above the bifurcation of carotid arteries had greater annual progression and correlated with more cardiovascular risk factors compared with those located below the bifurcation.
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Wu J, Xin J, Yang X, Sun J, Xu D, Zheng N, Yuan C. Deep morphology aided diagnosis network for segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black-blood vessel wall MRI. Med Phys 2019; 46:5544-5561. [PMID: 31356693 DOI: 10.1002/mp.13739] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/14/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Early detection of carotid atherosclerosis on the vessel wall (VW) magnetic resonance imaging (MRI) (VW-MRI) images can prevent the progression of cardiovascular disease. However, the manual inspection process of the VW-MRI images is cumbersome and has low reproducibility. Therefore in this paper, by using the convolutional neural networks (CNNs), we develop a deep morphology aided diagnosis (DeepMAD) network for automated segmentation of the VW of carotid artery and for automated diagnosis of the carotid atherosclerosis with the black-blood (BB) VW-MRI (i.e., the T1-weighted MRI) in a slice-by-slice manner. METHODS The proposed DeepMAD network consists of a segmentation subnetwork and a diagnosis subnetwork for performing the segmentation and diagnosis tasks on the BB-VW-MRI images, where the manual labeled lumen area, the manual labeled outer wall area and the manual labeled lesion Types based on the modified American Heart Association (AHA) criteria are used as the ground-truth. Specifically, a deep U-shape CNN with a weighted fusion layer is designed as the segmentation subnetwork, where the lumen area and the outer wall area can be simultaneously segmented under the supervision of the triple Dice loss to provide the vessel wall map as morphological information. Then, the image stream from the BB-VWMRI image and the morphology stream from the obtained vessel wall map are extracted from two deep CNNs and combined to obtain the diagnosis results of atherosclerosis in the diagnosis subnetwork. In addition, the triple input set is formed by three carotid regions of interest (ROIs) from three consecutive slices of the MRI sequence and input to the DeepMAD network, where the first and last slices used as additional adjacent slices to provide 2.5D spatial information along the carotid artery centerline for the intermediate slice, which is the target slice for segmentation and diagnosis in the study. RESULTS Compared to other existing methods, the DeepMAD network can achieve promising segmentation performances (0.9594 Dice for the lumen and 0.9657 Dice for the outer wall) and better diagnosis Accuracy of the carotid atherosclerosis (0.9503 AUC and 0.8916 Accuracy) in the test dataset (including invisible subjects) from same source as the training dataset. In addition, the trained DeepMAD model can be successfully transferred to another test dataset for segmentation and diagnosis tasks with remarkable performance (0.9475 Dice for the lumen and 0.9542 Dice for the outer wall, 0. 9227 AUC and 0.8679 Accuracy for diagnosis). CONCLUSIONS Even without the intervention of reviewers required for previous works, the proposed DeepMAD network automatically segments the lumen and the outer wall together and diagnoses the carotid atherosclerosis with high performances. The DeepMAD network can be used in clinical trials to help radiologists get rid of tedious reading tasks, such as screening review to separate the normal carotid from the atherosclerotic arteries and outlining the vessel wall contours.
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Affiliation(s)
- Jiayi Wu
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jingmin Xin
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Nanning Zheng
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Berry JD, Mehta A, Lin K, Ayers CR, Carroll T, Pandey A, Garside DB, Daviglus ML, Yuan C, Lloyd-Jones DM. Association of Long-Term Risk Factor Levels With Carotid Atherosclerosis: The Chicago Healthy Aging Magnetic Resonance Imaging Plaque Study (CHAMPS). Circ Cardiovasc Imaging 2019; 12:e009226. [PMID: 31522549 DOI: 10.1161/circimaging.119.009226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Absence of cardiovascular risk factors (RF) in young adulthood is associated with a lower risk for cardiovascular disease. However, it is unclear if low RF burden in young adulthood decreases the quantitative burden and qualitative features of atherosclerosis. METHODS Multi-contrast carotid magnetic resonance imaging was performed on 440 Chicago Healthy Aging Study participants in 2009 to 2011, whose RF (total cholesterol, blood pressure, diabetes mellitus, and smoking) were measured in 1967 to 1973. Participants were divided into 4 groups: low-risk (with total cholesterol <200 mg/dL and no treatment, blood pressure <120/80 mm Hg and no treatment, no smoking, and no diabetes mellitus), 0 high RF but some RF unfavorable (≥1 RF above low-risk threshold but below high-risk threshold), 1 high RF (total cholesterol ≥240 mg/dL or treated, blood pressure ≥140/90 or treated, diabetes mellitus, or smoking), and 2 or more high RF. Association of baseline RF status with carotid atherosclerosis (overall mean carotid wall thickness and lipid-rich necrotic core) at follow-up was assessed. RESULTS Among 424 participants with evaluable carotid magnetic resonance images, the mean age was 32 years at baseline and 73 years at follow-up; 67% were male, 86% white, and 36% were low-risk at baseline. Two or more high RF status was associated with higher carotid wall thickness (0.99±0.11 mm) and lipid-rich necrotic core prevalence (30%), as compared with low-risk group (0.94±0.09 mm and 17%, respectively). Each increment in baseline RF status was associated with higher carotid wall thickness (β-coefficient, 0.015; 95% CI, 0.004-0.026) and with higher lipid-rich necrotic core prevalence at older age (odds ratio, 1.26; 95% CI, 1.00-1.58) in models adjusted for baseline RF and demographics. CONCLUSIONS RF status in young adulthood is associated with the burden and quality of carotid atherosclerosis in older age suggesting that the decades-long protective effect of low-risk status might be mediated through a lower burden of quantitative and qualitative features of atherosclerotic plaque.
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Affiliation(s)
- Jarett D Berry
- Division of Cardiology, Department of Internal Medicine (J.D.B., A.P.), UT Southwestern Medical Center, Dallas, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.M.)
| | - Kai Lin
- Department of Radiology (K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Colby R Ayers
- Department of Clinical Sciences (C.R.A.), UT Southwestern Medical Center, Dallas, TX
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine (J.D.B., A.P.), UT Southwestern Medical Center, Dallas, TX
| | - Daniel B Garside
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago (D.B.G., M.L.D.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago (D.B.G., M.L.D.)
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Seattle (C.Y.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine (D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
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29
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Liu J, Sun J, Balu N, Ferguson MS, Wang J, Kerwin WS, Hippe DS, Wang A, Hatsukami TS, Yuan C. Semiautomatic carotid intraplaque hemorrhage volume measurement using 3D carotid MRI. J Magn Reson Imaging 2019; 50:1055-1062. [PMID: 30861249 DOI: 10.1002/jmri.26698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Presence of intraplaque hemorrhage (IPH) is a known risk factor for stroke and plaque progression. Accurate and reproducible measurement of IPH volume are required for further risk stratification. PURPOSE To develop a semiautomatic method to measure carotid IPH volume. STUDY TYPE Retrospective. POPULATION Patients scheduled for carotid endarterectomy and patients with 16-79% asymptomatic carotid stenosis by ultrasound. FIELD STRENGTH 3T. SEQUENCE Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MRI. ASSESSMENT A semiautomated volumetric measurement of IPH using signal intensity thresholding of 3D SNAP volume was implemented. Fourteen carotid endarterectomy patients were enrolled to determine the signal intensity threshold of IPH using histology. Thirty-three patients with 16-79% asymptomatic stenosis were scanned twice within 1 month to evaluate reproducibility. The normalized SNAP intensity with the highest Youden index for predicting IPH on histology was used for thresholding. Scan-rescan reproducibility of IPH measurement was assessed using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). STATISTICAL TESTS Receiver operating characteristic curve, area under the curve, Cohen's kappa, intraclass correlation coefficient, coefficient of variance (CV), and paired t-test. RESULTS IPH detection by the algorithm had substantial agreement with manual review (kappa: 0.92; 95% confidence interval [CI]: 0.83, 1.00) and moderate agreement with histology (kappa: 0.55; 95% CI: 0.34, 0.68). IPH volume measurements by the algorithm were strongly correlated with histology (Spearman's rho = 0.76, P = 0.002). IPH measurements were also reproducible, with ICCs of 0.86 (95% CI: 0.57, 0.96), 0.77 (95% CI: 0.32, 0.94), and 0.99 (95% CI: 0.93, 1.00) for maximum/mean normalized intensity and IPH volume, respectively. The corresponding CVs were 10.6%, 5.2%, and 11.8%. DATA CONCLUSION IPH volume measurements on SNAP MRI are highly reproducible using semiautomatic measurement. Level of Evidence 2 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2019;50:1055-1062.
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Affiliation(s)
- Jin Liu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Marina S Ferguson
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jinnan Wang
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - William S Kerwin
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Amy Wang
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, Washington, USA.,Department of Radiology, University of Washington, Seattle, Washington, USA
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Abstract
Background The quality of carotid wall MRI can benefit substantially from a dedicated RF coil that is tailored towards the human neck geometry and optimized for image signal-to-noise ratio (SNR), parallel imaging performance and RF penetration depth and coverage. In last decades, several of such dedicated carotid coils were introduced. However, a comparison of the more successful designs is still lacking. Objective To perform a head-to-head comparison over four dedicated MR carotid surface coils with 4, 6, 8 and 30 coil elements, respectively. Material and methods Ten volunteers were scanned on a 3T scanner. For each subject, multiple black-blood carotid vessel wall images were measured using the four coils with different parallel imaging settings. The performance of the coils was evaluated and compared in terms of image coverage, penetration depth and noise correlations between elements. Vessel wall of a common carotid section was delineated manually. Subsequently, images were assessed based on vessel wall morphology and image quality parameters. The morphological parameters consisted of the vessel wall area, thickness, and normalized wall index (wall area/total vessel area). Image quality parameters consisted of vessel wall SNR, wall-lumen contrast-to-noise ratio (CNR), the vessel g-factor, and CNRindex ((wall–lumen signal) / (wall+lumen signal)). Repeated measures analysis of variance (rmANOVA) was applied for each parameter for the averaged 10 slices for all volunteers to assess effect of coil and SENSE factor. If the rmANOVA was significant, post-hoc comparisons were conducted. Results No significant coil effect were found for vessel wall morphological parameters. SENSE acceleration affected some morphological parameters for 6- and 8-channel coils, but had no effect on the 30-channel coil. The 30-channel coil achieved high acceleration factors (10x) with significantly lower vessel g-factor values (ps ≤ 0.01), but lower vessel wall SNR and CNR values (ps ≤ 0.01). Conclusion All four coils were capable of high-quality carotid MRI. The 30-channel coil is recommended when rapid image acquisition acceleration is required for 3D measurements, whereas 6- and 8-channel coils demonstrated the highest SNR performance.
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Lu M, Peng P, Qiao H, Cui Y, Ma L, Cui B, Cai J, Zhao X. Association between age and progression of carotid artery atherosclerosis: a serial high resolution magnetic resonance imaging study. Int J Cardiovasc Imaging 2019; 35:1287-1295. [PMID: 30739271 DOI: 10.1007/s10554-019-01538-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
This study aimed to investigate the association between age and progression of carotid atherosclerotic plaques using serial high resolution magnetic resonance imaging (MRI). Symptomatic patients who had carotid atherosclerosis with 30-70% stenosis were enrolled in this study. Carotid MRI was performed at baseline and follow-up time point (≥ 6 months after baseline), respectively. The characteristics of carotid plaque progression among different age groups (> 75 years old, 60-75 years old and < 60 years old) were compared. Logistic regression was performed to relate age with carotid plaque progression. Of recruited 84 patients, 73 (mean age, 66.5 ± 11.4 years old; males, 82.2%) with 96 plaques were included in the final analysis. Compared with younger patients, older ones had significantly higher incidence of calcification in carotid plaques (> 75 years old: 91.3%, 60-75 years old: 65.7% and < 60 years old: 55.3%, p = 0.013), greater annual change of carotid wall volume (> 75 years old: 39.0 (4.3-104.6) mm3, 60-75 years old: 28.7 (- 28.0 to 73.7) mm3 and < 60 years old: 4.8 (- 27.1-31.9) mm3, p = 0.032) and maximum carotid wall area (> 75 years old: 6.1 (- 3.5 to 17.2) mm2, 60-75 years old: 2.4 (- 4.7 to 15.1) mm2 and < 60 years old: 1.4 (- 5.8 to 6.9) mm2, p = 0.046). Age (OR 1.44; 95% CI 1.10-1.89; p = 0.009) and hypertension (OR 4.61; 95% CI 1.41-15. 02; p = 0.011) were independent predictors in discriminating upper quartile of annual change of carotid wall volume after adjusting for all clinical factors. Older patients have faster progression rate in carotid plaques than younger ones and age is independently associated with carotid plaque progression. Our findings suggest that the carotid plaques of older patients need to be monitored more frequently.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Huiyu Qiao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Yuanyuan Cui
- Department of Radiology, PLA General Hospital, Beijing, 100853, China
| | - Lu Ma
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Bao Cui
- Department of Radiology, Chinese PLA Bethune International Peace Hospital, Shijiazhuang, China
| | - Jianming Cai
- Department of Radiology, PLA General Hospital, Beijing, 100853, China.
| | - Xihai Zhao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, 100084, China.
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Application of High-Resolution CUBE Sequence in Exploring Stroke Mechanisms of Atherosclerotic Stenosis of Middle Cerebral Artery. J Stroke Cerebrovasc Dis 2018; 28:156-162. [PMID: 30322755 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/17/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study aimed to analyze the vascular wall and atherosclerotic plaques of the middle cerebral artery (MCA) and compare their differences between patients with cerebral infarction and transient ischemic attack (TIA) using 3-dimensional fast-spin-echo T1-weighted sequence (namely CUBE). METHODS Forty-seven patients with atherosclerotic stenosis of the MCA were included in this study. They received magnetic resonance examinations with routine T1WI, T2WI, 3-dimensional time-of-flight magnetic resonance angiography and diffusion-weighted imaging, as well as high-resolution CUBE T1WI sequence. Two physicians independently observed the location and degree of enhancement of the atheromatous plaques. The vessel area and lumen area at the maximal-lumen-narrowing and reference site were measured to calculate the plaque area, rate of stenosis, and remodeling index of the MCA. The chi-squared test was used to compare the differences of degree of enhancement between the cerebral infarction and TIA groups. The differences of rate of stenosis and remodeling index were compared by independent sample t test. RESULTS Twenty-five lesion vessels in the infarction group and 22 in the TIA group were analyzed. The difference of stenosis rate between the groups was not statistically significant. The lesion vessels of infarction group had a significantly larger remodeling index and plaque area, and the plaques had a significantly higher degree of enhancement, compared to the TIA group. CONCLUSIONS CUBE T1WI can be used to characterize the MCA vessel wall and atherosclerotic plaque. Positive remodeling and enhanced plaques are closely correlated with the occurrence of brain stroke.
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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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Lu M, Peng P, Cui Y, Qiao H, Li D, Cai J, Zhao X. Association of Progression of Carotid Artery Wall Volume and Recurrent Transient Ischemic Attack or Stroke: A Magnetic Resonance Imaging Study. Stroke 2018; 49:614-620. [PMID: 29382804 DOI: 10.1161/strokeaha.117.019422] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/18/2017] [Accepted: 12/15/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the association between carotid plaque progression and subsequent recurrent events using magnetic resonance imaging. METHODS Sixty-three symptomatic patients with ipsilateral carotid atherosclerotic stenosis (30%-69% stenosis) determined by ultrasound underwent first and second carotid artery magnetic resonance imaging for carotid artery at baseline and ≥6 months after the first scan, respectively. All the patients had clinical follow-up after the second magnetic resonance scan for ≤5 years until the onset of recurrent transient ischemic attack or stroke. Presence/absence of carotid plaque compositional features, particularly intraplaque hemorrhage and fibrous cap rupture was identified. The annual progression of carotid wall volume between 2 magnetic resonance scans was measured. Univariate and multivariate Cox regression was used to calculate the hazard ratio and corresponding 95% confidence interval of carotid plaque features in discriminating recurrent events. Receiver-operating-characteristic-curve analysis was conducted to determine the area-under-the-curve of carotid plaque features in predicting recurrent events. RESULTS Sixty-three patients (mean age: 66.5±10.0 years old; 54 males) were eligible for final statistics analysis. During a mean follow-up duration of 55.1±13.6 months, 14.3% of patients (n=9) experienced ipsilateral recurrent transient ischemic attack/stroke. The annual progression of carotid wall volume was significantly associated with recurrent events before (hazard ratio, 1.14 per 10 mm3; 95% confidence interval, 1.02-1.27; P=0.019) and after (hazard ratio, 1.19 per 10 mm3; 95% confidence interval, 1.03-1.37; P=0.022) adjusted for confounding factors. In discriminating the recurrence of transient ischemia attack/stroke, receiver-operator curve analysis indicated that combined with annual progression of wall volume, there was a significant incremental improvement in the area-under-the-curve of intraplaque hemorrhage (area-under-the-curve: 0.69-0.81) and fibrous cap rupture (area-under-the-curve: 0.73-0.84). CONCLUSIONS The annual progression of carotid wall volume is independently associated with recurrent ischemic cerebrovascular events, and this measurement has added value for intraplaque hemorrhage and fibrous cap rupture in predicting future events.
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Affiliation(s)
- Mingming Lu
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Peng Peng
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Yuanyuan Cui
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Huiyu Qiao
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Dongye Li
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.)
| | - Jianming Cai
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.).
| | - Xihai Zhao
- From the Department of Radiology, PLA General Hospital, Beijing, China (M.L., Y.C., J.C.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (H.Q., D.L., X.Z.); and Department of Radiology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin, China (M.L., P.P.).
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Sun J, Zhao XQ, Balu N, Neradilek MB, Isquith DA, Yamada K, Cantón G, Crouse JR, Anderson TJ, Huston J, O'Brien K, Hippe DS, Polissar NL, Yuan C, Hatsukami TS. Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes: The MRI Substudy in AIM-HIGH. JACC Cardiovasc Imaging 2017; 10:241-249. [PMID: 28279371 DOI: 10.1016/j.jcmg.2016.06.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. BACKGROUND Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. METHODS As part of the event-driven clinical trial AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes), subjects with clinically established atherosclerotic disease underwent multicontrast carotid magnetic resonance imaging (MRI) to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazards survival models. RESULTS Of the 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (82% male, mean age 61 ± 9 years, 94% statin use). During median follow-up of 35.1 months, 18 subjects (8.4%) reached the AIM-HIGH endpoint. High lipid content (hazard ratio [HR] per 1 SD increase in percent lipid core volume: 1.57; p = 0.002) and thin/ruptured fibrous cap (HR: 4.31; p = 0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (HR: 3.00; p = 0.053). High calcification content (HR per 1 SD increase in percent calcification volume: 0.66; p = 0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment. CONCLUSIONS Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Xue-Qiao Zhao
- Department of Medicine, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Daniel A Isquith
- Department of Medicine, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Gádor Cantón
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - John R Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J Anderson
- Libin Cardiovascular Institute of Alberta and Cumming School of Medicine, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin O'Brien
- Department of Medicine, University of Washington, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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St Pierre S, Siegelman J, Obuchowski NA, Ma X, Paik D, Buckler AJ. Measurement Accuracy of Atherosclerotic Plaque Structure on CT Using Phantoms to Establish Ground Truth. Acad Radiol 2017; 24:1203-1215. [PMID: 28551396 PMCID: PMC5591770 DOI: 10.1016/j.acra.2017.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to characterize analytic performance of software-aided arterial vessel structure measurements across a range of scanner settings for computed tomography angiography where ground truth is known. We characterized performance for measurands that may be efficiently measured for clinical cases without use of software, as well as those that may be done manually but which is generally not done due to the effort level required unless software is employed. MATERIALS AND METHODS Four measurands (lumen area, stenosis, wall area, wall thickness) were evaluated using tissue-mimicking phantoms to estimate bias, heteroscedasticity, and limits of quantitation both pooled across scanner settings and individually for eight different settings. Reproducibility across scanner settings was also estimated. RESULTS Measurements of lumen area have a near constant bias of +1.3 mm for measurements ranging from 3 mm2 to 40 mm2; stenosis bias is +7% across a 30%-70% range; wall area bias is +14% across a 50-450 mm2 range; and wall thickness bias is +1.2 mm across a 3-9 mm range. All measurements possess properties that make them suitable for measuring longitudinal change. Lumen area demonstrates the most sensitivity to scanner settings (bias from as low as +.1 mm to as high as +2.7 mm); wall thickness demonstrates negligible sensitivity. CONCLUSIONS Variability across scanner settings for lumen measurands was generally higher than bias for a given setting. The converse was true for the wall measurands, where variability due to scanner settings was very low. Both bias and variability due to scanner settings of vessel structure were within clinically useful levels.
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Affiliation(s)
| | | | - Nancy A Obuchowski
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
| | - David Paik
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
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Coolen BF, Calcagno C, van Ooij P, Fayad ZA, Strijkers GJ, Nederveen AJ. Vessel wall characterization using quantitative MRI: what's in a number? MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:201-222. [PMID: 28808823 PMCID: PMC5813061 DOI: 10.1007/s10334-017-0644-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022]
Abstract
The past decade has witnessed the rapid development of new MRI technology for vessel wall imaging. Today, with advances in MRI hardware and pulse sequences, quantitative MRI of the vessel wall represents a real alternative to conventional qualitative imaging, which is hindered by significant intra- and inter-observer variability. Quantitative MRI can measure several important morphological and functional characteristics of the vessel wall. This review provides a detailed introduction to novel quantitative MRI methods for measuring vessel wall dimensions, plaque composition and permeability, endothelial shear stress and wall stiffness. Together, these methods show the versatility of non-invasive quantitative MRI for probing vascular disease at several stages. These quantitative MRI biomarkers can play an important role in the context of both treatment response monitoring and risk prediction. Given the rapid developments in scan acceleration techniques and novel image reconstruction, we foresee the possibility of integrating the acquisition of multiple quantitative vessel wall parameters within a single scan session.
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Affiliation(s)
- Bram F Coolen
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands. .,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pim van Ooij
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Wang J, Chen H, Sun J, Hippe DS, Zhang H, Yu S, Cai J, Xie L, Cui B, Yuan C, Zhao X, Yuan W, Liu H. Dynamic contrast-enhanced MR imaging of carotid vasa vasorum in relation to coronary and cerebrovascular events. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Yuan C, Sun J. MR Quantification of Plaque Lipid Content. JACC Cardiovasc Imaging 2017; 10:757-759. [DOI: 10.1016/j.jcmg.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 10/19/2022]
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40
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Reynoso E, Rodriguez-Granillo GA, Capunay C, Deviggiano A, Meli F, Carrascosa P. Spectral Signal Density of Carotid Plaque Using Dual-Energy Computed Tomography. J Neuroimaging 2017; 27:511-516. [DOI: 10.1111/jon.12440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Exequiel Reynoso
- Department of Neuroradiology; Diagnóstico Maipú; Buenos Aires Argentina
| | | | - Carlos Capunay
- Department of Cardiovascular Imaging; Diagnóstico Maipú; Buenos Aires Argentina
| | | | - Francisco Meli
- Department of Neuroradiology; Diagnóstico Maipú; Buenos Aires Argentina
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging; Diagnóstico Maipú; Buenos Aires Argentina
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41
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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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Wang X, Sun J, Zhao X, Hippe DS, Hatsukami TS, Liu J, Li R, Canton G, Song Y, Yuan C. Ipsilateral plaques display higher T1 signals than contralateral plaques in recently symptomatic patients with bilateral carotid intraplaque hemorrhage. Atherosclerosis 2017; 257:78-85. [PMID: 28110259 PMCID: PMC5325786 DOI: 10.1016/j.atherosclerosis.2017.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Prospective studies have shown a strong association between carotid intraplaque hemorrhage (IPH), detected by magnetic resonance imaging (MRI), and cerebrovascular ischemic events. However, IPH is also observed in a substantial number of asymptomatic patients. We hypothesized that there are differences in the characteristics of IPH+ plaques associated with recent symptoms, compared to IPH+ plaques not associated with recent symptoms. METHODS Patients with recent (≤2 weeks) anterior circulation ischemic events were scanned using a standardized multisequence protocol. Those showing IPH bilaterally were included and analyzed for differences in T1/T2 signals, plaque morphology, and coexisting plaque characteristics between the ipsilateral symptomatic and contralateral asymptomatic sides. RESULTS Thirty-one subjects (67 ± 9 years, 97% males) with bilateral IPH were studied. Despite comparable luminal stenosis (53 ± 42% vs. 53 ± 39%, p = 0.99), T1 signal of IPH measured as signal-intensity-ratio compared to muscle was stronger (SIRIPH-to-muscle: 5.8 ± 2.4 vs. 4.7 ± 1.8, p = 0.004) and tended to be more extensively distributed (IPH volume: 150 ± 199 vs. 88 ± 106 mm3, p = 0.071) on the symptomatic side. IPH+ plaques on the symptomatic side were longer (24 ± 6 vs. 21 ± 7 mm, p = 0.026) and associated with larger necrotic core volume (406 ± 354 vs. 291 ± 293 mm3, p = 0.039) than those on the asymptomatic side. CONCLUSIONS In recently symptomatic patients with bilateral carotid IPH, the symptomatic side showed stronger T1 signals, larger necrotic cores, and longer plaque length than the asymptomatic side. Serial studies on the temporal relationship between these imaging features and clinical events will eventually establish their diagnostic and prognostic value beyond the mere presence of IPH.
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Affiliation(s)
- Xianling Wang
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Jin Liu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Rui Li
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Yan Song
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Radiology, Beijing Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Biomedical Engineering, Tsinghua University, Beijing, China; Department of Bioengineering, University of Washington, Seattle, WA, USA.
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Mutharasan RK, Thaxton CS, Berry J, Daviglus ML, Yuan C, Sun J, Ayers C, Lloyd-Jones DM, Wilkins JT. HDL efflux capacity, HDL particle size, and high-risk carotid atherosclerosis in a cohort of asymptomatic older adults: the Chicago Healthy Aging Study. J Lipid Res 2017; 58:600-606. [PMID: 28049656 DOI: 10.1194/jlr.p069039] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 12/30/2016] [Indexed: 11/20/2022] Open
Abstract
HDL efflux capacity and HDL particle size are associated with atherosclerotic CVD (ASCVD) events in middle-aged individuals; however, it is unclear whether these associations are present in older adults. We sampled 402 Chicago Healthy Aging Study participants who underwent a dedicated carotid MRI assessment for lipid-rich necrotic core (LRNC) plaque. We measured HDL particle size, HDL particle number, and LDL particle number with NMR spectroscopy, as well as HDL efflux capacity. We quantified the associations between HDL particle size and HDL efflux using adjusted linear regression models. We quantified associations between the presence of LRNC and HDL and LDL particle number, HDL particle size, and HDL efflux capacity using adjusted logistic regression models. HDL efflux capacity was directly associated with large (β = 0.037, P < 0.001) and medium (β = 0.0065, P = 0.002) HDL particle concentration and inversely associated with small (β = -0.0049, P = 0.018) HDL particle concentration in multivariable adjusted models. HDL efflux capacity and HDL particle number were inversely associated with prevalent LRNC plaque in unadjusted models (odds ratio: 0.5; 95% confidence interval: 0.26, 0.96), but not after multivariable adjustment. HDL particle size was not associated with prevalent LRNC. HDL particle size was significantly associated with HDL efflux capacity, suggesting that differences in HDL efflux capacity may be due to structural differences in HDL particles. Future research is needed to determine whether HDL efflux is a marker of ASCVD risk in older populations.
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Affiliation(s)
- R Kannan Mutharasan
- Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - C Shad Thaxton
- Department of Urology and Institute of BioNanotechnology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - Jarett Berry
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago, IL 60612
| | - Chun Yuan
- University of Washington College of Engineering and University of Washington School of Medicine, University of Washington, Seattle, WA 98195
| | - Jie Sun
- University of Washington College of Engineering and University of Washington School of Medicine, University of Washington, Seattle, WA 98195
| | - Colby Ayers
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - John T Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
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Opriessnig P, Mangge H, Stollberger R, Deutschmann H, Reishofer G. In vivo cardiovascular magnetic resonance of 2D vessel wall diffusion anisotropy in carotid arteries. J Cardiovasc Magn Reson 2016; 18:81. [PMID: 27876066 PMCID: PMC5120527 DOI: 10.1186/s12968-016-0304-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diffusion weighted (DW) cardiovascular magnetic resonance (CMR) has shown great potential to discriminate between healthy and diseased vessel tissue by evaluating the apparent diffusion coefficient (ADC) along the arterial axis. Recently, ex vivo studies on porcine arteries utilizing diffusion tensor imaging (DTI) revealed a circumferential fiber orientation rather than an organization in axial direction, suggesting dominant diffusion perpendicular to the slice direction. In the present study, we propose a method to access tangential and radial diffusion of carotids in vivo by utilizing a pulse sequence that enables high resolution DW imaging in combination with a two-dimensional (2D) diffusion gradient direction sampling scheme perpendicular to the longitudinal axis of the artery. METHODS High resolution DTI of 12 healthy male volunteers (age: 25-60 years) was performed on one selected axial slice using a read-out segmented EPI (rs-EPI) sequence on a 3T MR scanner. RESULTS It was found consistently for all 12 volunteers, that the tangential component as the principle direction of diffusion. Mean vessel wall fractional anisotropy (FA) values ranged from 0.7 for the youngest to 0.56 for the oldest participant. Linear regression analysis between the FA values and volunteers age revealed a highly significant (P < 0.01) linear relationship with an adjusted R2 of 0.52. In addition, a linear trend (P < 0.1) could be observed between radial diffusivity (RD) and age. CONCLUSION These results point to FA being a sensitive parameter able to capture changes in the vascular architecture with age. In detail, the data demonstrate a decrease in FA with advancing age indicating possible alterations of tissue microstructural integrity. Moreover, analyzing 2D diffusion tensor directions is sufficient and applicable in a clinical setup concerning the overall scan time.
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Affiliation(s)
- Peter Opriessnig
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
| | - Harald Mangge
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
| | - Rudolf Stollberger
- Institute of Medical Engineering, Graz University of Technology, Stremayrgasse 16/III, A-8010 Graz, Austria
| | - Hannes Deutschmann
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Auenbruggerplatz 9, A-8036 Graz, Austria
| | - Gernot Reishofer
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Auenbruggerplatz 9, A-8036 Graz, Austria
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Sun J, Hatsukami TS. Plaque Imaging to Decide on Optimal Treatment: Medical Versus Carotid Endarterectomy Versus Carotid Artery Stenting. Neuroimaging Clin N Am 2016; 26:165-73. [PMID: 26610667 DOI: 10.1016/j.nic.2015.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many of the current guidelines for the management of carotid atherosclerosis are based on clinical trial findings published more than 2 decades ago. The lack of plaque information in clinical decision making represents a major shortcoming and highlights the need for contemporary trials based on characteristics of the atherosclerotic lesion itself, rather than luminal stenosis alone. This article summarizes the major dilemmas clinicians face in current practice, and discusses the rationale and evidence that plaque imaging may help to address these challenges and optimize the clinical management of carotid artery disease in the future.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican Street, Seattle, WA 98109, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, 850 Republican Street, Seattle, WA 98109, USA.
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Chiavaroli L, Mirrahimi A, Ireland C, Mitchell S, Sahye-Pudaruth S, Coveney J, Olowoyeye O, Maraj T, Patel D, de Souza RJ, Augustin LSA, Bashyam B, Blanco Mejia S, Nishi SK, Leiter LA, Josse RG, McKeown-Eyssen G, Moody AR, Berger AR, Kendall CWC, Sievenpiper JL, Jenkins DJA. Low-glycaemic index diet to improve glycaemic control and cardiovascular disease in type 2 diabetes: design and methods for a randomised, controlled, clinical trial. BMJ Open 2016; 6:e012220. [PMID: 27388364 PMCID: PMC4947767 DOI: 10.1136/bmjopen-2016-012220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2DM) produces macrovascular and microvascular damage, significantly increasing the risk of cardiovascular disease (CVD), renal failure and blindness. As rates of T2DM rise, the need for effective dietary and other lifestyle changes to improve diabetes management become more urgent. Low-glycaemic index (GI) diets may improve glycaemic control in diabetes in the short term; however, there is a lack of evidence on the long-term adherence to low-GI diets, as well as on the association with surrogate markers of CVD beyond traditional risk factors. Recently, advances have been made in measures of subclinical arterial disease through the use of MRI, which, along with standard measures from carotid ultrasound (CUS) scanning, have been associated with CVD events. We therefore designed a randomised, controlled, clinical trial to assess whether low-GI dietary advice can significantly improve surrogate markers of CVD and long-term glycaemic control in T2DM. METHODS AND ANALYSIS 169 otherwise healthy individuals with T2DM were recruited to receive intensive counselling on a low-GI or high-cereal fibre diet for 3 years. To assess macrovascular disease, MRI and CUS are used, and to assess microvascular disease, retinal photography and 24-hour urinary collections are taken at baseline and years 1 and 3. Risk factors for CVD are assessed every 3 months. ETHICS AND DISSEMINATION The study protocol and consent form have been approved by the research ethics board of St. Michael's Hospital. If the study shows a benefit, these data will support the use of low-GI and/or high-fibre foods in the management of T2DM and its complications. TRIAL REGISTRATION NUMBER NCT01063374; Pre-results.
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Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arash Mirrahimi
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Christopher Ireland
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandra Mitchell
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Judy Coveney
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Omodele Olowoyeye
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Tishan Maraj
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Livia S A Augustin
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | - Balachandran Bashyam
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephanie K Nishi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Robert G Josse
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gail McKeown-Eyssen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Alan R Berger
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
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47
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Cardiovascular imaging 2015 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2016; 32:697-709. [DOI: 10.1007/s10554-016-0877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schwarz F, Strobl FF, Cyran CC, Helck AD, Hartmann M, Schindler A, Nikolaou K, Reiser MF, Saam T. Reproducibility and differentiation of cervical arteriopathies using in vivo high-resolution black-blood MRI at 3 T. Neuroradiology 2016; 58:569-576. [DOI: 10.1007/s00234-016-1665-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/12/2016] [Indexed: 12/22/2022]
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O'Brien KD, Hippe DS, Chen H, Neradilek MB, Probstfield JL, Peck S, Isquith DA, Canton G, Yuan C, Polissar NL, Zhao XQ, Kerwin WS. Longer duration of statin therapy is associated with decreased carotid plaque vascularity by magnetic resonance imaging. Atherosclerosis 2016; 245:74-81. [PMID: 26708287 PMCID: PMC8629315 DOI: 10.1016/j.atherosclerosis.2015.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/06/2015] [Accepted: 11/26/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Plaque neovasculature is a major route for lipoprotein and leukocyte ingress into plaques, and has been identified as a risk factor for carotid plaque disruption. Vp, a variable derived from pharmacokinetic modeling of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), correlates with plaque neovasculature density. Because lipid-lowering therapy has been associated with regression of neovasculature in animal models, we sought to determine clinical correlates of carotid plaque neovasculature (as assessed by Vp) in participants on statin therapy for established cardiovascular disease. METHODS 98 participants from an AIM-HIGH sub-study underwent DCE-MRI of their carotid arteries. Expert readers who were blinded to all clinical variables analyzed the MR images to measure carotid plaque Vp in all participants. Associations between Vp and duration of statin therapy and other clinical risk factors were analyzed. RESULTS Prior duration of statin treatment at enrollment ranged from <1 year (21%) 1-5 years (40%) and >5 years (39%). In univariate analyses, shorter duration of statin therapy (P = 0.01), the presence of metabolic syndrome (P = 0.02), and higher body mass index (P = 0.01) and lipoprotein(a) (P = 0.01) were all significantly associated with higher baseline Vp values. In multivariate analyses, significant associations remained between shorter duration of statin therapy (P = 0.004) and lipoprotein(a) (P = 0.04). CONCLUSIONS These are the first human, in vivo findings suggesting a relationship between duration of statin therapy and regression of carotid plaque neovasculature. Future longitudinal studies are warranted both to confirm this finding and to address whether changes in neovasculature may translate into change in risk for plaque disruption. CLINICALTRIALS. GOV IDENTIFIERS NCT00880178, NCT01178320 and NCT00120289.
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Affiliation(s)
- Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | | | - Jeffrey L Probstfield
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Suzanne Peck
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Daniel A Isquith
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Xue-Qiao Zhao
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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Singh N, Moody AR, Roifman I, Bluemke DA, Zavodni AEH. Advanced MRI for carotid plaque imaging. Int J Cardiovasc Imaging 2015; 32:83-9. [PMID: 26293362 PMCID: PMC4706840 DOI: 10.1007/s10554-015-0743-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 10/28/2022]
Abstract
Atherosclerosis is the ubiquitous underling pathological process that manifests in heart attack and stroke, cumulating in the death of one in three North American adults. High-resolution magnetic resonance imaging (MRI) is able to delineate atherosclerotic plaque components and total plaque burden within the carotid arteries. Using dedicated hardware, high resolution images can be obtained. Combining pre- and post-contrast T1, T2, proton-density, and magnetization-prepared rapid acquisition gradient echo weighted fat-saturation imaging, plaque components can be defined. Post-processing software allows for semi- and fully automated quantitative analysis. Imaging correlation with surgical specimens suggests that this technique accurately differentiates plaque features. Total plaque burden and specific plaque components such as a thin fibrous cap, large fatty or necrotic core and intraplaque hemorrhage are accepted markers of neuroischemic events. Given the systemic nature of atherosclerosis, emerging science suggests that the presence of carotid plaque is also an indicator of coronary artery plaque burden, although the preliminary data primarily involves patients with stable coronary disease. While the availability and cost-effectiveness of MRI will ultimately be important determinants of whether carotid MRI is adopted clinically in cardiovascular risk assessment, the high accuracy and reliability of this technique suggests that it has potential as an imaging biomarker of future risk.
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Affiliation(s)
- Navneet Singh
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Idan Roifman
- Division of Cardiology, Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - David A Bluemke
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Anna E H Zavodni
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada.
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