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Pruijssen JT, Schreuder FHBM, Wilbers J, Kaanders JHAM, de Korte CL, Hansen HHG. Performance evaluation of commercial and non-commercial shear wave elastography implementations for vascular applications. ULTRASONICS 2024; 140:107312. [PMID: 38599075 DOI: 10.1016/j.ultras.2024.107312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Shear wave elastography (SWE) is mainly used for stiffness estimation of large, homogeneous tissues, such as the liver and breasts. However, little is known about its accuracy and applicability in thin (∼0.5-2 mm) vessel walls. To identify possible performance differences among vendors, we quantified differences in measured wave velocities obtained by commercial SWE implementations of various vendors over different imaging depths in a vessel-mimicking phantom. For reference, we measured SWE values in the cylindrical inclusions and homogeneous background of a commercial SWE phantom. Additionally, we compared the accuracy between a research implementation and the commercially available clinical SWE on an Aixplorer ultrasound system in phantoms and in vivo in patients. METHODS SWE measurements were performed over varying depths (0-35 mm) using three ultrasound machines with four ultrasound probes in the homogeneous 20 kPa background and cylindrical targets of 10, 40, and 60 kPa of a multi-purpose phantom (CIRS-040GSE) and in the anterior and posterior wall of a homogeneous polyvinyl alcohol vessel-mimicking phantom. These phantom data, along with in vivo SWE data of carotid arteries in 23 patients with a (prior) head and neck neoplasm, were also acquired in the research and clinical mode of the Aixplorer ultrasound machine. Machine-specific estimated phantom stiffness values (CIRS phantom) or wave velocities (vessel phantom) over all depths were visualized, and the relative error to the reference values and inter-frame variability (interquartile range/median) were calculated. Correlations between SWE values and target/vessel wall depth were explored in phantoms and in vivo using Spearman's correlations. Differences in wave velocities between the anterior and posterior arterial wall were assessed with Wilcoxon signed-rank tests. Intra-class correlation coefficients were calculated for a sample of ten patients as a measure of intra- and interobserver reproducibility of SWE analyses in research and clinical mode. RESULTS There was a high variability in obtained SWE values among ultrasound machines, probes, and, in some cases, with depth. Compared to the homogeneous CIRS-background, this variation was more pronounced for the inclusions and the vessel-mimicking phantom. Furthermore, higher stiffnesses were generally underestimated. In the vessel-mimicking phantom, anterior wave velocities were (incorrectly) higher than posterior wave velocities (3.4-5.6 m/s versus 2.9-5.9 m/s, p ≤ 0.005 for 3/4 probes) and remarkably correlated with measurement depth for most machines (Spearman's ρ = -0.873-0.969, p < 0.001 for 3/4 probes). In the Aixplorer's research mode, this difference was smaller (3.3-3.9 m/s versus 3.2-3.6 m/s, p = 0.005) and values did not correlate with measurement depth (Spearman's ρ = 0.039-0.659, p ≥ 0.002). In vivo, wave velocities were higher in the posterior than the anterior vessel wall in research (left p = 0.001, right p < 0.001) but not in clinical mode (left: p = 0.114, right: p = 0.483). Yet, wave velocities correlated with vessel wall depth in clinical (Spearman's ρ = 0.574-0.698, p < 0.001) but not in research mode (Spearman's ρ = -0.080-0.466, p ≥ 0.003). CONCLUSIONS We observed more variation in SWE values among ultrasound machines and probes in tissue with high stiffness and thin-walled geometry than in low stiffness, homogeneous tissue. Together with a depth-correlation in some machines, where carotid arteries have a fixed location, this calls for caution in interpreting SWE results in clinical practice for vascular applications.
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Affiliation(s)
- Judith T Pruijssen
- Medical Ultrasound Imaging Center (MUSIC), Department of Medical Imaging/Radiology, Radboud university medical center, Nijmegen, the Netherlands.
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joyce Wilbers
- Center of Expertise for Cancer Survivorship, Radboud university medical center, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Center (MUSIC), Department of Medical Imaging/Radiology, Radboud university medical center, Nijmegen, the Netherlands; Physics of Fluid Group, MESA+ Institute for Nanotechnology, and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Hendrik H G Hansen
- Medical Ultrasound Imaging Center (MUSIC), Department of Medical Imaging/Radiology, Radboud university medical center, Nijmegen, the Netherlands
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de Buck MHS, Jezzard P, Frost R, Randell C, Hurst K, Choudhury RP, Robson MD, Biasiolli L. 10-channel phased-array coil for carotid wall MRI at 3T. PLoS One 2023; 18:e0288529. [PMID: 37556496 PMCID: PMC10411804 DOI: 10.1371/journal.pone.0288529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Accurate assessment of plaque accumulation near the carotid bifurcation is important for the effective prevention and treatment of stroke. However, vessel and plaque delineation using MRI can be limited by low contrast-to-noise ratio (CNR) and long acquisition times. In this work, a 10-channel phased-array receive coil design for bilateral imaging of the carotid bifurcation using 3T MRI is proposed. METHODS The proposed 10-channel receive coil was compared to a commercial 4-channel receive coil configuration using data acquired from phantoms and healthy volunteers (N = 9). The relative performance of the coils was assessed, by comparing signal-to-noise ratio (SNR), noise correlation, g-factor noise amplification, and the CNR between vessel wall and lumen using black-blood sequences. Patient data were acquired from 12 atherosclerotic carotid artery disease patients. RESULTS The 10-channel coil consistently provided substantially increased SNR in phantoms (+77 ± 27%) and improved CNR in healthy carotid arteries (+62 ± 11%), or reduced g-factor noise amplification. Patient data showed excellent delineation of atherosclerotic plaque along the length of the carotid bifurcation using the 10-channel coil. CONCLUSIONS The proposed 10-channel coil design allows for improved visualization of the carotid arteries and the carotid bifurcation and increased parallel imaging acceleration factors relative to a commercial 4-channel coil design.
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Affiliation(s)
- Matthijs H. S. de Buck
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Peter Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Robert Frost
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Radiology, Harvard Medical School, Boston, MA, United States of America
| | | | - Katherine Hurst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Robin P. Choudhury
- Acute Vascular Imaging Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew D. Robson
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Perspectum, Gemini One, John Smith Drive, Oxford, United Kingdom
| | - Luca Biasiolli
- Acute Vascular Imaging Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Chen X, Zhao Y, Spence JD, Chiu B. Quantification of Local Vessel Wall and Plaque Volume Change for Assessment of Effects of Therapies on Carotid Atherosclerosis Based on 3-D Ultrasound Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:773-786. [PMID: 36566092 DOI: 10.1016/j.ultrasmedbio.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/21/2022] [Accepted: 10/23/2022] [Indexed: 06/17/2023]
Abstract
We developed a new method to measure the voxel-based vessel-wall-plus-plaque volume (VWV). In addition to quantifying local thickness change as in the previously introduced vessel-wall-plus-plaque thickness (VWT) metric, voxel-based VWV further considers the circumferential change associated with vascular remodeling. Three-dimensional ultrasound images were acquired at baseline and 1 y afterward. The vessel wall region was divided into small voxels with the voxel-based VWV change (ΔVVol%) computed by taking the percentage volume difference between corresponding voxels in the baseline and follow-up images. A 3-D carotid atlas was developed to allow visualization of the local thickness and circumferential change patterns in the pomegranate versus the placebo groups. A new patient-based biomarker was obtained by computing the mean ΔVVol% over the entire 3-D map for each patient (ΔVVol%¯). ΔVVol%¯ detected a significant difference between patients randomized to pomegranate juice/extract and placebo groups (p = 0.0002). The number of patients required by ΔVVol%¯ to establish statistical significance was approximately a third of that required by the local VWT biomarker. The increased sensitivity afforded by the proposed biomarker improves the cost-effectiveness of clinical studies evaluating new anti-atherosclerotic treatments.
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Affiliation(s)
- Xueli Chen
- Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China
| | - Yuan Zhao
- Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China
| | - J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada
| | - Bernard Chiu
- Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China.
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Kassem M, Florea A, Mottaghy FM, van Oostenbrugge R, Kooi ME. Magnetic resonance imaging of carotid plaques: current status and clinical perspectives. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1266. [PMID: 33178798 PMCID: PMC7607136 DOI: 10.21037/atm-2020-cass-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition. Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T1-weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects. Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.
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Affiliation(s)
- Mohamed Kassem
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Alexandru Florea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Robert van Oostenbrugge
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, MUMC+, Maastricht, The Netherlands
| | - M Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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McNally JS, Hinckley PJ, Sakata A, Eisenmenger LB, Kim SE, De Havenon AH, Quigley EP, Iacob E, Treiman GS, Parker DL. Magnetic Resonance Imaging and Clinical Factors Associated With Ischemic Stroke in Patients Suspected of Cervical Artery Dissection. Stroke 2019; 49:2337-2344. [PMID: 30355108 DOI: 10.1161/strokeaha.118.021868] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cervical artery dissection is a major cause of ischemic stroke in the young and presents with various imaging findings, including stenosis and intramural hematoma (IMH). Our goal was to determine the relative contribution of lumen findings and IMH to acute ischemic stroke and whether a heavily T1-weighted sequence could more reliably detect IMH. Methods- Institutional review board approval was obtained for this retrospective study of 254 patients undergoing magnetic resonance imaging/magnetic resonance angiography for suspected dissection. Imaging included standard turbo spin-echo (TSE) T1-fat saturation and heavily T1-weighted flow-suppressed magnetization-prepared rapid acquisition gradient-recalled echo sequences. Subjects with stents (1) or atherosclerotic disease (26) were excluded, leaving 227 subjects. Kappa analysis was used to determine IMH interrater reliability on magnetization-prepared rapid acquisition gradient-recalled echo and T1-fat saturation in 4 vessels per subject. Lumen findings, cardiovascular risk factors, medications, and nondissection stroke sources were recorded. Mixed-effects multivariate Poisson regression was used to determine the prevalence ratio of each factor with acute ischemic stroke, accounting for 4 vessels per patient with backward elimination to a threshold P value of 0.10. Results- Patients were 41.9% men, mean age of 47.3±16.6 years, with 114 dissections and 107 strokes. IMH interrater reliability was significantly higher for magnetization-prepared rapid acquisition gradient-recalled echo (κ=0.83; 95% CI, 0.78-0.86) versus T1-fat saturation (0.58; 95% CI, 0.57-0.68). The final acute stroke prediction model included magnetization-prepared rapid acquisition gradient-recalled echo-detected IMH (prevalence ratio, 2.0; 95% CI, 1.1-3.9; P=0.034), stenosis, pseudoaneurysm, male sex, current smoking, and nondissection stroke sources. The final model had high discrimination for acute stroke (area under the curve, 0.902; 95% CI, 0.872-0.932), compared with models without stenosis (0.861; 95% CI, 0.821-0.902), and without stenosis and IMH (0.831; 95% CI, 0.783-0.879). All 3 models were significantly different at P<0.05. Conclusions- Along with stenosis, IMH detection significantly contributed to acute ischemic stroke pathogenesis in patients with suspected cervical artery dissection. In addition, IMH detection can be made more reliable with heavily T1-weighted sequences.
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Affiliation(s)
- J Scott McNally
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
| | - Peter J Hinckley
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
| | - Akihiko Sakata
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
| | - Laura B Eisenmenger
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
| | - Seong-Eun Kim
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
| | - Adam H De Havenon
- Department of Neurology (A.H.D.H.), University of Utah, Salt Lake City
| | - Edward P Quigley
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
| | - Eli Iacob
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
| | - Gerald S Treiman
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City.,Department of Surgery (G.S.T.), University of Utah, Salt Lake City.,Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Dennis L Parker
- From the Department of Radiology, Utah Center for Advanced Imaging Research (J.S.M., P.J.H., A.S., L.B.E., S.-E.K., E.P.Q., E.I., G.S.T., D.L.P.), University of Utah, Salt Lake City
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McNally JS, Kim SE, Mendes J, Hadley JR, Sakata A, De Havenon AH, Treiman GS, Parker DL. Magnetic Resonance Imaging Detection of Intraplaque Hemorrhage. MAGNETIC RESONANCE INSIGHTS 2017; 10:1-8. [PMID: 28469441 PMCID: PMC5348123 DOI: 10.1177/1178623x17694150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/25/2017] [Indexed: 11/16/2022]
Abstract
Carotid artery atherosclerosis is a major cause of ischemic stroke. For more than 30 years, future stroke risk and carotid stroke etiology have been determined using percent diameter stenosis based on clinical trials in the 1990s. In the past 10 years, magnetic resonance imaging (MRI) sequences have been developed to detect carotid intraplaque hemorrhage. By detecting carotid intraplaque hemorrhage, MRI identifies potential stroke sources that are often overlooked by lumen imaging. In addition, MRI can dramatically improve assessment of future stroke risk beyond lumen stenosis alone. In this review, we discuss the use of heavily T1-weighted MRI sequences used to detect carotid intraplaque hemorrhage. In addition, advances in ciné imaging, motion robust techniques, and specialized neck coils will be reviewed. Finally, the clinical use and future impact of MRI plaque hemorrhage imaging will be discussed.
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Affiliation(s)
- J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Seong-Eun Kim
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Jason Mendes
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - J Rock Hadley
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Akihiko Sakata
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Adam H De Havenon
- Department of Neurology, The University of Utah, Salt Lake City, UT, USA
| | - Gerald S Treiman
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, The University of Utah, Salt Lake City, UT, USA
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Beck MJ, Parker DL, Bolster BD, Kim SE, McNally JS, Treiman GS, Hadley JR. Interchangeable neck shape-specific coils for a clinically realizable anterior neck phased array system. Magn Reson Med 2017; 78:2460-2468. [PMID: 28185303 DOI: 10.1002/mrm.26632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/22/2016] [Accepted: 01/11/2017] [Indexed: 11/08/2022]
Abstract
PURPOSE To demonstrate the interchangeable neck shape-specific (NSS) coil concept that supplements standard commercial spine and head/neck coils to provide simultaneous high-resolution (hi-res) head/neck imaging with high signal-to-noise ratio (SNR). METHODS Two NSS coils were constructed on formers designed to fit two different neck shapes. A 7-channel (7ch) ladder array was constructed on a medium neck former, and a 9-channel (9ch) ladder array was constructed on large neck former. Both coils were interchangeable with the same preamp housing. RESULTS The 7ch and 9ch coils demonstrate SNR gains of approximately 4 times and 3 times over the Siemens 20-channel head/neck coil in the carotid arteries of our volunteers, respectively. Coupling between the Siemens 32-channel spine coil, Siemens 20-channel head/neck coil, and the NSS coils was negligible, allowing for simultaneous hi-res head/neck imaging with high SNR. CONCLUSIONS This study demonstrates that supplementing existing commercial spine and head/neck coils with an NSS coil allows uniform simultaneous hi-res imaging with high SNR in the anterior neck, while maintaining SNR of the commercial coil in the head and posterior neck. Magn Reson Med 78:2460-2468, 2017. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Michael J Beck
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Seong-Eun Kim
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Gerald S Treiman
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA.,Veterans Affairs Department of Surgery (VASLCHCS), Salt Lake City, Utah, USA
| | - J Rock Hadley
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
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Eisenmenger LB, Aldred BW, Kim SE, Stoddard GJ, de Havenon A, Treiman GS, Parker DL, McNally JS. Prediction of Carotid Intraplaque Hemorrhage Using Adventitial Calcification and Plaque Thickness on CTA. AJNR Am J Neuroradiol 2016; 37:1496-503. [PMID: 27102316 DOI: 10.3174/ajnr.a4765] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Carotid intraplaque hemorrhage is associated with stroke, plaque thickness, stenosis, ulceration, and adventitial inflammation. Conflicting data exist on whether calcification is a marker of plaque instability, and no data exist on adventitial calcification. Our goal was to determine whether adventitial calcification and soft plaque (a rim sign) help predict carotid intraplaque hemorrhage. MATERIALS AND METHODS This was a retrospective cohort study of 96 patients who underwent carotid MRA and CTA within 1 month, from 2009 to 2016. We excluded occlusions (n = 4) and near occlusions (n = 0), leaving 188 carotid arteries. Intraplaque hemorrhage was detected by using MPRAGE. Calcification, adventitial pattern, stenosis, maximum plaque thickness (total, soft, and hard), ulceration, and intraluminal thrombus on CTA were recorded. Atherosclerosis risk factors and medications were recorded. We used mixed-effects multivariable Poisson regression, accounting for 2 vessels per patient. For the final model, backward elimination was used with a threshold of P < .10. Receiver operating characteristic analysis determined intraplaque hemorrhage by using the area under the curve. RESULTS Our final model included the rim sign (prevalence ratio = 11.9, P < .001) and maximum soft-plaque thickness (prevalence ratio = 1.2, P = .06). This model had excellent intraplaque hemorrhage prediction (area under the curve = 0.94), outperforming the rim sign, maximum soft-plaque thickness, NASCET stenosis, and ulceration (area under the curve = 0.88, 0.86, 0.77, and 0.63, respectively; P < .001). Addition of the rim sign performed better than each marker alone, including maximum soft-plaque thickness (area under the curve = 0.94 versus 0.86, P < .001), NASCET stenosis (area under the curve = 0.90 versus 0.77, P < .001), and ulceration (area under the curve = 0.90 versus 0.63, P < .001). CONCLUSIONS The CTA rim sign of adventitial calcification with internal soft plaque is highly predictive of carotid intraplaque hemorrhage.
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Affiliation(s)
- L B Eisenmenger
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - B W Aldred
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - S-E Kim
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - G J Stoddard
- Department of Orthopedics (G.J.S.), Design and Biostatistics Center
| | | | - G S Treiman
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research Department of Surgery (G.S.T.), University of Utah, Salt Lake City, Utah Department of Surgery (G.S.T.), VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - D L Parker
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
| | - J S McNally
- From the Department of Radiology (L.B.E., B.W.A., S.-E.K., G.S.T., D.L.P., J.S.M.), Utah Center for Advanced Imaging Research
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McNally JS, Burton TM, Aldred BW, Kim SE, McLaughlin MS, Eisenmenger LB, Stoddard GJ, Majersik JJ, Miller DV, Treiman GS, Parker DL. Vitamin D and Vulnerable Carotid Plaque. AJNR Am J Neuroradiol 2016; 37:2092-2099. [PMID: 27313129 DOI: 10.3174/ajnr.a4849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans. MATERIALS AND METHODS In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. To determine the association of low vitamin D levels with MR imaging detected intraplaque hemorrhage, we performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. MR imaging detected intraplaque hemorrhage volume was also correlated with vitamin D levels and maximum plaque thickness. Thirty-five patients underwent carotid endarterectomy, and histology-detected intraplaque hemorrhage was correlated with vitamin D levels and total plaque area. RESULTS Low vitamin D levels (<30 ng/mL, prevalence ratio = 2.05, P = .03) were a significant predictor of MR imaging detected intraplaque hemorrhage, along with plaque thickness (prevalence ratio = 1.40, P < .001). MR imaging detected intraplaque hemorrhage volume linearly correlated with plaque thickness (partial r = 0.45, P < .001) and low vitamin D levels (partial r = 0.26, P = .003). Additionally, histology-detected intraplaque hemorrhage area linearly correlated with plaque area (partial r = 0.46, P < .001) and low vitamin D levels (partial r = 0.22, P = .03). The association of intraplaque hemorrhage volume with low vitamin D levels was also higher with ischemic stroke. CONCLUSIONS Low vitamin D levels and plaque thickness predict carotid intraplaque hemorrhage and outperform lumen markers of vulnerable plaque. This research demonstrates a significant link between low vitamin D levels and carotid intraplaque hemorrhage.
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Affiliation(s)
- J S McNally
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - T M Burton
- Department of Neurology (T.M.B., J.J.M.)
| | - B W Aldred
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - S-E Kim
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - M S McLaughlin
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - L B Eisenmenger
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
| | - G J Stoddard
- Department of Orthopedics, Study Design and Biostatistics Center (G.J.S)
| | | | | | - G S Treiman
- Department of Surgery at the University of Utah and VA Salt Lake City Health Care System, Salt Lake City, Utah (G.S.T.)
| | - D L Parker
- From the Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research (J.S.M., B.W.A., S.-E.K., M.S.M., L.B.E., D.L.P.)
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McLaughlin MS, Hinckley PJ, Treiman SM, Kim SE, Stoddard GJ, Parker DL, Treiman GS, McNally JS. Optimal Prediction of Carotid Intraplaque Hemorrhage Using Clinical and Lumen Imaging Markers. AJNR Am J Neuroradiol 2015; 36:2360-6. [PMID: 26338923 DOI: 10.3174/ajnr.a4454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/03/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging detects intraplaque hemorrhage with high accuracy by using the magnetization-prepared rapid acquisition of gradient echo sequence. Still, MR imaging is not readily available for all patients, and many undergo CTA instead. Our goal was to determine essential clinical and lumen imaging predictors of intraplaque hemorrhage, as indicators of its presence and clues to its pathogenesis. MATERIALS AND METHODS In this retrospective cross-sectional study, patients undergoing stroke work-up with MR imaging/MRA underwent carotid intraplaque hemorrhage imaging. We analyzed 726 carotid plaques, excluding vessels with non-carotid stroke sources (n = 420), occlusions (n = 7), or near-occlusions (n = 3). Potential carotid imaging predictors of intraplaque hemorrhage included percentage diameter and millimeter stenosis, plaque thickness, ulceration, and intraluminal thrombus. Clinical predictors were recorded, and a multivariable logistic regression model was fitted. Backward elimination was used to determine essential intraplaque hemorrhage predictors with a thresholded 2-sided P < .10. Receiver operating characteristic analysis was also performed. RESULTS Predictors of carotid intraplaque hemorrhage included plaque thickness (OR = 2.20, P < .001), millimeter stenosis (OR = 0.46, P < .001), ulceration (OR = 4.25, P = .020), age (OR = 1.11, P = .001), and male sex (OR = 3.23, P = .077). The final model discriminatory value was excellent (area under the curve = 0.932). This was significantly higher than models using only plaque thickness (area under the curve = 0.881), millimeter stenosis (area under the curve = 0.830), or ulceration (area under the curve= 0.715, P < .001). CONCLUSIONS Optimal discrimination of carotid intraplaque hemorrhage requires information on plaque thickness, millimeter stenosis, ulceration, age, and male sex. These factors predict intraplaque hemorrhage with high discriminatory power and may provide clues to the pathogenesis of intraplaque hemorrhage. This model could be used to predict the presence of intraplaque hemorrhage when MR imaging is contraindicated.
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Affiliation(s)
- M S McLaughlin
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - P J Hinckley
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - S M Treiman
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - S-E Kim
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - G J Stoddard
- Department of Orthopedics (G.J.S.), Study Design and Biostatistics Center
| | - D L Parker
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
| | - G S Treiman
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research Department of Surgery (G.S.T.), University of Utah, Salt Lake City, Utah Department of Surgery (G.S.T.), VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - J S McNally
- From the Department of Radiology (M.S.M., P.J.H., S.M.T., S.-E.K., D.L.P., G.S.T., J.S.M.), Utah Center for Advanced Imaging Research
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11
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Treiman GS, McNally JS, Kim SE, Parker DL. Correlation of Carotid Intraplaque Hemorrhage and Stroke Using 1.5 T and 3 T MRI. MAGNETIC RESONANCE INSIGHTS 2015; 8:1-8. [PMID: 26056469 PMCID: PMC4454204 DOI: 10.4137/mri.s23560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 01/06/2023]
Abstract
Carotid therosclerotic disease causes approximately 25% of the nearly 690,000 ischemic strokes each year in the United States. Current risk stratification based on percent stenosis does not provide specific information on the actual risk of stroke for most individuals. Prospective randomized studies have found only 10 to 12% of asymptomatic patients will have a symptomatic stroke within 5 years. Measurements of percent stenosis do not determine plaque stability or composition. Reports have concluded that cerebral ischemic events associated with carotid plaque are intimately associated with plaque instability. Analysis of retrospective studies has found that plaque composition is important in risk stratification. Only MRI has the ability to identify and measure the detailed components and morphology of carotid plaque and provides more detailed information than other currently available techniques. MRI can accurately detect carotid hemorrhage, and MRI identified carotid hemorrhage correlates with acute stroke.
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Affiliation(s)
- Gerald S Treiman
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA ; Department of Surgery, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA ; Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Seong-Eun Kim
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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12
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McNally JS, McLaughlin MS, Hinckley PJ, Treiman SM, Stoddard GJ, Parker DL, Treiman GS. Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke 2014; 46:84-90. [PMID: 25406146 DOI: 10.1161/strokeaha.114.006286] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage (IPH) is associated with acute and future stroke. IPH is also associated with lumen markers of stroke risk including stenosis, plaque thickness, and ulceration. Whether IPH adds further predictive value to these other variables is unknown. The purpose of this study was to determine whether IPH improves carotid-source stroke prediction. METHODS In this retrospective cross-sectional study, patients undergoing stroke workup were imaged with MRI and IPH detection. Seven hundred twenty-six carotid-brain image pairs were analyzed after excluding vessels with noncarotid plaque stroke sources (420) and occlusions (7) or near-occlusions (3). Carotid imaging characteristics were recorded, including percent diameter and mm stenosis, plaque thickness, ulceration, intraluminal thrombus, and IPH. Clinical confounders were recorded, and a multivariable logistic regression model was fitted. Backward elimination was used to determine essential carotid-source stroke predictors with a threshold 2-sided P<0.10. Receiver operating characteristic analysis was performed to determine discriminatory value. RESULTS Significant predictors of carotid-source stroke included intraluminal thrombus (odds ratio=103.6; P<0.001), IPH (odds ratio=25.2; P<0.001), current smoking (odds ratio=2.78; P=0.004), and thickness (odds ratio=1.24; P=0.020). The final model discriminatory value was excellent (area under the curve=0.862). This was significantly higher than the final model without IPH (area under the curve=0.814), or models using only stenosis as a continuous variable (area under the curve=0.770) or cutoffs of 50% and 70% (area under the curve=0.669), P<0.001. CONCLUSIONS After excluding patients with noncarotid plaque stroke sources, optimal discrimination of carotid-source stroke was obtained with intraluminal thrombus, IPH, plaque thickness, and smoking history but not ulceration and stenosis.
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Affiliation(s)
- J Scott McNally
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.).
| | - Michael S McLaughlin
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Peter J Hinckley
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Scott M Treiman
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Gregory J Stoddard
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Dennis L Parker
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Gerald S Treiman
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
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13
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Scott McNally J, Yoon HC, Kim SE, Narra KK, McLaughlin MS, Parker DL, Treiman GS. Carotid MRI Detection of Intraplaque Hemorrhage at 3T and 1.5T. J Neuroimaging 2014; 25:390-6. [PMID: 25040677 DOI: 10.1111/jon.12146] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 03/27/2014] [Accepted: 03/30/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Carotid intraplaque hemorrhage leads to plaque progression and ischemic events. Detection can be accomplished with 3T T1w sequences, but may be limited by false-positive lipid/necrosis. The purpose of this study was threefold: (1) to determine if magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) detects intraplaque hemorrhage versus lipid/necrosis; (2) if 3T MPRAGE image quality is retained at 1.5T; and (3) to determine observer agreement. METHODS MPRAGE positive areas were compared to hemorrhage and lipid/necrosis areas from 100 carotid endarterectomy slides in 12 subjects using multivariable linear regression. Image quality was determined between 3T and 1.5T in 716 carotid arteries using t-tests and multivariable linear regression. Kappa analysis was used to determine agreement. RESULTS Intraplaque hemorrhage, not lipid/necrosis, was a significant predictor of MPRAGE positive area before and after adjusting for confounders (slope = .52 vs. .51, P < .001). Image quality at 3T was slightly lower than 1.5T (mean 3.87 vs. 4.34, P < .0001). 3T image quality remained slightly decreased before and after adjusting for confounders (slope = -.46 vs. -.41, P < .001). Kappa values for inter-/intraobserver agreement were .807/.919 at 3T and .803/.871 at 1.5T. CONCLUSIONS Carotid MPRAGE detects intraplaque hemorrhage, not lipid/necrosis. 3T image quality was retained at 1.5T with very good observer agreement.
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Affiliation(s)
- J Scott McNally
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT
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14
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Mendes J, Parker DL, Kim SE, Treiman GS. Reduced blood flow artifact in intraplaque hemorrhage imaging using CineMPRAGE. Magn Reson Med 2013; 69:1276-84. [PMID: 22760825 PMCID: PMC3465506 DOI: 10.1002/mrm.24354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 05/01/2012] [Accepted: 05/04/2012] [Indexed: 12/21/2022]
Abstract
Magnetization prepared rapid acquisition gradient echo (3D MPRAGE) has been shown to be a sensitive method to image carotid intraplaque hemorrhage. As the MPRAGE sequence used to identify potential intraplaque hemorrhage does not utilize cardiac gating, it is difficult to optimize the inversion times due to the dynamic nature of flowing blood. As a result, a best fit inversion time is often determined experimentally and then used for in vivo clinical examination. This results in compromised blood suppression and occasional hemorrhage mimicking flow artifacts. We demonstrate that a retrospective cardiac correlated reconstruction can be applied to the conventional MPRAGE sequence (CineMPRAGE) to more accurately identify blood signal. This CineMPRAGE reconstruction uses the data from a standard nongated MPRAGE sequence to generate a full sequence of cardiac correlated images throughout the cardiac cycle and, therefore, provides a dynamic view of the carotid artery and a better ability to discern blood signal from potential intraplaque hemorrhage. In our preliminary study of 35 patients, signal from potential hemorrhage was constant over the cardiac cycle, whereas any signal from blood flow artifact was observed as an oscillating signal over the cardiac cycle.
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Affiliation(s)
- Jason Mendes
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah 84108, USA.
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15
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Tate Q, Kim SE, Treiman G, Parker DL, Hadley JR. Increased vessel depiction of the carotid bifurcation with a specialized 16-channel phased array coil at 3T. Magn Reson Med 2012; 69:1486-93. [PMID: 22777692 DOI: 10.1002/mrm.24380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/23/2012] [Accepted: 05/26/2012] [Indexed: 11/11/2022]
Abstract
The purpose of this work was to design and construct a multichannel receive-only radiofrequency coil for 3T magnetic resonance imaging of the human carotid artery and bifurcation with optimized signal-to-noise ratio (SNR) in the carotid vessels along the full extent of the neck. A neck phantom designed to match the anatomy of a subject with a neck representing the body habitus often seen in subjects with carotid arterial disease was constructed. Sixteen circular coil elements were arranged on a semirigid fiberglass former that closely fit the shape of the phantom, resulting in a 16-channel bilateral phased array coil. Comparisons were made between this coil and a typical 4-channel carotid coil in a study of 10 carotid vessels in five healthy volunteers. The 16-channel carotid coil showed a 73% average improvement in SNR at the carotid bifurcation. This coil also maintained an SNR greater than the peak SNR of the 4-channel coil over a vessel length of 10 cm. The resulting increase in SNR improved vessel depiction of the carotid arteries over an extended field of view, and demonstrated better image quality for higher parallel imaging reduction factors compared to the 4-channel coil.
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Affiliation(s)
- Quinn Tate
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah 84108, USA
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16
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Koning W, Bluemink JJ, Langenhuizen EAJ, Raaijmakers AJ, Andreychenko A, van den Berg CAT, Luijten PR, Zwanenburg JJM, Klomp DWJ. High-resolution MRI of the carotid arteries using a leaky waveguide transmitter and a high-density receive array at 7 T. Magn Reson Med 2012; 69:1186-93. [PMID: 22760686 DOI: 10.1002/mrm.24345] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/12/2012] [Accepted: 05/01/2012] [Indexed: 11/09/2022]
Affiliation(s)
- W. Koning
- Department of Radiology; UMC; Utrecht The Netherlands
| | - J. J. Bluemink
- Department of Radiotherapy; UMC; Utrecht The Netherlands
| | | | | | | | | | - P. R. Luijten
- Department of Radiology; UMC; Utrecht The Netherlands
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Kim SE, Treiman GS, Roberts JA, Jeong EK, Shi X, Hadley JR, Parker DL. In vivo and ex vivo measurements of the mean ADC values of lipid necrotic core and hemorrhage obtained from diffusion weighted imaging in human atherosclerotic plaques. J Magn Reson Imaging 2011; 34:1167-75. [DOI: 10.1002/jmri.22736] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 07/15/2011] [Indexed: 11/10/2022] Open
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Mendes J, Parker DL, Hulet J, Treiman GS, Kim SE. CINE turbo spin echo imaging. Magn Reson Med 2011; 66:1286-92. [PMID: 21702060 DOI: 10.1002/mrm.22909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 11/11/2022]
Abstract
High-resolution turbo spin echo (TSE) images have demonstrated important details of carotid artery morphology; however, it is evident that pulsatile blood and wall motion related to the cardiac cycle are still significant sources of image degradation. Although ECG gating can reduce artifacts due to cardiac-induced pulsations, gating is rarely used because it lengthens the acquisition time and can cause image degradation due to nonconstant repetition time. This work introduces a relatively simple method of converting a conventional TSE acquisition into a retrospectively ECG-correlated cineTSE sequence. The cineTSE sequence generates a full sequence of ECG-correlated images at each slice location throughout the cardiac cycle in the same scan time that is conventionally used by standard TSE sequences to produce a single image at each slice location. The cineTSE images exhibit reduced pulsatile artifacts associated with a gated sequence but without the increased scan time or associated nonconstant repetition time effects.
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Affiliation(s)
- Jason Mendes
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA.
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Mendes J, Parker DL. Intrinsic detection of motion in segmented sequences. Magn Reson Med 2010; 65:1084-9. [PMID: 21413072 DOI: 10.1002/mrm.22681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 09/09/2010] [Accepted: 09/19/2010] [Indexed: 11/08/2022]
Abstract
While many motion correction techniques for MRI have been proposed, their use is often limited by increased patient preparation, decreased patient comfort, additional scan time, or the use of specialized sequences not available on many commercial scanners. For this reason, we propose a simple self-navigating technique designed to detect motion in segmented sequences. We demonstrate that comparing two segments containing adjacent sets of k-space lines results in an aliased error function. A global shift of the aliased error function indicates the presence of in-plane rigid-body translation, while other types of motion are evident in the dispersion or breadth of the error function. Since segmented sequences commonly acquire data in sets of adjacent k-space lines, this method provides these sequences with an inherent method of detecting object motion. Motion corrupted data can then be reacquired proactively or in some cases corrected or removed retrospectively.
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Affiliation(s)
- Jason Mendes
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah 84108, USA
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Abstract
This review examines the state of the art in vessel wall imaging by magnetic resonance imaging (MRI) with an emphasis on the biomechanical assessment of atherosclerotic plaque. Three areas of advanced techniques are discussed. First, alternative contrast mechanisms, including susceptibility, magnetization transfer, diffusion, and perfusion, are presented as to how they facilitate accurate determination of plaque constituents underlying biomechanics. Second, imaging technologies including hardware and sequences, are reviewed as to how they provide the resolution and signal-to-noise ratio necessary for determining plaque structure. Finally, techniques for combining MRI data into an overall assessment of plaque biomechanical properties, including wall shear stress and internal plaque strain, are presented. The paper closes with a discussion of the extent to which these techniques have been applied to different arteries commonly targeted by vessel wall MRI.
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Affiliation(s)
- William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA 98109, USA.
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