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Albricker ACL, Freire CMV, Santos SND, Alcantara MLD, Cantisano AL, Porto CLL, Amaral SID, Veloso OCG, Morais Filho DD, Teodoro JAR, Petisco ACGP, Saleh MH, Barros MVLD, Barros FS, Engelhorn ALDV, Engelhorn CA, Nardino ÉP, Silva MADM, Biagioni LC, Souza AJD, Sarpe AKP, Oliveira ACD, Moraes MRDS, Francisco Neto MJ, Françolin PC, Rochitte CE, Iquizli R, Santos AASMDD, Muglia VF, Naves BDL. Recommendation Update for Vascular Ultrasound Evaluation of Carotid and Vertebral Artery Disease: DIC, CBR and SABCV - 2023. Arq Bras Cardiol 2023; 120:e20230695. [PMID: 37991060 DOI: 10.36660/abc.20230695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Ana Cristina Lopes Albricker
- Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, MG - Brasil
- IMEDE - Instituto Mineiro de Ultrassonografia, Belo Horizonte, MG - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Empresa Brasileira de Serviços Hospitalares (UBSERH), Brasília, DF - Brasil
| | | | | | | | | | | | - Orlando Carlos Glória Veloso
- Rede UnitedHealth Group (UHG), Rio de Janeiro, RJ - Brasil
- Hospital Pasteur, Rio de Janeiro, RJ - Brasil
- Hospital Américas, Rio de Janeiro, RJ - Brasil
- Hospital de Clínicas Mário Lioni, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Érica Patrício Nardino
- Faculdade de Medicina do ABC Paulista, SP - Brasil
- Faculdade de Medicina Unoeste, Guarujá, SP - Brasil
| | | | | | | | | | | | | | | | - Peter Célio Françolin
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (Hcor), São Paulo, SP - Brasil
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2
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Schneider MK, Wang J, Kare A, Adkar SS, Salmi D, Bell CF, Alsaigh T, Wagh D, Coller J, Mayer A, Snyder SJ, Borowsky AD, Long SR, Lansberg MG, Steinberg GK, Heit JJ, Leeper NJ, Ferrara KW. Combined near infrared photoacoustic imaging and ultrasound detects vulnerable atherosclerotic plaque. Biomaterials 2023; 302:122314. [PMID: 37776766 PMCID: PMC10872807 DOI: 10.1016/j.biomaterials.2023.122314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 10/02/2023]
Abstract
Atherosclerosis is an inflammatory process resulting in the deposition of cholesterol and cellular debris, narrowing of the vessel lumen and clot formation. Characterization of the morphology and vulnerability of the lesion is essential for effective clinical management. Here, near-infrared auto-photoacoustic (NIRAPA) imaging is shown to detect plaque components and, when combined with ultrasound imaging, to differentiate stable and vulnerable plaque. In an ex vivo study of photoacoustic imaging of excised plaque from 25 patients, 88.2% sensitivity and 71.4% specificity were achieved using a clinically-relevant protocol. In order to determine the origin of the NIRAPA signal, immunohistochemistry, spatial transcriptomics and spatial proteomics were co-registered with imaging and applied to adjacent plaque sections. The highest NIRAPA signal was spatially correlated with bilirubin and associated blood-based residue and with the cytoplasmic contents of inflammatory macrophages bearing CD74, HLA-DR, CD14 and CD163 markers. In summary, we establish the potential to apply the NIRAPA-ultrasound imaging combination to detect vulnerable carotid plaque and a methodology for fusing molecular imaging with spatial transcriptomic and proteomic methods.
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Affiliation(s)
- Martin Karl Schneider
- Molecular Imaging Program at Stanford and Bio-X Program, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - James Wang
- Molecular Imaging Program at Stanford and Bio-X Program, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Aris Kare
- Molecular Imaging Program at Stanford and Bio-X Program, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Shaunak S Adkar
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Darren Salmi
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Caitlin F Bell
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Tom Alsaigh
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dhananjay Wagh
- Sequencing Group Stanford Genomics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - John Coller
- Sequencing Group Stanford Genomics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | | | - Sarah J Snyder
- Department of Radiology and Neurosurgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Alexander D Borowsky
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Davis, CA 95616, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco, San Francisco, CA 94110, USA
| | - Maarten G Lansberg
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Jeremy J Heit
- Department of Radiology and Neurosurgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Nicholas J Leeper
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Katherine W Ferrara
- Molecular Imaging Program at Stanford and Bio-X Program, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
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Uchihara Y, Saito K, Motoyama R, Ishibashi-Ueda H, Yamaguchi E, Hatakeyama K, Tanaka A, Kataoka H, Iihara K, Sugie K, Koga M, Toyoda K, Nagatsuka K, Ihara M. Neovascularization From the Carotid Artery Lumen Into the Carotid Plaque Confirmed by Contrast-Enhanced Ultrasound and Histology. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1798-1803. [PMID: 37202244 DOI: 10.1016/j.ultrasmedbio.2023.04.002] [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: 01/31/2023] [Revised: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study was aimed at assessing intraplaque neovessels, focusing on neovascularization from the vascular luminal side using contrast-enhanced ultrasound (CEUS) and determining that this contrast effect indicates that the neovessel is connected to the vessel lumen histopathologically. Whether plaque vulnerability can be assessed more accurately was also investigated. METHODS We enrolled consecutive patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and pre-operative CEUS with perflubutane of the carotid arteries. We graded the contrast effect semi-quantitatively from the vascular luminal and adventitial sides. We compared the contrast effect with the pathological findings, especially the neovascularization of the CEA specimens. RESULTS In total, 68 carotid arterial atheromatous plaques (47 symptomatic) were analyzed. Symptomatic plaques were significantly correlated with stronger contrast effects from the luminal side than from the adventitial side (p = 0.0095). Microbubbles from the luminal side appeared to flow mainly into the plaque shoulder. The contrast effect value for the plaque shoulder and neovessel density were significantly correlated (ρ = 0.35, p = 0.031). Neovessel density was significantly higher in symptomatic than in asymptomatic plaques (56.2 ± 43.7/mm2 and 18.1 ± 15.2/mm2, respectively, p < 0.0001). Serial histological sections of CEA specimens in a symptomatic plaque with a strong contrast effect from the luminal side revealed multiple neovessels fenestrated to the vessel lumen with endothelial cells, consistent with the CEUS findings. CONCLUSION Contrast-enhanced ultrasound can be used to evaluate neovessels originating from the luminal side, histopathologically confirmed in serial sections. Symptomatic vulnerable plaque is correlated more significantly with intraplaque neovascularization from the luminal side than with neovascularization from the adventitia.
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Affiliation(s)
- Yuto Uchihara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Nara Medical University, Nara, Japan.
| | - Kozue Saito
- Department of Neurology, Nara Medical University, Nara, Japan; Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rie Motoyama
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | | | - Eriko Yamaguchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akito Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Nara Medical University, Nara, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuyuki Nagatsuka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
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He F, Hou W, Lan Y, Gao W, Zhou M, Li J, Liu S, Yang B, Zhang J. High Contrast Detection of Carotid Neothrombus with Strong Near-Infrared Absorption Selenium Nanosphere Enhanced Photoacoustic Imaging. Int J Nanomedicine 2023; 18:4043-4054. [PMID: 37520300 PMCID: PMC10377622 DOI: 10.2147/ijn.s404743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Background Carotid artery thrombosis is the leading cause of stroke. Since there are no apparent symptoms in the early stages of carotid atherosclerosis onset, it causes a more significant clinical diagnosis. Photoacoustic (PA) imaging provides high contrast and good depth information, which has been used for the early detection and diagnosis of many diseases. Methods We investigated thrombus formation by using 20% ferric chloride (FeCl3) in the carotid arteries of KM mice for the thrombosis model. The near-infrared selenium/polypyrrole (Se@PPy) nanomaterials are easy to synthesize and have excellent optical absorption in vivo, which can be used as PA contrast agents to obtain thrombosis information. Results In vitro experiments showed that Se@PPy nanocomposites have fulfilling PA ability in the 700 nm to 900 nm wavelength range. In the carotid atherosclerosis model, maximum PA signal enhancement up to 3.44, 4.04, and 5.07 times was observed by injection of Se@PPy nanomaterials, which helped to diagnose the severity of carotid atherosclerosis. Conclusion The superior PA signal of Se@PPy nanomaterials can identify the extent of atherosclerotic carotid lesions, demonstrating the feasibility of PA imaging technology in diagnosing carotid thrombosis lesion formation. This study demonstrates nanocomposites and PA techniques for imaging and diagnosing carotid thrombosis in vivo.
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Affiliation(s)
- Fengbing He
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Wenzhong Hou
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Yintao Lan
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
- Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong, People’s Republic of China
| | - Weijian Gao
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Mengyu Zhou
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Jinghang Li
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Shutong Liu
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Bin Yang
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
| | - Jian Zhang
- Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, People’s Republic of China
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Schneider MK, Wang J, Kare A, Adkar SS, Salmi D, Bell CF, Alsaigh T, Wagh D, Coller J, Mayer A, Snyder SJ, Borowsky AD, Long SR, Lansberg MG, Steinberg GK, Heit JJ, Leeper NJ, Ferrara KW. Combined near infrared photoacoustic imaging and ultrasound detects vulnerable atherosclerotic plaque. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.11.23291099. [PMID: 37398016 PMCID: PMC10312879 DOI: 10.1101/2023.06.11.23291099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Atherosclerosis is an inflammatory process resulting in the deposition of cholesterol and cellular debris, narrowing of the vessel lumen and clot formation. Characterization of the morphology and vulnerability of the lesion is essential for effective clinical management. Photoacoustic imaging has sufficient penetration and sensitivity to map and characterize human atherosclerotic plaque. Here, near infrared photoacoustic imaging is shown to detect plaque components and, when combined with ultrasound imaging, to differentiate stable and vulnerable plaque. In an ex vivo study of photoacoustic imaging of excised plaque from 25 patients, 88.2% sensitivity and 71.4% specificity were achieved using a clinically-relevant protocol. In order to determine the origin of the near-infrared auto-photoacoustic (NIRAPA) signal, immunohistochemistry, spatial transcriptomics and proteomics were applied to adjacent sections of the plaque. The highest NIRAPA signal was spatially correlated with bilirubin and associated blood-based residue and inflammatory macrophages bearing CD74, HLA-DR, CD14 and CD163 markers. In summary, we establish the potential to apply the NIRAPA-ultrasound imaging combination to detect vulnerable carotid plaque.
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6
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Kurosaki Y, Kinosada M, Ikeda H, Yamashita H, Yoshida K, Chin M. Clinical features and long-term outcomes of symptomatic low-grade carotid stenosis. J Stroke Cerebrovasc Dis 2022; 31:106779. [PMID: 36179612 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106779] [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: 07/11/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In symptomatic low-grade stenosis, most of the reports did not clarify the long-term outcome. This study aims to clarify the clinical features and long-term outcomes of symptomatic low-grade stenosis cases. MATERIALS AND METHODS We included 123 symptomatic patients with low-grade (<50%) carotid stenosis. The relative plaque signal intensity (rSI) and expansive remodeling rate (ERR) were measured using carotid magnetic resonance imaging (MRI). Antiplatelet therapy and treatment for atherosclerosis risk factors were administered in all cases. Carotid endarterectomy (CEA) was performed when ischemic symptoms appeared, or the percent stenosis progressed despite medical treatment. RESULTS The mean percent stenosis, rSI, and ERR on admission were 22.3, 1.70, and 2.01, respectively. The mean volume of the hyperintense plaque on carotid MRI was 641.4± 540 mm3. Sixty percent of cases involved intraplaque hemorrhage and expansive remodeling. During a mean follow-up of 52 months, recurrence of ischemic events was confirmed in 45 cases (36.6%). Of the 67 cases performed follow-up MRI, 34 cases (50%) had an increased volume of T1-hyperintense plaque. CEA or carotid artery stenting was performed in 49 cases. During a mean follow-up of 57.8 months after CEA, two cases of death (fatal intracerebral hemorrhage and asphyxia) and one case of brain stem lacunar infarction were observed, but ipsilateral ischemic events were not. CONCLUSION Most of the symptomatic patients with low-grade stenosis had both intraplaque hemorrhage and expansive remodeling and presented a high risk of recurrence and stenosis progression. CEA may have preventive effects against ischemic events in low-grade stenosis.
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Affiliation(s)
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Haruki Yamashita
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University School of Medicine, 54 Shogoin Kawahara-Cho Sakyo-ku, Kyoto 606-8507, Japan.
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
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Lim EY, Cho AH. Dynamic Changes of Carotid Atherosclerosis and Their Relation with Stroke Recurrence in Patients with Stroke or Transient Ischemic Attack. Curr Neurovasc Res 2022; 19:303-310. [PMID: 35996235 DOI: 10.2174/1567202619666220822141804] [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: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to show dynamic changes in carotid and vertebral artery using carotid Doppler ultrasonography (DUS) through a long-term follow- up exam, and determine their associations with stroke recurrence. METHODS We consecutively enrolled stroke or transient ischemic attack (TIA) patients who had undergone DUS more than twice with intervals of three months or more. Stroke recurrence during follow-up was also investigated by reviewing medical records. Progress or regress of plaque was defined as more than 0.1 mm change from the initial scan with a semi-quantitative measurement. The development of new plaque was also regarded as plaque progress. Increased intima-media thickness and plaque presence were interpreted at the initial and follow-up scans. Factors related to progression or regression were analyzed. The relationship between plaque change and stroke recurrence was investigated. RESULTS A total of 201 patients were enrolled (186 ischemic stroke patients and 15 TIA patients). There were 61 (30.3%) females. Their mean age was 64.2 ± 9.9 years. During a follow-up of 35.0 ± 22.6 (mean ± SD) months, plaque progress was observed in 92 (45.8%) and plaque regress in 13 (6.5%). Stroke recurred in 18 patients. Plaque progression showed no significant association with age, risk factors, statin use, or subtype. After adjustment of age, sex, diabetes, and stroke subtype, multiple logistic regression showed a significant association of plaque progression with stroke recurrence (odds ratio: 3.8, 95% confidence interval: 1.1 to 13.1, p = 0.034). Patients with plaque regress were significantly younger than those without plaque regress (57.8 years vs. 64.6 years, p = 0.041). CONCLUSION Plaque progression occurred in 46% of stroke or TIA patients. Plaque progression was significantly associated with clinical stroke recurrence. Plaque regressed in 6.5% of patients. Patients with regression were younger than those without.
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Affiliation(s)
- Eun-Ye Lim
- Department of Neurology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - A-Hyun Cho
- Department of Neurology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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8
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Chen S, Liu C, Chen X, Liu WV, Ma L, Zha Y. A Radiomics Approach to Assess High Risk Carotid Plaques: A Non-invasive Imaging Biomarker, Retrospective Study. Front Neurol 2022; 13:788652. [PMID: 35350403 PMCID: PMC8957977 DOI: 10.3389/fneur.2022.788652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to construct a radiomics-based MRI sequence from high-resolution magnetic resonance imaging (HRMRI), combined with clinical high-risk factors for non-invasive differentiation of the plaque of symptomatic patients from asyptomatic patients. Methods A total of 115 patients were retrospectively recruited. HRMRI was performed, and patients were diagnosed with symptomatic plaques (SPs) and asymptomatic plaques (ASPs). Patients were randomly divided into training and test groups in the ratio of 7:3. T2WI was used for segmentation and extraction of the texture features. Max-Relevance and Min-Redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were employed for the optimized model. Radscore was applied to construct a diagnostic model considering the T2WI texture features and patient demography to assess the power in differentiating SPs and ASPs. Results SPs and ASPs were seen in 75 and 40 patients, respectively. Thirty texture features were selected by mRMR, and LASSO identified a radscore of 16 radiomics features as being related to plaque vulnerability. The radscore, consisting of eight texture features, showed a better diagnostic performance than clinical information, both in the training (area under the curve [AUC], 0.923 vs. 0.713) and test groups (AUC, 0.989 vs. 0.735). The combination model of texture and clinical information had the best performance in assessing lesion vulnerability in both the training (AUC, 0.926) and test groups (AUC, 0.898). Conclusion This study demonstrated that HRMRI texture features provide incremental value for carotid atherosclerotic risk assessment.
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Affiliation(s)
- Sihan Chen
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Changsheng Liu
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Xixiang Chen
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
| | - Weiyin Vivian Liu
- Advanced Application Team, MR Research, GE Healthcare, Beijing, China
| | - Ling Ma
- He Kang Corporate Management (SH) Co. Ltd, Shanghai, China
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University and Hubei General Hospital, Wuhan, China
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Siepmann T, Barlinn K, Floegel T, Barlinn J, Pallesen LP, Puetz V, Kitzler HH. CT Angiography Manual Multiplanar Vessel Diameter Measurement vs. Semiautomated Perpendicular Area Minimal Caliber Computation of Internal Carotid Artery Stenosis. Front Cardiovasc Med 2021; 8:740237. [PMID: 34957236 PMCID: PMC8695607 DOI: 10.3389/fcvm.2021.740237] [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: 07/12/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the diagnostic agreement of CT angiography (CTA) manual multiplanar reformatting (MPR) stenosis diameter measurement and semiautomated perpendicular stenosis area minimal caliber computation of extracranial internal carotid artery (ICA) stenosis. Methods: We analyzed acute cerebral ischemia CTA at our tertiary stroke center in a 12-month period. Prospective NASCET-type stenosis grading for each ICA was independently performed using (1) MPR to manually determine diameters and (2) perpendicular stenosis area with minimal caliber semiautomated computation to grade luminal constriction. Corresponding to clinically relevant NASCET strata, results were grouped into severity ranges: normal, 1–49%, 50–69%, and 70–99%, and occlusion. Results: We included 647 ICA pairs from 330 patients (median age of 74 [66–80, IQR]; 38–92 years; 58% men; median NIHSS 4 [1–9, IQR]). MPR diameter and semiautomated caliber measurements resulted in stenosis grades of 0–49% in 143 vs. 93, 50–69% in 29 vs. 27, 70–99% in 6 vs. 14, and occlusion in 34 vs. 34 ICAs (p = 0.003), respectively. We found excellent reliability between repeated manual CTA assessments of one expert reader (ICC = 0.997; 95% CI, 0.993–0.999) and assessments of two expert readers (ICC = 0.972; 95% CI, 0.936–0.988). For the semiautomated vessel analysis software, both intrarater reliability and interrater reliability were similarly strong (ICC = 0.981; 95% CI, 0.952–0.992 and ICC = 0.745; 95% CI, 0.486–0.883, respectively). However, Bland–Altman analysis revealed a mean difference of 1.6% between the methods within disease range with wide 95% limits of agreement (−16.7–19.8%). This interval even increased with exclusively considered vessel pairs of stenosis ≥1% (mean 5.3%; −24.1–34.7%) or symptomatic stenosis ≥50% (mean 0.1%; −25.7–26.0%). Conclusion: Our findings suggest that MPR-based diameter measurement and the semiautomated perpendicular area minimal caliber computation methods cannot be used interchangeably for the quantification of ICA steno-occlusive disease.
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Affiliation(s)
- Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Floegel
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hagen H Kitzler
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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10
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Mishra SC, Singh V, Gupta A, Sharma S, Tyagi L. Blocked Filter of Anti-Embolic Device During Carotid Artery Stenting: A Rare Occurrence Posing Challenging Diagnostic Dilemma. Cureus 2021; 13:e19219. [PMID: 34873545 PMCID: PMC8639398 DOI: 10.7759/cureus.19219] [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] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
The use of anti-embolic devices (AED’s) is a common practice in carotid artery stenting (CAS). It prevents the passage of blood clots and thrombi generated during the procedure from embolizing into the intracranial circulation. Disadvantages include the passage of small particles and complications related to advancement, deployment, and recovery of the filters. The filter of the AED can get clogged due to the high load of the emboli generated during CAS causing a slowing of the intracranial blood flow which normalizes once the filter is removed. Here, we are presenting a case of the filter of AED getting blocked due to entrapped thrombi or blood clots and mimicking dissection and, sharing our experiences associated with the event.
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Affiliation(s)
- Sarvesh C Mishra
- Radio-Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Vivek Singh
- Radio-Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Aviral Gupta
- Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Srishti Sharma
- Radio-Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Lavanya Tyagi
- Obstetrics and Gynecology, Javitri Hospital and Test Tube Baby Centre, Lucknow, IND
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11
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Lyu Q, Zhang B, Tian X, Huang Y, Hui P. Association of Carotid Plaque Vulnerability and Cardiovascular Risk Factors in Patients Undergoing Carotid Endarterectomy. World Neurosurg 2021; 158:e778-e787. [PMID: 34838772 DOI: 10.1016/j.wneu.2021.11.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The association between high-risk cardiovascular factors and atherosclerotic is well established. However, whether plaque vulnerability is related to specific cardiovascular risk factors remains unknown. The association between plaque vulnerability and cardiovascular risk factors was evaluated in plaques removed in a carotid endarterectomy. METHODS Consecutive subjects scheduled for a carotid endarterectomy were recruited. All patients' baseline characteristics, risk factors, laboratory results, cardiovascular disease history, and medication use history were collected preoperatively. Histopathologic features within the vulnerable plaques were analyzed postoperatively. Risk factors for plaque vulnerability were assessed by univariate and multivariate analyses with adjustment for potential confounders. RESULTS A total of 128 carotid plaques were removed during the carotid endarterectomy. On multivariate analysis, hypertension (odds ratio [OR] 5.971, 95% confidence interval [CI] 1.959-18.203, P = 0.002) and dyslipidemia (OR 3.822, 95% CI 1.317-11.089, P = 0.014) were independently associated with plaque vulnerability. Hypertension was independently associated with the presence of a ruptured fibrous cap (OR 6.122, 95% CI 2.318-16.166, P < 0.001), intraplaque hemorrhage (OR 3.535, 95% CI 1.551-8.055, P = 0.003), and a large lipid core (OR 2.335, 95% CI 1.053-5.180, P = 0.037). The incidence of having a large lipid core was increased by 3.216-fold in patients with dyslipidemia (95% CI 1.409-7.340, P = 0.006). When the multivariate analysis was restricted to symptomatic patients, hypertension (OR 5.005, 95% CI 1.294-19.350, P = 0.020) was the most significant risk factor associated with vulnerable plaque. CONCLUSION The composition heterogeneity in the atherosclerotic plaque was significantly correlated to specific cardiovascular risk factors.
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Affiliation(s)
- Qi Lyu
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China; Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Bai Zhang
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojie Tian
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yabo Huang
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China.
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12
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Regi SS, Irodi A, Keshava SN, Agarwal S. Balanced Steady-State Free Precision and Time of Flight Noncontrast Magnetic Resonance Angiography in Peripheral Arterial Disease. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1730845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Purpose To determine the diagnostic efficacy of balanced steady-state free precession (bSSFP) and time-of-flight (TOF)-based noncontrast magnetic resonance angiography (NC-MRA) in lower limb peripheral arterial disease (PAD).
Material and Methods 10 patients with suspected PAD underwent both NC-MRA (bSSFP and 2D TOF) and contrast-enhanced MR angiography (CE-MRA)/CT angiography (CTA). A total of 170 arterial segments (17 segments in each patient) were analyzed on NC-MRA and compared with CE-MRA/CTA for quality of images and for estimating the degree of stenoses. Image quality was graded as 1—poor, 2—fair, 3—good, and 4—excellent. The degree of stenoses was graded as 0—normal, 1— ≤ 50% narrowing, 2— > 50% narrowing, 3—near complete/100% occlusion. Sensitivity, specificity, positive predictive value, and negative predictive value of NC-MRA in identifying significant stenosis, as compared with CE-MRA/CTA, were estimated.
Results a) Mean grade of the image quality of NC-MRA was 3.10 and the CE-MRA/CTA was 3.64. b) The agreement in the estimation of the degree of stenosis on NC-MRA as compared with CE-MRA/CTA was substantial in aortoiliac segments (weighted kappa 0.646 [95% CI] [0.361–0.931] [p < 0.001]), almost perfect in femoropopliteal segments (weighted kappa 0.911 [95% CI] [0.79–1.032] [p < 0.001]), and poor in infrapopliteal segments (weighted kappa 0.052 [95% CI] [0.189–0.293] [p < 0.33587]).
Conclusion TOF and bSSFP-based NC-MRA was found to be comparable to the CE-MRA/CTA in the evaluation of PAD in lower limbs in the aortoiliac and femoropopliteal regions. NC-MRA was especially helpful in assessing the aortoiliac vessels and femoropopliteal vessels, with the imaging of infrapopliteal arteries being suboptimal.
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Affiliation(s)
- Soumya Susan Regi
- Division of Clinical Radiology, Department of Diagnostic Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Division of Clinical Radiology, Department of Diagnostic Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shyamkumar N. Keshava
- Division of Clinical Radiology, Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunil Agarwal
- Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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13
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Saba L, Sanfilippo R, Suri JS, Cademartiri F, Corrias G, Mannelli L, Zucca S, Senis I, Montisci R, Wintermark M. Does Carotid Artery Tortuosity Play a Role in Stroke? Can Assoc Radiol J 2021; 72:789-796. [PMID: 33656944 DOI: 10.1177/0846537121991057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To explore the association between carotid artery length and tortuosity, and the occurrence of stroke. MATERIAL AND METHODS In this retrospective study, IRB approved, 411 consecutive patients (males: 245; median age: 56 ± 12 years, age range: 21-93 years) with anterior circulation ischemic stroke were included. Only patients that underwent CTA within 7 days were considered and stroke caused by cardiac embolism and thoracic aorta embolism were excluded. For each patient, both carotid arteries were considered, and the ICA, CCA-ICA length and tortuosity were calculated. Inter-observer analysis was quantified with the Bland-Altman test. Mann-Whitney test and logistic regression analysis were also calculated to test the association between length and tortuosity with the occurrence of stroke. RESULTS In the final analysis, 166 patients (males: 72; median age: 54 ± 12 years, age range: 24-89 years) with anterior circulation ischemic stroke that were admitted to our hospital between February 2008 and December 2013 were included. The results showed a good concordance for the length of the vessels with a mean variation of 0.7% and 0.5% for CCA-ICA and ICA length respectively an for the tortuosity with a mean variation of 0.2% and -0.4% for CCA-ICA and ICA respectively. The analysis shows a statistically significant association between the tortuosity index of the ICA and CCA-ICA sides with stroke (P value = 0.0001 in both cases) and these findings were confirmed also with the logistic regression analysis. CONCLUSION Results of this study suggest that tortuosity index is associated with the presence of stroke whereas the length of the carotid arteries does not play a significant role.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Roberto Sanfilippo
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | | | - Giuseppe Corrias
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | | | - Serena Zucca
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Ignazio Senis
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Roberto Montisci
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Max Wintermark
- Department of Radiology, 6429University of Stanford, CA, USA
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14
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Hazem M, Elsamman M, Bazeed S, Zaki M. Noninvasive prediction of carotid artery atherosclerosis by multiple abdominal fat indices measured via ultrasonography. Ultrasonography 2020; 40:366-377. [PMID: 33525857 PMCID: PMC8217801 DOI: 10.14366/usg.20109] [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: 07/15/2020] [Accepted: 10/24/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the efficiency of multiple abdominal fat indices as measured via ultrasonography for predicting the presence and severity of carotid artery atherosclerosis and to compare the predictive capacity of ultrasonographic measurements to that of anthropometric measurements. METHODS A total of 92 patients were included in this study. All participants underwent clinical and laboratory assessments, and anthropometric measurements were obtained. Ultrasound examinations were performed to measure the values of all abdominal fat indices and the intimamedia thickness, as well as to detect the presence of atherosclerotic plaques. Univariate and multivariate logistic regression analyses were performed. RESULTS In the multivariate analysis, significant associations were detected between carotid artery atherosclerosis and posterior right perinephric fat thickness (PRPFT) (hazard ratio [HR], 15.23; P<0.001), preperitoneal fat thickness (PPFT) (HR, 4.31; P=0.003), visceral adipose tissue volume (VAT) (HR, 7.61; P<0.001), visceral fat thickness (VFT) (HR, 8.84; P<0.001), the ratio of VFT to subcutaneous fat thickness (VFT/SCFT) (HR, 9.39; P<0.001), and waist-to-height ratio (WHtR) (HR, 2.65; P=0.046). In the multivariate analysis, significant associations were also detected between carotid artery plaque and PRPFT (HR, 7.09; P<0.001), the abdominal wall fat index (AFI) (HR, 3.58; P=0.010), and VFT/SCFT (HR, 4.17; P=0.006). CONCLUSION Many abdominal fat indices as measured by ultrasound were found to be strong predictors of carotid artery atherosclerosis, including PRPFT, VFT/SCFT, VFT, VAT, PPFT, and WHtR. Moreover, PRPFT, VFT/SCFT, and AFI were identified as strong predictors of the presence of carotid artery plaque.
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Affiliation(s)
- Mohammed Hazem
- Department of Surgery, Faculty of Medicine, King Faisal University, Al-hofuf, Saudi Arabia.,Department of Radiology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mahmoud Elsamman
- Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Shamardan Bazeed
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohammed Zaki
- Department of Radiology, Faculty of Medicine, Sohag University, Sohag, Egypt
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15
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Del Brutto VJ, Gornik HL, Rundek T. Why are we still debating criteria for carotid artery stenosis? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1270. [PMID: 33178802 PMCID: PMC7607093 DOI: 10.21037/atm-20-1188a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The risk of new or recurrent stroke is high among patients with extracranial carotid artery stenosis and the benefit of carotid revascularization is associated to the degree of luminal stenosis. Catheter-based digital subtraction angiography (DSA) as the diagnostic gold-standard for carotid stenosis (CS) has been replaced by non-invasive techniques including duplex ultrasound, computed-tomography angiography, and magnetic resonance angiography (MRA). Duplex ultrasound is the primary noninvasive diagnostic tool for detecting, grading and monitoring of carotid artery stenosis due to its low cost, high resolution, and widespread availability. However, as discussed in this review, there is a wide range of practice patterns in use of ultrasound diagnostic criteria for carotid artery stenosis. To date, there is no internationally accepted standard for the gradation of CS. Discrepancies in ultrasound criteria may result in clinically relevant misclassification of disease severity leading to inappropriate referral, or lack of it, to revascularization procedures, and potential for consequential adverse outcome. The Society of Radiologists in Ultrasound (SRU), either as originally outlined or in a modified form, are the most common criteria applied. However, such criteria have received criticism for relying primarily on peak systolic velocities, a parameter that when used in isolation could be misleading. Recent proposals rely on a multiparametric approach in which the hemodynamic consequences of carotid narrowing beyond velocity augmentation are considered for an accurate stenosis classification. Consensus criteria would provide standardized parameters for the diagnosis of CS and considerably improve quality of care. Accrediting bodies around the world have called for consensus on unified criteria for diagnosis of CS. A healthy debate between professionals caring for patients with CS regarding optimal CS criteria still continues.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather L Gornik
- Department of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
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16
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Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use? PLoS One 2020; 15:e0237856. [PMID: 32877415 PMCID: PMC7467222 DOI: 10.1371/journal.pone.0237856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background and purpose MR contrast-enhanced techniques are undergoing increased scrutiny since the FDA applied a warning for gadolinium-based MR contrast agents due to gadolinium deposition within multiple organ systems. While CE-MRA provides excellent image quality, is it required in a screening carotid study? This study compares 2D TOF and 3D TOF MRA vs. CE-MRA in defining carotid stenosis in a large clinical patient population, and with multiple readers with varying experience. Materials and methods 200 consecutive patients had their carotid bifurcations evaluated with 2D TOF, 3D TOF and CE-MRA sequences by 6 board-certified neuroradiologists. Stenosis and quality of examinations were defined for each study. Inter-rater reliability was assessed using two-way random effects intraclass correlation coefficients. Intra-reader reliability was computed via weighted Cohen’s κ. Weighted Cohen’s κ were also computed to assess agreement in stenosis ratings between enhanced images and unenhanced images. Results Agreement between unenhanced and enhanced ratings was substantial with a pooled weighted κ of 0.733 (0.628–0.811). For 5 of the 6 readers, the combination of unenhanced 2D TOF and 3D TOF showed better agreement with contrast-enhanced than either 2D TOF or 3D TOF alone. Intra-reader reliability was substantial. Conclusions The combination of 2D TOF and 3D TOF MRA showed substantial agreement with CE-MRA regarding degree of carotid stenosis in this large outpatient population across multiple readers of varying experience. Given the scrutiny that GBCA are undergoing due to concerns regarding CNS and soft tissue deposition, it seems prudent to reserve CE-MRA for cases which are not satisfactorily answered by the nonenhanced study or other noninvasive examinations.
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17
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Lyu Q, Tian X, Ding Y, Yan Y, Huang Y, Zhou P, Hui P. Evaluation of Carotid Plaque Rupture and Neovascularization by Contrast-Enhanced Ultrasound Imaging: an Exploratory Study Based on Histopathology. Transl Stroke Res 2020; 12:49-56. [PMID: 32601933 DOI: 10.1007/s12975-020-00825-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022]
Abstract
A significant portion of ischemic stroke is on account of emboli caused by fibrous cap rupture of vulnerable plaque with intraplaque neovascularization as a significant triggering factor to plaque vulnerability. Contrast-enhanced ultrasound (CEUS) could offer detailed information on plaque surface and intraplaque microvascular. This study aims to comprehensively assess the value of CEUS for the detection of plaque rupture and neovascularization in histologically verified plaques that had been removed from the patients who had undergone carotid endarterectomy (CEA). Fifty-one consecutive subjects (mean age, 67.0 ± 6.5 years; 43 [84.3%] men) scheduled for CEA were recruited. Standard ultrasound and CEUS were performed prior to surgery. Based on the direction of the contrast agents that diffuse within the plaques, plaques were divided as "inside-out" direction (contrast agents diffuse from the artery lumen towards the inside of the plaque) and non-inside-out direction. Plaque enhancement was assessed by using a semi-quantitative grading scale (grade 1: no enhancement; grade 2: moderate enhancement; grade 3: extensive enhancement). Plaques were evaluated for histopathologic characteristics according to Oxford Plaque Study (OPS) standard postoperative. Intraplaque neovascularization as manifested by the appearance of CD34-positive microvessels was characterized in terms of microvessel density (MVD), microvessel area (MVA), and microvessel shape (MVS). In 51 plaques, the sensitivity, specificity, positive, and negative predictive values of contrast agent inside-out direction diffusion for the detection of plaque fibrous cap rupture were 87.5%, 92.6%, 91.3%, and 89.3%, respectively. The incidence of cap rupture was significantly higher in contrast agent inside-out direction diffusion than non-inside-out direction diffusion (73.9% vs 25.0%, p < 0.001), and inside-out direction diffusion did exhibit higher frequency of vulnerable plaques (OPS grades 3-4) (95.7% vs 53.6%, p = 0.001). Multivariate logistic regression analysis revealed the contrast agent inside-out direction diffusion as an independent correlate to plaque rupture (OR 8.5, 95% CI 2.4-30.1, p = 0.001). With increasing plaque enhancement, plaque MVD (p < 0.001), plaque MVA (p = 0.012), and percentage of highly irregular-shaped microvessels increased (p < 0.001). Contrast agent inside-out direction diffusion could indicate plaque rupture. The increase in plaque enhancement paralleled increased, larger, and more irregular-shaped microvessels, which may suggest an increased risk of plaque vulnerability.
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Affiliation(s)
- Qi Lyu
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Xiaojie Tian
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Yafang Ding
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Yanhong Yan
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Yabo Huang
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Peng Zhou
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China.
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Sato S, Okada T. [Image Characteristics of T 1 Weighted Magnetic Resonance Imaging Techniques for Plaque Tissue Characterization (Comparison with Conventional Spin Echo Method)]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:41-53. [PMID: 31956186 DOI: 10.6009/jjrt.2020_jsrt_76.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the tissue characterization of plaques using magnetic resonance imaging (MRI), T1-weighted imaging is important. However, T1-weighted imaging are obtained by various imaging methods, and show different contrasts depending on parameters such as repetition time, echo time, and inversion time. To evaluate the tissue characterization of plaques using MRI, the characteristics are estimated and evaluated using the strength of the plaque-to-muscle signal intensity ratio (PMR), which is the value obtained by dividing the signal intensity of the plaque by that of the sternocleidomastoid muscle or myocardium. In the present research, we aim to obtain the PMR by phantom experiment and grasp the image characteristics for T1 and T2 values of different T1-weighted imaging methods. In addition, since the PMR of the conventional spin echo (SE) method of T1-weighted imaging (two-dimensional (2D) T1WI SE) is reported to have high discrimination ability in plaque tissue characterization, the experimental results were compared with those of 2D T1WI SE. Among the protocols examined, 3D sampling perfection with application optimized contrasts using different flip angle evolutions, T1-variable, motion-sensitized driven equilibrium (1-axis 300 ms2*mT/m) + had the same tissue characterization ability as 2D T1 WI SE, and was the most suitable imaging method. Moreover, in the gradient echo method, the effect of T2 values was smaller than that of 2D T1 WI SE, and it was suggested that the PMR of the plaque may be lowered when there is a change in the tissue properties that the T2 value and T1 value are prolonged due to liquefaction. The results of this phantom experiment are expected help in selecting the imaging method aimed at optimization and the image characteristics of different T1-weighted imaging method can be grasped.
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Affiliation(s)
- Satoru Sato
- Department of Radiology, Ehime Prefectural Imabari Hospital (Current address: Department of Radiology, Ehime Prefectural Central Hospital)
| | - Takeshi Okada
- Department of Radiology, Ehime Prefectural Imabari Hospital
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19
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Liu Y, Zhu Y, Jia W, Sun D, Zhao L, Zhang C, Wang C, Chen G, Fu S, Bo Y, Xing Y. Association between lipid profiles and presence of carotid plaque. Sci Rep 2019; 9:18011. [PMID: 31784590 PMCID: PMC6884522 DOI: 10.1038/s41598-019-54285-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/01/2019] [Indexed: 02/02/2023] Open
Abstract
It is indicated that lipids profiles are associated with carotid plaque and Atherosclerosis. However, studies about the relationship between serum lipid profiles and carotid plaque composition in Chinese Population is limited. We conducted a cross-sectional study among 3,214 participants between January 2015 and December 2017 in China, to investigate the association between various lipid profiles and the prevalence of carotid plaque. Logistic regression model was used to investigate the association between plasma lipid profiles and odds of carotid plaque. Analysis of covariance (ANCOVA) was used to compare the mean plasma lipid profiles among different number and composition of carotid artery plaques. HDL-C, Non-HDL-C levels, TC/HDL-C, LDL-C/HDL-C were significantly associated with the presence of carotid plaque; HDL-C, LDL-C, Non-HDL-C levels, TC/HDL-C, LDL-C/HDL-C were significantly associated with the presence of common carotid artery (CCA) plaque. Compare with participants without carotid plaque, increased level of LDL-C/HDL-C was found in those with echolucent/polytype plaque. Similarly, compared with participants without CCA plaque, increased level of LDL-C/HDL-C was found in those with echolucent plaque. In conclusion, we found that serum HDL-C, Non-HDLc level, TC/HDLc, and LDLc/HDLc were all associated with the prevalence of carotid plaque, and LDL-C/HDL-C differed among different group of carotid plaque composition.
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Affiliation(s)
- Yanhua Liu
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yongjian Zhu
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wenrui Jia
- Depatment of Physical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Dan Sun
- Depatment of Physical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Li Zhao
- Depatment of Physical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chen Zhang
- Depatment of Physical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Cuicui Wang
- Depatment of Physical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Gaiyun Chen
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Sanxian Fu
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yacong Bo
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yurong Xing
- Depatment of Physical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Song S, Heo R, Lee SE, Park J, Lee J, Kim S, Cho IJ, Chang HJ. Comparing the feasibility and accuracy of three-dimensional ultrasound to two-dimensional ultrasound and computed tomography angiography in the assessment of carotid atherosclerosis. Echocardiography 2019; 36:2241-2250. [PMID: 31742790 DOI: 10.1111/echo.14543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 09/29/2019] [Accepted: 10/22/2019] [Indexed: 12/01/2022] Open
Abstract
AIMS Two-dimensional ultrasound (2D-US) is the mainstay imaging technique used to evaluate carotid atherosclerosis. An automated single sweep three-dimensional ultrasound (3D-US) technique became available. We evaluated the feasibility and accuracy of 3D-US in the assessment of carotid plaques compared to those of 2D-US. Carotid computed tomography angiography (CTA) was used as a reference. METHODS AND RESULTS Among 126 stroke patients who underwent carotid 2D-US, 73 underwent 3D-US and carotid CTA. 3D-US was pursued when there were carotid plaques or when area stenosis was ≥ 20% by 2D-US. Both 2D- and 3D-US images of the carotid arteries were acquired using a dedicated ultrasound system that was equipped with the single sweep volumetric transducer. In total, 266 arteries from 73 patients were selected for comparison of the detection rate of carotid plaques between 2D- and 3D-US. Among the 73 patients, carotid CTA detected 139 plaques. 3D-US demonstrated a higher detection rate of carotid plaques than did 2D-US (108 plaques (77.9%) vs. 70 plaques (50.4%)) when using carotid CTA as a reference standard. Carotid plaque volume (PV) of 133 vessels from 73 patients were quantitatively evaluated using both 3D-US and carotid CTA. Plaque volume of carotid artery was comparable between 3D-US and CTA (148.5 ± 133.0 mm3 vs. 154.1 ± 134.6 mm3 , P = .998, R: 0.9825, P-value for r < .001). CONCLUSION 3D-US using a single sweep technique was a feasible and accurate method of detecting arterial plaques and assessing plaque volume.
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Affiliation(s)
- Shinjeong Song
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.,Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University, Seoul, South Korea
| | - Ran Heo
- Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University, Seoul, South Korea.,Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Centre, Seoul, Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.,Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University, Seoul, South Korea
| | - Jinki Park
- Medical Imaging Research Group, Samsung Medison, Seoul, Korea
| | - Jinyong Lee
- Medical Imaging Research Group, Samsung Medison, Seoul, Korea
| | - Sujin Kim
- Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University, Seoul, South Korea
| | - In Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.,Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University, Seoul, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.,Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Ramanathan R, Dey D, Nørgaard BL, Goeller M, Bjerrum IS, Antulov R, Diederichsen ACP, Sidelmann JJ, Gram JB, Sand NPR. Carotid plaque composition by CT angiography in asymptomatic subjects: a head-to-head comparison to ultrasound. Eur Radiol 2019; 29:5920-5931. [PMID: 30915562 DOI: 10.1007/s00330-019-06086-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/27/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe carotid plaque composition by computed tomography angiography (CTA) in asymptomatic subjects and to compare this to carotid plaque assessment by ultrasound, coronary plaques by coronary CTA, and inflammatory biomarkers in plasma. METHODS Middle-aged asymptomatic men, n = 43, without known cardiovascular disease and diabetes were included. Plaques in coronary and carotid arteries were evaluated using CTA. Total plaque volumes and plaque composition were assessed by a validated plaque analysis software. The 60% centile cut point was used to divide the population into low or high carotid total plaque volumes. The occurrence of carotid plaques and intima-media thickness (IMT) was estimated by ultrasound. RESULTS Carotid plaque by ultrasound was undiagnosed in 13 of 28 participants (46%) compared to CTA. Participants having carotid plaques by ultrasound had significantly higher absolute volumes of all CTA-defined carotid plaque subtypes and a higher fraction of calcified plaque. A high carotid total plaque volume was independently associated with age (adjusted odds ratio (OR) 1.41 [95% confidence interval (CI) 1.14-1.74], p = 0.001), IMT (adjusted OR 2.26 [95% CI 1.10-4.65], p = 0.03), and D-dimer (adjusted OR 8.86 [95% CI 1.26-62.37], p = 0.03). All coronary plaque features were significantly higher in participants with a high carotid total plaque volume. CONCLUSION The occurrence of carotid plaques in asymptomatic individuals is underestimated by ultrasound compared to plaque assessment by CTA. Carotid plaque composition by CTA is different in individuals with and without carotid plaques by ultrasound. KEY POINTS • The occurrence of carotid plaques by ultrasound was underestimated in 46% of participants who had plaques by carotid CTA. • Participants with carotid plaques by ultrasound had higher volumes of all plaque subtypes and a higher calcified plaque component as determined by carotid CTA compared to participants without carotid plaques by ultrasound. • A high carotid total plaque volume was independently associated with age, intima-media thickness, and D-dimer.
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Affiliation(s)
- Ramshanker Ramanathan
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark.
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, 90048, USA
| | - Bjarne L Nørgaard
- Department of Cardiology, Skejby University Hospital, Aarhus, Denmark
| | - Markus Goeller
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, 90048, USA
| | - Ida S Bjerrum
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ronald Antulov
- Department of Radiology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | | | - Johannes J Sidelmann
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jørgen B Gram
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Niels Peter R Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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22
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Zhou R, Luo Y, Fenster A, Spence JD, Ding M. Fractal dimension based carotid plaque characterization from three-dimensional ultrasound images. Med Biol Eng Comput 2018; 57:135-146. [PMID: 30046955 DOI: 10.1007/s11517-018-1865-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/02/2018] [Indexed: 12/14/2022]
Abstract
Irregularity of the plaque surface associated with previous plaque rupture plays an important role in the risk estimation of stroke caused by carotid atherosclerotic lesions. Thus, the aim of this study is to develop and validate novel vulnerability biomarkers from three-dimensional ultrasound (3DUS) images by analyzing the surface morphological characteristics of carotid plaque using fractal geometry features. In the experiments, a total of 38 3DUS plaque images were obtained from two groups of patients treated with 80 mg of atorvastatin or placebo daily for 3 months respectively. Two types of 3D fractal dimensions (FDs) were used to describe the smoothness of plaque surface morphology and the roughness from intensity of 3DUS images. Student's t test showed that the two fractal features were effective for detecting the statin-related changes in carotid atherosclerosis with p < 0.00023 and p < 0.0113 respectively. It was concluded that the 3D FD measurements were effective for analyzing carotid plaque characteristics and especially effective for evaluating the impact of atorvastatin treatment. Graphical abstract ᅟ.
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Affiliation(s)
- Ran Zhou
- Medical Ultrasound Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
- Key Laboratory of Molecular Biophysics of Education Ministry of China, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
| | - Yongkang Luo
- Medical Ultrasound Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
- Key Laboratory of Molecular Biophysics of Education Ministry of China, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
| | - Aaron Fenster
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
| | - John David Spence
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Mingyue Ding
- Medical Ultrasound Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China.
- Key Laboratory of Molecular Biophysics of Education Ministry of China, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China.
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23
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Boyko M, Kalashyan H, Becher H, Romanchuk H, Saqqur M, Rempel JL, Derksen C, Shuaib A, Khan K. Comparison of Carotid Doppler Ultrasound to Other Angiographic Modalities in the Measurement of Carotid Artery Stenosis. J Neuroimaging 2018; 28:683-687. [PMID: 29917285 DOI: 10.1111/jon.12532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/30/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to compare Doppler ultrasound (DUS) to other angiographic modalities: computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). METHODS All DUS studies performed at Stroke Prevention Clinic (SPC) from 2011 to 2013 and referred for further angiographic modalities were included. Patients were excluded if the corresponding angiographic modality was not performed within 6 months of DUS. Patients were also excluded if they underwent interventions before DUS or between the time of DUS and the corresponding angiographic modality. The degree of stenosis was classified as mild (<50%), moderate (50-69%), severe (70-99%), or occlusion (100%). RESULTS In total, 245 patients were identified. Nine patients were excluded (3.7%). Overall 472 Doppler studies of single ICAs from 236 patients were included in our analysis. Age was 65 ± 13 years and 136 patients were males (57.6%). There was an excellent agreement between DUS and CTA (kappa = .9 [P < .001], n = 274), good agreement with MRA (kappa = .8 [P < .001], n = 242), and excellent agreement with DSA (kappa = .92 [P < .001], n = 18). There was excellent agreement between CTA and MRA (kappa = .87, n = 46). CONCLUSION Doppler ultrasound performed in a dedicated SPC by an experienced sonographer and reviewed by a certified stroke neurologist serves as a reliable initial screening tool in determining carotid artery stenosis.
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Affiliation(s)
- Matthew Boyko
- Department of Neurology, University of Calgary, Calgary, AB, Canada
| | - Hayrapet Kalashyan
- Department of Medicine, University of Alberta Stroke Program, Edmonton, AB, Canada
| | - Harald Becher
- Department of Cardiology, University of Alberta Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
| | - Helen Romanchuk
- Department of Medicine, University of Alberta Stroke Program, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Medicine, University of Alberta Stroke Program, Edmonton, AB, Canada
| | | | - Carol Derksen
- Department of Medicine, University of Alberta Stroke Program, Edmonton, AB, Canada
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta Stroke Program, Edmonton, AB, Canada
| | - Khurshid Khan
- Department of Medicine, University of Alberta Stroke Program, Edmonton, AB, Canada
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24
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Molinari F, Liboni W, Giustetto P, Pavanelli E, Marsico A, Suri JS. Carotid Plaque Characterization with Contrast-Enhanced Ultrasound Imaging and its Histological Validation. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431671003400402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Better methods are needed to determine the course of intervention in patients with atherosclerosis; therefore, plaque characterization is increasing in importance. Current guidelines suggest that the degree of stenosis and symptoms are the only criteria for the selection of the surgical intervention. However, there remain some challenges. The characterization of plaque morphology may help determine the best course of therapy. Magnetic resonance imaging and computed tomography are current standard techniques to evaluate plaque morphology, but they are expensive and unsuitable for long term surveillance and monitoring. Objective In this research, an ultrasound-based methodology for the characterization of carotid plaques is shown. This technique requires the injection of a small volume (approximately 1.5 mL) of contrast agent and the acquisition of postcontrast images. The rationale of this technique is that poorly perfused tissues (such as lipids) show a lower contrast enhancement with respect to highly perfused tissues (such as fibrous and muscular tissue). Methods The technique consists of two steps. First, the plaque region is automatically segmented by a completely user-independent algorithm. Then, the portion of the wall corresponding to the plaque is analyzed and color-coded intensity is assigned to a specific tissue. Performance evaluation was performed against histology. Twenty plaque specimens were sent to pathology for reporting. Correlation of the histology report and of the contrast-enhanced ultrasound analysis was performed. Results Plaque components that could be effectively identified were thrombi, lipids, fibrous/muscular tissue, and calcium. Overall the errors on 20 plaques between automated classification and histology were: 3.1 ± 1.1% for thrombus, 4.2 ± 1.5% for lipids, 5 ± 3.4% for fibrous/muscular tissue, and 3.2 ± 1.0% for calcium. Conclusion Despite the need for further investigation and a quantitative evaluation of the results, this methodology showed encouraging results. This analysis architecture is undergoing validation in a neurology division and is aimed at being used for the follow-up of patients and quantification of drug therapy effects.
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Affiliation(s)
- Filippo Molinari
- Biolab, Department of Electronics, Politecnico di Torino, Torino, Italy
| | | | | | | | | | - Jasjit S. Suri
- Biomedical Technologies Inc., Denver, CO
- Department of Biomedical Engineering, Idaho State University (Aff), Pocatello, ID
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25
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Johnson JL, Merrilees M, Shragge J, van Wijk K. All-optical extravascular laser-ultrasound and photoacoustic imaging of calcified atherosclerotic plaque in excised carotid artery. PHOTOACOUSTICS 2018; 9:62-72. [PMID: 29707480 PMCID: PMC5914201 DOI: 10.1016/j.pacs.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/05/2017] [Accepted: 01/16/2018] [Indexed: 05/16/2023]
Abstract
Photoacoustic (PA) imaging may be advantageous as a safe, non-invasive imaging modality to image the carotid artery. However, calcification that accompanies atherosclerotic plaque is difficult to detect with PA due to the non-distinct optical absorption spectrum of hydroxyapatite. We propose reflection-mode all-optical laser-ultrasound (LUS) imaging to obtain high-resolution, non-contact, non-ionizing images of the carotid artery wall and calcification. All-optical LUS allows for flexible acquisition geometry and user-dependent data acquisition for high repeatability. We apply all-optical techniques to image an excised human carotid artery. Internal layers of the artery wall, enlargement of the vessel, and calcification are observed with higher resolution and reduced artifacts with nonconfocal LUS compared to confocal LUS. Validation with histology and X-ray computed tomography (CT) demonstrates the potential for LUS as a method for non-invasive imaging in the carotid artery.
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Affiliation(s)
- Jami L. Johnson
- University of Auckland, Faculty of Science, Department of Physics, Dodd-Walls Centre for Photonic and Quantum Technologies, Private Bag 92019, Auckland 1010, New Zealand
- Corresponding author.
| | - Mervyn Merrilees
- University of Auckland, Faculty of Medical and Health Sciences, Department of Anatomy and Medical Imaging, Private Bag 92019, Auckland 1142, New Zealand
| | - Jeffrey Shragge
- Colorado School of Mines, Center for Wave Phenomena, Geophysics Department, Golden, CO, USA
| | - Kasper van Wijk
- University of Auckland, Faculty of Science, Department of Physics, Dodd-Walls Centre for Photonic and Quantum Technologies, Private Bag 92019, Auckland 1010, New Zealand
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26
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Hoelter P, Lang S, Weibart M, Schmidt M, Knott MFX, Engelhorn T, Essig M, Kloska S, Doerfler A. Prospective intraindividual comparison of gadoterate and gadobutrol for cervical and intracranial contrast-enhanced magnetic resonance angiography. Neuroradiology 2017; 59:1233-1239. [PMID: 28913611 DOI: 10.1007/s00234-017-1922-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Gadobutrol (GB) is reported to provide improved relaxivity and concentration compared to gadoterate (GT). This study was designed to intraindividually compare quantitative and qualitative enhancement characteristics of GB to GT in cervicocranial magnetic resonance angiography (MRA) of patients with cerebrovascular disease (CVD). METHODS Patients (n = 54) with CVD underwent two identical contrast-enhanced magnetic resonance angiography (CE-MRA) examinations of the cervical and intracranial vasculature in randomized order, using GB and GT in equimolar dose. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were obtained by two independent neuroradiologists, blinded to the applied contrast agents. Qualitative assessment was performed using a three-point scale with a focus on M1/M2 segments. RESULTS One thousand and twenty-six vessel segments were analyzed. GB revealed a significantly higher SNR (p = 0.032) and CNR (p = 0.031) in all vessel segments. GB featured a significantly higher SNR and CNR in thoracic (p = 0.022; p = 0.016) and cervical vessels (p = 0.03; p = 0.038), as well as in the posterior circulation (p = 0.012; p = 0.005). In blinded qualitative assessment, overall preference was given to GB (p = 0.02), showing a significant better delineation of the M1/M2 segments (p = 0.041). CONCLUSION Compared to GT, the use of GB results in a significantly higher SNR and CNR in cervical and cerebral CE-MRA, leading to a better delineation of the intracranial vasculature. Present results underline the potential of GB for improved CE-MRA assessment of vasculature in CVD patients.
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Affiliation(s)
- Philip Hoelter
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Stefan Lang
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Marina Weibart
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Manuel Schmidt
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Michael F X Knott
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Marco Essig
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - Stephan Kloska
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
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27
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Cheung WK, Shah BN, Stanziola A, Gujral DM, Chahal NS, Cosgrove DO, Senior R, Tang MX. Differential Intensity Projection for Visualisation and Quantification of Plaque Neovascularisation in Contrast-Enhanced Ultrasound Images of Carotid Arteries. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:831-837. [PMID: 28094067 DOI: 10.1016/j.ultrasmedbio.2016.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/02/2016] [Accepted: 11/22/2016] [Indexed: 06/06/2023]
Abstract
Studies have reported that intraplaque neovascularisation (IPN) is closely correlated with plaque vulnerability. In this study, a new image processing approach, differential intensity projection (DIP), was developed to visualise and quantify IPN in contrast-enhanced non-linear ultrasound image sequences of carotid arteries. DIP used the difference between the local temporal maximum and the local temporal average signals to identify bubbles against tissue non-linear artefact and noise. The total absolute and relative areas occupied by bubbles within each plaque were calculated to quantify IPN. In vitro measurements on a laboratory phantom were made, followed by in vivo measurements in which 24 contrast-enhanced non-linear ultrasound image sequences of carotid arteries from 48 patients were selected and motion corrected. The results using DIP were compared with those obtained by maximum intensity projection (MIP) and visual assessment. The results indicated that DIP can significantly reduce non-linear propagation tissue artefacts and is much more specific in detecting bubble signals than MIP, being able to reveal microbubble signals that are buried in tissue artefacts in the corresponding MIP image. A good correlation was found between microvascular area (MVA) (r = 0.83, p < 0.001)/microvascular density (r = 0.77, p < 0.001) obtained using DIP and the corresponding expert visual grades, comparing favourably to r = 0.26 and 0.23 obtained using MIP on the same data. In conclusion, the proposed method exhibits great potential in quantification of IPN in contrast-enhanced ultrasound images of carotid arteries.
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Affiliation(s)
| | - Benoy N Shah
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | | | | | - Navtej S Chahal
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - David O Cosgrove
- Department of Imaging, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, UK; Biomedical Research Unit, Imperial College London, London, UK
| | - Meng-Xing Tang
- Department of Bioengineering, Imperial College, London, UK.
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Abstract
In this chapter we review the optimal imaging modalities for subacute and chronic stroke. We discuss the utility of computed tomography (CT) and multimodal CT imaging. Further, we analyze the importance of specific magnetic resonance imaging sequences, such as diffusion-weighted imaging for acute ischemic stroke, T2/fluid-attenuated inversion recovery for subacute and chronic stroke, and susceptibility imaging for detection of intracranial hemorrhages. Different ischemic stroke mechanisms are reviewed, and how these imaging modalities may aid in the determination of such. Further, we analyze how topographic patterns in ischemic stroke may provide important clues to the diagnosis, in addition to the temporal evolution of the stroke. Lastly, specific cerebrovascular occlusive diseases are reviewed, with emphasis on the optimal imaging modalities and their findings in each condition.
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29
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Shi Y, Gao Y, Zou X, Chen L, Li Y. Imaging of carotid artery inflammatory plaques with superparamagnetic nanoparticles and an external magnet collar. J Mater Chem B 2017; 5:797-806. [PMID: 32263848 DOI: 10.1039/c6tb02849g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Stroke is one of the top three fatal diseases in human history.
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Affiliation(s)
- Yimin Shi
- Department of Neurosurgery
- Huashan Hospital
- Fudan University
- Shanghai 200040
- P. R. China
| | - Yongping Gao
- Lab of Low-Dimensional Materials Chemistry
- Key Laboratory for Ultrafine Materials of Ministry of Education
- School of Materials Science and Engineering
- East China University of Science and Technology
- Shanghai 200237
| | - Xiang Zou
- Department of Neurosurgery
- Huashan Hospital
- Fudan University
- Shanghai 200040
- P. R. China
| | - Liang Chen
- Department of Neurosurgery
- Huashan Hospital
- Fudan University
- Shanghai 200040
- P. R. China
| | - Yongsheng Li
- Lab of Low-Dimensional Materials Chemistry
- Key Laboratory for Ultrafine Materials of Ministry of Education
- School of Materials Science and Engineering
- East China University of Science and Technology
- Shanghai 200237
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30
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de Korte CL, Fekkes S, Nederveen AJ, Manniesing R, Hansen HRHG. Review: Mechanical Characterization of Carotid Arteries and Atherosclerotic Plaques. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2016; 63:1613-1623. [PMID: 27249826 DOI: 10.1109/tuffc.2016.2572260] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of death and is in the majority of cases due to the formation of atherosclerotic plaques in arteries. Initially, thickening of the inner layer of the arterial wall occurs. Continuation of this process leads to plaque formation. The risk of a plaque to rupture and thus to induce an ischemic event is directly related to its composition. Consequently, characterization of the plaque composition and its proneness to rupture are of crucial importance for risk assessment and treatment strategies. The carotid is an excellent artery to be imaged with ultrasound because of its superficial position. In this review, ultrasound-based methods for characterizing the mechanical properties of the carotid wall and atherosclerotic plaque are discussed. Using conventional echography, the intima media thickness (IMT) can be quantified. There is a wealth of studies describing the relation between IMT and the risk for myocardial infarction and stroke. Also the carotid distensibility can be quantified with ultrasound, providing a surrogate marker for the cross-sectional mechanical properties. Although all these parameters are associated with CVD, they do not easily translate to individual patient risk. Another technique is pulse wave velocity (PWV) assessment, which measures the propagation of the pressure pulse over the arterial bed. PWV has proven to be a marker for global arterial stiffness. Recently, an ultrasound-based method to estimate the local PWV has been introduced, but the clinical effectiveness still needs to be established. Other techniques focus on characterization of plaques. With ultrasound elastography, the strain in the plaque due to the pulsatile pressure can be quantified. This technique was initially developed using intravascular catheters to image coronaries, but recently noninvasive methods were successfully developed. A high correlation between the measured strain and the risk for rupture was established. Acoustic radiation force impulse (ARFI) imaging also provides characterization of local plaque components based on mechanical properties. However, both elastography and ARFI provide an indirect measure of the elastic modulus of tissue. With shear wave imaging, the elastic modulus can be quantified, although the carotid artery is one of the most challenging tissues for this technique due to its size and geometry. Prospective studies still have to establish the predictive value of these techniques for the individual patient. Validation of ultrasound-based mechanical characterization of arteries and plaques remains challenging. Magnetic resonance imaging is often used as the "gold" standard for plaque characterization, but its limited resolution renders only global characterization of the plaque. CT provides information on the vascular tree, the degree of stenosis, and the presence of calcified plaque, while soft plaque characterization remains limited. Histology still is the gold standard, but is available only if tissue is excised. In conclusion, elastographic ultrasound techniques are well suited to characterize the different stages of vascular disease.
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31
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Kim J, Park JE, Nahrendorf M, Kim DE. Direct Thrombus Imaging in Stroke. J Stroke 2016; 18:286-296. [PMID: 27733029 PMCID: PMC5066439 DOI: 10.5853/jos.2016.00906] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/01/2016] [Accepted: 09/17/2016] [Indexed: 01/02/2023] Open
Abstract
There is an emergent need for imaging methods to better triage patients with acute stroke for tissue-plasminogen activator (tPA)-mediated thrombolysis or endovascular clot retrieval by directly visualizing the size and distribution of cerebral thromboemboli. Currently, magnetic resonance (MR) or computed tomography (CT) angiography visualizes the obstruction of blood flow within the vessel lumen rather than the thrombus itself. The present visualization method, which relies on observation of the dense artery sign (the appearance of cerebral thrombi on a non-enhanced CT), suffers from low sensitivity. When translated into the clinical setting, direct thrombus imaging is likely to enable individualized acute stroke therapy by allowing clinicians to detect the thrombus with high sensitivity, assess the size and nature of the thrombus more precisely, serially monitor the therapeutic effects of thrombolysis, and detect post-treatment recurrence. This review is intended to provide recent updates on stroke-related direct thrombus imaging using MR imaging, positron emission tomography, or CT.
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Affiliation(s)
- Jongseong Kim
- Molecular Imaging and Neurovascular Research (MINER) Laboratory, Dongguk University Ilsan Hospital, Goyang, Korea.,Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA )
| | - Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Matthias Nahrendorf
- Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA ).,Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dong-Eog Kim
- Molecular Imaging and Neurovascular Research (MINER) Laboratory, Dongguk University Ilsan Hospital, Goyang, Korea.,Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA ).,Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
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Suttmeyer B, Teichgräber U, Rathke H, Albrecht L, Güttler F, Schnackenburg B, Hamm B, de Bucourt M. Initial experience with imaging of the lower extremity arteries in an open 1.0 Tesla MRI system using the triggered angiography non-contrast-enhanced sequence (TRANCE) compared to digital subtraction angiography (DSA). ACTA ACUST UNITED AC 2016; 61:383-92. [DOI: 10.1515/bmt-2014-0181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 11/09/2015] [Indexed: 11/15/2022]
Abstract
Abstract
Purpose:
The aim of this study was to evaluate the feasibility and validity of arterial lower limb imaging with triggered angiography non-contrast enhanced (TRANCE) in an open MRI at 1.0 Tesla (T) compared to digital subtraction angiography (DSA).
Material and methods:
ECG-gated, non-contrast-enhanced magnetic resonance angiography (MRA) was performed in a 1.0-T high-field open magnetic resonance imaging (MRI) system which generates a vertical magnetic field. Three acquisition levels were defined (abdominal and pelvic level, arterial segments above the knee and segments below the knee) and a total of 1782 vessel diameter measurements were taken on a total of 11 patients with suspected peripheral arterial occlusive disease (PAOD) (8 men, 3 women; average age 66 years). In each patient, 162 vessel segments (81 each with TRANCE and DSA) were defined and measured. Pearson correlation coefficients were calculated.
Results:
At the abdominal/pelvic level, all mean values measured with DSA exceeded the mean values obtained with TRANCE. Above the knee, mean vessel diameters were measured smaller in DSA in six, equal in three, and larger in two vessel segments. Below the knee, all measured averages, except for the tibiofibular tract (TFT) measurements, were larger in TRANCE. In total, two small (≤0.3), two moderate (>0.3), 11 good (>0.5), 10 high (>0.7) and 13 very high (>0.8) correlations were obtained.
Conclusions:
Non-contrast-enhanced imaging of the lower limb arteries using a TRANCE-sequence in a 1.0 T open MRI system is feasible with the protocol presented; however, TRANCE tends to underestimate larger vessels and overestimate smaller vessels compared to DSA.
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Detection of carotid artery stenosis using histological specimens: a comparison of CT angiography, magnetic resonance angiography, digital subtraction angiography and Doppler ultrasonography. Acta Neurochir (Wien) 2016; 158:1505-14. [PMID: 27255656 DOI: 10.1007/s00701-016-2842-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is accepted as a primary modality to treat carotid stenosis. The accuracy of measuring carotid stenosis is important for indication of the CEA procedure. Different diagnostic tools have been developed and used in the past 2 decades for the diagnosis of carotid stenosis. Only a few studies, however, have focused on the comparison of different diagnostic tools to histological findings of carotid plaque. METHOD Patients with internal carotid artery (ICA) stenosis were investigated primarily by computed tomography angiography (CTA). Digital subtraction angiography (DSA), Doppler ultrasonography (DUS) and magnetic resonance angiography (MRA) were performed as well. Atherosclerotic plaque specimens were transversally cut into smaller segments and histologically processed. The slides were scanned and specimens showing maximal stenosis were determined; the minimal diameter and the diameter of the whole plaque were measured. High quality histological specimen and histological measurement was considered to be the prerequisite for inclusion into the analysis. The preoperative findings were compared with histological measurement. CTA and histological measurements were obtained from 152 patients. DSA measurements were available in 138 of these cases, MRA in 107 and DUS in 88. A comparison between preoperative and histological findings was performed. In addition, correlation coefficients were computed and tested. RESULTS A significant correlation was found for each of the diagnostic procedures. The strongest correlation coefficient and the best allocation of stenosis into clinical significant groups (<50 %, 50-69 %, ≥70 %) was observed for CTA. Mean differences in the whole cohort between preoperative and histological measurements were as follows: CTA underestimated histological measurement by 2.4 % (based on European Carotid Surgery Trial [ECST] methodology) and 11.9 % (based on North American Symptomatic Carotid Endarterectomy Trial [NASCET] methodology). DSA underestimated the histological measurement by 7 % (ECST) and 12.2 % (NASCET). MRA overestimated the histological measurement by 2.6 % (ECST) and underestimated by 0.6 % (NASCET). DUS overestimated the stenosis by 1.8 %. CONCLUSIONS CTA yields the best accuracy in detection of carotid stenosis, provided that all axial slices of the stenosis are checked and carefully analysed. DSA underestimates moderate and mild ICA stenosis, whereas DUS overestimates high-grade ICA stenosis. For MRA, a relatively low correlation coefficient was observed with histological findings. We conclude that CTA-ecst technique is the most reliable technique for carotid stenosis measurement.
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Barlinn K, Floegel T, Kitzler HH, Kepplinger J, Siepmann T, Pallesen LP, Bodechtel U, Reichmann H, Alexandrov AV, Puetz V. Multi-parametric ultrasound criteria for internal carotid artery disease-comparison with CT angiography. Neuroradiology 2016; 58:845-51. [PMID: 27230916 DOI: 10.1007/s00234-016-1706-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. METHODS Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. RESULTS A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r s = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. CONCLUSION Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results.
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Affiliation(s)
- Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Thomas Floegel
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.,Department of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hagen H Kitzler
- Department of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jessica Kepplinger
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ulf Bodechtel
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Volker Puetz
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Abdominal fat distribution and carotid atherosclerosis in a general population: a semi-automated method using magnetic resonance imaging. Jpn J Radiol 2016; 34:414-22. [PMID: 27015838 DOI: 10.1007/s11604-016-0540-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Available evidence suggests functional differences in visceral and subcutaneous fat. We investigated the association between quantitative measures of central adiposity with indicators of carotid atherosclerosis including intima-media thickness (IMT) and plaque in a general population using a semi-automated method on magnetic resonance imaging (MRI) data. METHODS In this cross-sectional study 200 subjects (52 % female), aged 50-77 years, were randomly selected from Golestan Cohort Study. Participants underwent ultrasound examination of carotid arteries and abdominal MRI. Segmentation and calculation of visceral (VFA) and subcutaneous fat area (SFA) were performed on three levels using semi-automated software. Various conventional anthropometric indices were also measured. RESULTS Among 191 enrolled subjects, 77 (40 %) participants had IMT ≥0.8 mm. Carotid plaques were detected in 86 (44 %) subjects. In separate multivariate analysis models, unlike SFA and other anthropometric indices, the last tertile of VFA values was associated with at least threefold excess risk for IMT ≥0.8 mm (OR 3.8, 95 % CI 1.36-6.94, p = 0.02). There was no significant difference between mean values of categorized obesity indices in subjects with and without plaque, while participants in the highest tertile of VFA values were demonstrated to have higher risk of more than one plaque (OR 4.57, 95 % CI 1.03-20.11, p = 0.034). CONCLUSIONS A higher amount of visceral fat, measured by a semi-automated technique using MRI, is associated with increased IMT and having more than one carotid plaque in a general population, while subcutaneous fat measures are poor indicators for identifying carotid atherosclerosis.
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Ha SM, Suh SI, Seo WK, Seol HY. Arterial Wall Imaging in Symptomatic Carotid Stenosis: Delayed Enhancement on MDCT Angiography. Neurointervention 2016; 11:18-23. [PMID: 26958408 PMCID: PMC4781912 DOI: 10.5469/neuroint.2016.11.1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate progressive enhancement in the carotid arterial wall overlying plaque in the symptomatic side for patients with cerebrovascular symptoms until delayed phase using MDCTA. Materials and Methods Twenty-one patients (all men; ages, 49-82 years; mean, 67.8 ± 8.4 years) with recent stroke and severe extracranial carotid stenosis were retrospectively analyzed. Pre-, early- and delayed phase images of MDCTA were obtained, and Hounsfield units (HU) of carotid walls were measured. We also measured HU of the asymptomatic contralateral carotid arterial wall for comparison. Friedman's test and Wilcoxon signed-rank test were used to evaluate the differences between groups. Results The averaged HU of the carotid wall in the symptomatic side was higher on the delayed phase (65.8 ± 14.2 HU) compared to early arterial phase (54.2 ± 12.6 HU). The averaged HU difference of wall enhancement between pre-contrast and delayed phase (28.0 ± 14.8 HU) was significantly higher than the between pre-contrast and early arterial phase (16.4 ± 12.1 HU) with P < 0.05. In analysis of the contralateral asymptomatic side, the HU difference between pre-contrast and delayed phase (15.5 ± 12.0 HU) showed no significant higher value than between pre-contrast and early arterial phase (14.9 ± 10.9 HU). Conclusion The pronounced enhancement of the carotid wall in the delayed phase on MDCTA was demonstrated in symptomatic patients with severe internal carotid artery stenosis. In the future, we need more comparative studies to verify this finding as one of risk stratification.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hae Young Seol
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kurosaki Y, Yoshida K, Fukumitsu R, Sadamasa N, Handa A, Chin M, Yamagata S. Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity. J Neurosurg 2016; 124:736-42. [DOI: 10.3171/2015.2.jns142783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity.
METHODS
Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI< 1.40 and ERR ≥ 1.66; Group C = rSI ≥ 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group.
RESULTS
Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01).
CONCLUSIONS
In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, which should be validated by a prospective, randomized study of asymptomatic patients.
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Affiliation(s)
| | - Kazumichi Yoshida
- 2Department of Neurosurgery, Kyoto University School of Medicine, Kyoto, Japan
| | - Ryu Fukumitsu
- 2Department of Neurosurgery, Kyoto University School of Medicine, Kyoto, Japan
| | - Nobutake Sadamasa
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Akira Handa
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Masaki Chin
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
| | - Sen Yamagata
- 1Department of Neurosurgery, Kurashiki Central Hospital, Okayama; and
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Teng Z, Feng J, Zhang Y, Sutcliffe MPF, Huang Y, Brown AJ, Jing Z, Lu Q, Gillard JH. A uni-extension study on the ultimate material strength and extreme extensibility of atherosclerotic tissue in human carotid plaques. J Biomech 2015; 48:3859-67. [PMID: 26472304 PMCID: PMC4655866 DOI: 10.1016/j.jbiomech.2015.09.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/16/2015] [Accepted: 09/24/2015] [Indexed: 12/26/2022]
Abstract
Atherosclerotic plaque rupture occurs when mechanical loading exceeds its material strength. Mechanical analysis has been shown to be complementary to the morphology and composition for assessing vulnerability. However, strength and stretch thresholds for mechanics-based assessment are currently lacking. This study aims to quantify the ultimate material strength and extreme extensibility of atherosclerotic components from human carotid plaques. Tissue strips of fibrous cap, media, lipid core and intraplaque hemorrhage/thrombus were obtained from 21 carotid endarterectomy samples of symptomatic patients. Uni-extension test with tissue strips was performed until they broke or slid. The Cauchy stress and stretch ratio at the peak loading of strips broken about 2 mm away from the clamp were used to characterize their ultimate strength and extensibility. Results obtained indicated that ultimate strength of fibrous cap and media were 158.3 [72.1, 259.3] kPa (Median [Inter quartile range]) and 247.6 [169.0, 419.9] kPa, respectively; those of lipid and intraplaque hemorrhage/thrombus were 68.8 [48.5, 86.6] kPa and 83.0 [52.1, 124.9] kPa, respectively. The extensibility of each tissue type were: fibrous cap – 1.18 [1.10, 1.27]; media – 1.21 [1.17, 1.32]; lipid – 1.25 [1.11, 1.30] and intraplaque hemorrhage/thrombus – 1.20 [1.17, 1.44]. Overall, the strength of fibrous cap and media were comparable and so were lipid and intraplaque hemorrhage/thrombus. Both fibrous cap and media were significantly stronger than either lipid or intraplaque hemorrhage/thrombus. All atherosclerotic components had similar extensibility. Moreover, fibrous cap strength in the proximal region (closer to the heart) was lower than that of the distal. These results are helpful in understanding the material behavior of atherosclerotic plaques.
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Affiliation(s)
- Zhongzhao Teng
- Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Yongxue Zhang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | | | - Yuan Huang
- Department of Radiology, University of Cambridge, UK
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, UK
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
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Cheung WK, Gujral DM, Shah BN, Chahal NS, Bhattacharyya S, Cosgrove DO, Eckersley RJ, Harrington KJ, Senior R, Nutting CM, Tang MX. Attenuation Correction and Normalisation for Quantification of Contrast Enhancement in Ultrasound Images of Carotid Arteries. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1876-1883. [PMID: 25843515 DOI: 10.1016/j.ultrasmedbio.2015.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 12/15/2014] [Accepted: 02/21/2015] [Indexed: 06/04/2023]
Abstract
An automated attenuation correction and normalisation algorithm was developed to improve the quantification of contrast enhancement in ultrasound images of carotid arteries. The algorithm first corrects attenuation artefact and normalises intensity within the contrast agent-filled lumen and then extends the correction and normalisation to regions beyond the lumen. The algorithm was first validated on phantoms consisting of contrast agent-filled vessels embedded in tissue-mimicking materials of known attenuation. It was subsequently applied to in vivo contrast-enhanced ultrasound (CEUS) images of human carotid arteries. Both in vitro and in vivo results indicated significant reduction in the shadowing artefact and improved homogeneity within the carotid lumens after the correction. The error in quantification of microbubble contrast enhancement caused by attenuation on phantoms was reduced from 55% to 5% on average. In conclusion, the proposed method exhibited great potential in reducing attenuation artefact and improving quantification in contrast-enhanced ultrasound of carotid arteries.
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Affiliation(s)
| | | | - Benoy N Shah
- Biomedical Research Unit, NHLI, Imperial College, London, UK
| | - Navtej S Chahal
- Biomedical Research Unit, NHLI, Imperial College, London, UK
| | | | | | | | | | - Roxy Senior
- Biomedical Research Unit, NHLI, Imperial College, London, UK
| | | | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, UK.
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A novel trigger for cholesterol-dependent smooth muscle contraction mediated by the sphingosylphosphorylcholine-Rho-kinase pathway in the rat basilar artery: a mechanistic role for lipid rafts. J Cereb Blood Flow Metab 2015; 35:835-42. [PMID: 25605290 PMCID: PMC4420858 DOI: 10.1038/jcbfm.2014.260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 02/04/2023]
Abstract
Hyperlipidemia is a risk factor for abnormal cerebrovascular events. Rafts are cholesterol-enriched membrane microdomains that influence signal transduction. We previously showed that Rho-kinase-mediated Ca(2+) sensitization of vascular smooth muscle (VSM) induced by sphingosylphosphorylcholine (SPC) has a pivotal role in cerebral vasospasm. The goals of the study were to show SPC-Rho-kinase-mediated VSM contraction in vivo and to link this effect to cholesterol and rafts. The SPC-induced VSM contraction measured using a cranial window model was reversed by Y-27632, a Rho-kinase inhibitor, in rats fed a control diet. The extent of SPC-induced contraction correlated with serum total cholesterol. Total cholesterol levels in the internal carotid artery (ICA) were significantly higher in rats fed a cholesterol diet compared with a control diet or a β-cyclodextrin diet, which depletes VSM cholesterol. Western blotting and real-time PCR revealed increases in flotillin-1, a raft marker, and flotillin-1 mRNA in the ICA in rats fed a cholesterol diet, but not in rats fed the β-cyclodextrin diet. Depletion of cholesterol decreased rafts in VSM cells, and prevention of an increase in cholesterol by β-cyclodextrin inhibited SPC-induced contraction in a cranial window model. These results indicate that cholesterol potentiates SPC-Rho-kinase-mediated contractions of importance in cerebral vasospasm and are compatible with a role for rafts in this process.
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Makris GC, Teng Z, Patterson AJ, Lin JM, Young V, Graves MJ, Gillard JH. Advances in MRI for the evaluation of carotid atherosclerosis. Br J Radiol 2015; 88:20140282. [PMID: 25826233 DOI: 10.1259/bjr.20140282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Carotid artery atherosclerosis is an important source of mortality and morbidity in the Western world with significant socioeconomic implications. The quest for the early identification of the vulnerable carotid plaque is already in its third decade and traditional measures, such as the sonographic degree of stenosis, are not selective enough to distinguish those who would really benefit from a carotid endarterectomy. MRI of the carotid plaque enables the visualization of plaque composition and specific plaque components that have been linked to a higher risk of subsequent embolic events. Blood suppressed T1 and T2 weighted and proton density-weighted fast spin echo, gradient echo and time-of-flight sequences are typically used to quantify plaque components such as lipid-rich necrotic core, intraplaque haemorrhage, calcification and surface defects including erosion, disruption and ulceration. The purpose of this article is to review the most important recent advances in MRI technology to enable better diagnostic carotid imaging.
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Affiliation(s)
- G C Makris
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Z Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - A J Patterson
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - J-M Lin
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - V Young
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - M J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - J H Gillard
- Department of Radiology, University of Cambridge, Cambridge, UK
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Wiberg S, Schoos M, Sillesen H, Thomsen C, Hassager C, Steinbrüchel D, Schroeder T, Clemmensen P, Kelbæk H. Cerebral lesions in patients undergoing coronary artery bypass grafting in relation to asymptomatic carotid and vertebral artery stenosis. Ann Vasc Dis 2015; 8:7-13. [PMID: 25848425 DOI: 10.3400/avd.oa.14-00073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/01/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the associations between neurologically asymptomatic CAS and VAS and the occurrence of subclinical cerebral lesions after CABG verified by magnetic resonance imaging. METHODS CABG patients were included and CAS and VAS were identified by magnetic resonance angiography. Cerebral magnetic resonance imaging was performed to identify new post-operative subclinical cerebral lesions. The associations between CAS/VAS post-operative cerebral lesions were investigated. RESULTS Forty-six patients were included in the study. 13% had significant CAS and 11% had significant VAS. Thirty-five percent had new cerebral infarction postoperatively. We found a significant association between the presence of cerebral vessel stenosis and acute cerebral infarction (67% vs. 27%, p = 0.047). However none of the patients with stenosis had isolated cerebral lesions in the ipsilateral vascular territory. CONCLUSION Asymptomatic CAS and VAS is common in CABG patients and is associated with an increased risk of postoperative cerebral infarction. Our study suggests that asymptomatic CAS and VAS primarily are risk markers rather than causal factors for cerebral infarction after CABG.
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Affiliation(s)
- Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Schoos
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Thomsen
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Steinbrüchel
- Department of Thoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torben Schroeder
- Centre for Clinical Education, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Internal medicine, Nykoebing F Hospital, Nykoebing, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Roskilde Hospital, Roskilde, Denmark
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Simpson RJ, Akwei S, Hosseini AA, MacSweeney ST, Auer DP, Altaf N. MR imaging-detected carotid plaque hemorrhage is stable for 2 years and a marker for stenosis progression. AJNR Am J Neuroradiol 2015; 36:1171-5. [PMID: 25742988 DOI: 10.3174/ajnr.a4267] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/12/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-detected carotid plaque hemorrhage is associated with an increased risk of recurrent ischemic cerebrovascular events and could be an indicator of disease progression; however, there are limited data regarding the dynamics of the MR imaging-detected carotid plaque hemorrhage signal. We assessed the temporal change of this signal and its impact on carotid disease progression. MATERIALS AND METHODS Thirty-seven symptomatic patients with 54 carotid stenoses of >30% on sonography underwent serial MR imaging during 24 months. A signal-intensity ratio of >1.5 between the carotid plaque and adjacent muscle was defined as plaque hemorrhage, and a change in signal-intensity ratio of >0.31 between time points was considered significant. Sixteen patients underwent ≥2 carotid sonography scans to determine the peak systolic velocities and degree of stenosis with time. RESULTS Of the 54 carotids, 28 had the presence of hyperintense signal on an MR imaging sequence (PH+) and 26 had the absence of hyperintense signal on an MR imaging sequence (PH-) at baseline. The signal-intensity ratio was stable in 33/54 carotid plaques, but 39% showed a change. Plaque hemorrhage classification did not change in 87% of carotid plaques, but 4 became PH+, and 3, PH-. As a group, PH+ carotids did not change significantly in signal-intensity ratio (P = .585), whereas PH- showed an increased signal-intensity ratio at 24.5 months (P = .02). In PH+ plaques, peak systolic velocities significantly increased by 22 ± 39.8 cm/s from baseline to last follow-up sonography (Z = 2.427, P = .013). CONCLUSIONS During 2 years, MR imaging-detected carotid plaque hemorrhage status remained stable in most (87%) cases with 4 (7%) incident plaque hemorrhages. PH+ plaques were associated with increased flow velocity during the follow-up period.
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Affiliation(s)
- R J Simpson
- From the Radiological Sciences Group (R.J.S., S.A., A.A.H., D.P.A., N.A.), Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom Department of Vascular and Endovascular Surgery (R.J.S., S.T.M., N.A.), Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom.
| | - S Akwei
- From the Radiological Sciences Group (R.J.S., S.A., A.A.H., D.P.A., N.A.), Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - A A Hosseini
- From the Radiological Sciences Group (R.J.S., S.A., A.A.H., D.P.A., N.A.), Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - S T MacSweeney
- Department of Vascular and Endovascular Surgery (R.J.S., S.T.M., N.A.), Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - D P Auer
- From the Radiological Sciences Group (R.J.S., S.A., A.A.H., D.P.A., N.A.), Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - N Altaf
- From the Radiological Sciences Group (R.J.S., S.A., A.A.H., D.P.A., N.A.), Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom Department of Vascular and Endovascular Surgery (R.J.S., S.T.M., N.A.), Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
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Rad MP, Zakavi SR, Layegh P, Khooei A, Bahadori A. Incidental Thyroid Abnormalities on Carotid Color Doppler Ultrasound: Frequency and Clinical Significance. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Material properties of components in human carotid atherosclerotic plaques: a uniaxial extension study. Acta Biomater 2014; 10:5055-5063. [PMID: 25200842 PMCID: PMC4226324 DOI: 10.1016/j.actbio.2014.09.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/31/2014] [Accepted: 09/01/2014] [Indexed: 12/17/2022]
Abstract
Computational modelling to calculate the mechanical loading within atherosclerotic plaques has been shown to be complementary to defining anatomical plaque features in determining plaque vulnerability. However, its application has been partially impeded by the lack of comprehensive knowledge about the mechanical properties of various tissues within the plaque. Twenty-one human carotid plaques were collected from endarterectomy. The plaque was cut into rings, and different type of atherosclerotic tissues, including media, fibrous cap (FC), lipid and intraplaque haemorrhage/thrombus (IPH/T) was dissected for uniaxial extension testing. In total, 65 media strips from 17 samples, 59 FC strips from 14 samples, 38 lipid strips from 11 samples, and 21 IPH/T strips from 11 samples were tested successfully. A modified Mooney–Rivlin strain energy density function was used to characterize the stretch–stress relationship. The stiffnesses of media and FC are comparable, as are lipid and IPH/T. However, both media and FC are stiffer than either lipid or IPH/T. The median values of incremental Young’s modulus of media, FC, lipid and IPH/T at λ = 1 are 290.1, 244.5, 104.4, 52.9, respectively; they increase to 1019.5, 817.4, 220.7 and 176.9 at λ = 1.1; and 4302.7, 3335.0, 533.4 and 268.8 at λ = 1.15 (unit, kPa; λ, stretch ratio). The material constants of each tissue type are suggested to be: media, c1 = 0.138 kPa, D1 = 3.833 kPa and D2 = 18.803; FC, c1 = 0.186 kPa, D1 = 5.769 kPa and D2 = 18.219; lipid, c1 = 0.046 kPa, D1 = 4.885 kPa and D2 = 5.426; and IPH/T, c1 = 0.212 kPa, D1 = 4.260 kPa and D2 = 5.312. It is concluded that all soft atherosclerotic tissues are non-linear, and both media and FC are stiffer than either lipid or IPH/T.
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Tadokoro Y, Sakaguchi M, Yamagami H, Okazaki S, Furukado S, Matsumoto M, Miwa K, Yagita Y, Mochizuki H, Kitagawa K. Echogenicity of Medium-to-Large Carotid Plaques Predicts Future Vascular Events. Cerebrovasc Dis 2014; 38:354-61. [DOI: 10.1159/000365651] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 07/02/2014] [Indexed: 11/19/2022] Open
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Abstract
Internal carotid artery (ICA) plaques constitute one major source of retinal and cerebral brain embolism. Current guidelines recommend optimal treatment of cardiovascular risk factors and recanalization based on the degree of ICA stenosis. However, ICA plaque composition, motion, vascularization, and local hemodynamics have only received limited attention as potential and independent risk factors for plaque rupture. The European Carotid Surgery Trial (ECST) showed an increased risk of stroke recurrence even in moderate stenosis if the plaque surface was ulcerated in angiography. Further indicators of plaque instability and thus vulnerability were established by native or contrast-enhanced two-dimensional duplex ultrasound, CT, and MRI. Due to high soft tissue contrast, multi-contrast MRI seems to be ideally suited to identify plaque compositions that are prone to rupture, although data from large clinical trials proving the independent predictive value of plaque morphology are lacking. The role of cardiovascular risk factors for atherosclerosis of the common carotid artery is well established. Nevertheless, little is known concerning the impact of local hemodynamics on plaque development, progression, and rupture. Wall shear stress, the friction force acting on the endothelium of the vessel wall, was shown to be able to induce local atherosclerosis and vulnerable plaques in animal models. Plaque movement and deformation was limited to investigations using ultrasound in order to identify plaques at risk. Similarly, models to calculate tensile plaque stress seem to be able to identify peak mechanical stress acting on plaque surfaces that make such regions susceptible to rupture. In this review, current evidence regarding the correlation of plaque location, composition, and local hemodynamics at the carotid artery bifurcation will be presented. Moreover, the potential benefit of a future comprehensive and individual risk assessment will be discussed.
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Affiliation(s)
- Andreas Harloff
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
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Elwertowski M, Małek G. Standards of the Polish Ultrasound Society - update. Examination of extracranial carotid and vertebral arteries. J Ultrason 2014; 14:179-91. [PMID: 26673158 PMCID: PMC4579696 DOI: 10.15557/jou.2014.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 05/16/2014] [Accepted: 05/22/2014] [Indexed: 12/03/2022] Open
Abstract
The role of a standard is to describe examination techniques, recommended norms as well as principles necessary to obtain results and draw appropriate conclusions, rather than a description of pathologies. The paper presents a technique for carotid artery examination as well as currently recommended standards. According to San Francisco Consensus from 2003, a significant stenosis of 70% may be detected when systolic velocity in the internal carotid artery stenosis is >230 cm/s, and the diastolic velocity is >100 cm/s. The common carotid artery velocity is also taken into account. Hemodynamic evaluation is therefore the primary method for the assessment of the degree of internal carotid artery stenosis. It is important that the examination is performed at an insonation angle of 60° as measurements at higher angles result in an exponential increase in measurement error. Also, an extended version of standards involving measurements performed behind stenosis, which are used in some clinics, is included in the paper. The paper further presents guidelines for the description of the identified pathologies, which ensure that the findings prove unambiguous for clinicians, especially when stenosis eligible for surgical intervention is detected. Morphological measurement of stenosis (according to NASCET criteria) is only of supplementary character (confirming morphological grounds for the increase of velocity) and has no critical importance, especially due to high measurement divergence. Description of atherosclerotic plaques, especially hypoechoic ones, which are considered potentially unstable and may lead to a raised risk of stroke, is a very important element of examination. The paper is based on Standards of the Polish Ultrasound Society and updated based on the latest literature reports.
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Affiliation(s)
- Michał Elwertowski
- Klinika Chirurgii Ogólnej i Chorób Klatki Piersiowej, Warszawski Uniwersytet Medyczny, Warszawa, Polska
| | - Grzegorz Małek
- Pracownia Ultrasonografii Naczyniowej i Echokardiografii, Zakład Radiologii, Instytut Gruźlicy i Chorób Płuc, Warszawa, Polska
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Huang Y, Teng Z, Sadat U, Graves MJ, Bennett MR, Gillard JH. The influence of computational strategy on prediction of mechanical stress in carotid atherosclerotic plaques: comparison of 2D structure-only, 3D structure-only, one-way and fully coupled fluid-structure interaction analyses. J Biomech 2014; 47:1465-71. [PMID: 24529358 PMCID: PMC3989027 DOI: 10.1016/j.jbiomech.2014.01.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Compositional and morphological features of carotid atherosclerotic plaques provide complementary information to luminal stenosis in predicting clinical presentations. However, they alone cannot predict cerebrovascular risk. Mechanical stress within the plaque induced by cyclical changes in blood pressure has potential to assess plaque vulnerability. Various modeling strategies have been employed to predict stress, including 2D and 3D structure-only, 3D one-way and fully coupled fluid-structure interaction (FSI) simulations. However, differences in stress predictions using different strategies have not been assessed. METHODS Maximum principal stress (Stress-P1) within 8 human carotid atherosclerotic plaques was calculated based on geometry reconstructed from in vivo computerized tomography and high resolution, multi-sequence magnetic resonance images. Stress-P1 within the diseased region predicted by 2D and 3D structure-only, and 3D one-way FSI simulations were compared to 3D fully coupled FSI analysis. RESULTS Compared to 3D fully coupled FSI, 2D structure-only simulation significantly overestimated stress level (94.1 kPa [65.2, 117.3] vs. 85.5 kPa [64.4, 113.6]; median [inter-quartile range], p=0.0004). However, when slices around the bifurcation region were excluded, stresses predicted by 2D structure-only simulations showed a good correlation (R(2)=0.69) with values obtained from 3D fully coupled FSI analysis. 3D structure-only model produced a small yet statistically significant stress overestimation compared to 3D fully coupled FSI (86.8 kPa [66.3, 115.8] vs. 85.5 kPa [64.4, 113.6]; p<0.0001). In contrast, one-way FSI underestimated stress compared to 3D fully coupled FSI (78.8 kPa [61.1, 100.4] vs. 85.5 kPa [64.4, 113.7]; p<0.0001). CONCLUSIONS A 3D structure-only model seems to be a computationally inexpensive yet reasonably accurate approximation for stress within carotid atherosclerotic plaques with mild to moderate luminal stenosis as compared to fully coupled FSI analysis.
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Affiliation(s)
- Yuan Huang
- University Departments of Radiology, University of Cambridge, UK
| | - Zhongzhao Teng
- University Departments of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Martin J Graves
- University Departments of Radiology, University of Cambridge, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, UK
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Kastis GA, Kyriakopoulou D, Gaitanis A, Fernández Y, Hutton BF, Fokas AS. Evaluation of the spline reconstruction technique for PET. Med Phys 2014; 41:042501. [DOI: 10.1118/1.4867862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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