Quantitative X-ray imaging of intraplaque hemorrhage in aortas of apoE(-/-)/LDL(-/-) double knockout mice

Arterial Wall Perfusion Measured with Photon Counting Spectral X-ray CT

Early atherosclerosis changes perfusion of the arterial wall due to localized proliferation of the vasa vasorum. When contrast agent passes through the artery, some enters the vasa vasorum and increases radiopacity of the arterial wall. Technical challenges to detecting changes in vasa vasorum density include the thin arterial wall, partial volume averaging at the arterial lumen/wall interface and calcification within the wall. We used a photon-counting spectral CT scanner to study carotid arteries of anesthetized pigs and micro-CT of these arteries to quantify vasa vasorum density. The left carotid artery wall was injected with autologous blood to stimulate vasa vasorum angiogenesis. The scans were performed at 25-120 keV; the tube-current-time product was 550 mAs. A 60 mL bolus of iodine contrast agent was injected into the femoral vein at 5mL/s. Two seconds post injection, an axial scan was acquired at every 3 s over 60 s (i.e., 20 time points). Each time point acquired 28 contiguous transaxial slices with reconstructed voxels 0.16 × 0.16 × 1 mm³. Regions-of-interest in the outer 2/3 of the arterial wall and in the middle 2/3 of the lumen were drawn and their enhancements plotted versus time. Lumenal CT values peaked several seconds after injection and then returned towards baseline. Arterial wall CT values peaked concurrent to the lumen. The peak arterial wall enhancement in the left carotid arterial wall correlated with increased vasa vasorum density observed in micro-CT images of the isolated arteries.

In Vitro/In Vivo Toxicity Evaluation and Quantification of Iron Oxide Nanoparticles

Increasing biomedical applications of iron oxide nanoparticles (IONPs) in academic and commercial settings have alarmed the scientific community about the safety and assessment of toxicity profiles of IONPs. The great amount of diversity found in the cytotoxic measurements of IONPs points toward the necessity of careful characterization and quantification of IONPs. The present document discusses the major developments related to in vitro and in vivo toxicity assessment of IONPs and its relationship with the physicochemical parameters of IONPs. Major discussion is included on the current spectrophotometric and imaging based techniques used for quantifying, and studying the clearance and biodistribution of IONPs. Several invasive and non-invasive quantification techniques along with the pitfalls are discussed in detail. Finally, critical guidelines are provided to optimize the design of IONPs to minimize the toxicity.

Synthesis of acid-stabilized iron oxide nanoparticles and comparison for targeting atherosclerotic plaques: evaluation by MRI, quantitative MPS, and TEM alternative to ambiguous Prussian blue iron staining

To further optimize citrate-stabilized VSOPs (very small iron oxide particles, developed for MR angiography) for identification of atherosclerotic plaques, we modified their surface during synthesis using eight other acids for electrostatic stabilization. This approach preserves effective production for clinical application. Five particles were suitable to be investigated in targeting plaques of apoE(-/-) mice. Accumulation was evaluated by ex vivo MRI, TEM, and quantitatively by magnetic particle spectroscopy (MPS). Citric- (VSOP), etidronic-, tartaric-, and malic-acid-coated particles accumulated in atherosclerotic plaques with highest accumulation for VSOP (0.2‰ of injected dose). Targets were phagolysosomes of macrophages and of altered endothelial cells. In vivo MRI with VSOP allowed for definite plaque identification. Prussian blue staining revealed abundant endogenous iron in plaques, indistinguishable from particle iron. In apoE(-/-) mice, VSOPs are still the best anionic iron oxide particles for imaging atherosclerotic plaques. MPS allows for quantification of superparamagnetic nanoparticles in such small specimens.

FROM THE CLINICAL EDITOR

The presence of vulnerable plaques in arteries is important for the prediction of acute coronary events. VSOP (very small iron oxide particles, developed for MR angiography) have been shown to be very sensitive in identifying atherosclerotic plaques. The authors studied here further modification to the surface of VSOP during synthesis and compared their efficacy.

Clinical applications of spectral molecular imaging: potential and challenges

Spectral molecular imaging is a new X-ray-based imaging technology providing highly specific 3D imaging at high spatial resolution that has the potential to measure disease activity and response to treatment noninvasively. The ability to identify and quantify components of tissue and biomarkers of disease activity derive from the properties of the photon-processing detector. Multiple narrow sections of the energy spectrum are sampled simultaneously, providing a range of energy dependent Hounsfield units. As each material has a specific measurable X-ray spectrum, spectroscopic imaging allows for multiple materials to be quantified and differentiated from each other simultaneously. The technology, currently in its infancy, is set to grow rapidly, much as magnetic resonance did. The critical clinical applications have not yet been established, but it is likely to play a major role in identifying and directing treatment for unstable atherosclerotic plaque, assessing activity and response to treatment of a range of inflammatory diseases, and monitoring biomarkers of cancer and its treatment. If combined with Positron-emission tomography (PET), spectral molecular imaging could have a far greater effective role in cancer diagnosis and treatment monitoring than PET-CT does at present. It is currently used for small animal and specimen imaging. There are many challenges to be overcome before spectral imaging can be introduced into clinical medicine - these include technological improvements to detector design, bonding to the semiconductor layer, image reconstruction and display software, identifying which biomarkers are of most relevance to the disease in question, and accelerating drug discovery enabled by the new capabilities provided by spectral imaging.

A mechanistic analysis of the role of microcalcifications in atherosclerotic plaque stability: potential implications for plaque rupture

The role of microcalcifications (μCalcs) in the biomechanics of vulnerable plaque rupture is examined. Our laboratory previously proposed (Ref. 44), using a very limited tissue sample, that μCalcs embedded in the fibrous cap proper could significantly increase cap instability. This study has been greatly expanded. Ninety-two human coronary arteries containing 62 fibroatheroma were examined using high-resolution microcomputed tomography at 6.7-μm resolution and undecalcified histology with special emphasis on calcified particles <50 μm in diameter. Our results reveal the presence of thousands of μCalcs, the vast majority in lipid pools where they are not dangerous. However, 81 μCalcs were also observed in the fibrous caps of nine of the fibroatheroma. All 81 of these μCalcs were analyzed using three-dimensional finite-element analysis, and the results were used to develop important new clinical criteria for cap stability. These criteria include variation of the Young's modulus of the μCalc and surrounding tissue, μCalc size, and clustering. We found that local tissue stress could be increased fivefold when μCalcs were closely spaced, and the peak circumferential stress in the thinnest nonruptured cap (66 μm) if no μCalcs were present was only 107 kPa, far less than the proposed minimum rupture threshold of 300 kPa. These results and histology suggest that there are numerous μCalcs < 15 μm in the caps, not visible at 6.7-μm resolution, and that our failure to find any nonruptured caps between 30 and 66 μm is a strong indication that many of these caps contained μCalcs.

Spectral CT of carotid atherosclerotic plaque: comparison with histology

OBJECTIVE

To distinguish components of vulnerable atherosclerotic plaque by imaging their energy response using spectral CT and comparing images with histology.

METHODS

After spectroscopic calibration using phantoms of plaque surrogates, excised human carotid atherosclerotic plaques were imaged using MARS CT using a photon-processing detector with a silicon sensor layer and microfocus X-ray tube (50 kVp, 0.5 mA) at 38-μm voxel size. The plaques were imaged, sectioned and re-imaged using four threshold energies: 10, 16, 22 and 28 keV; then sequentially stained with modified Von Kossa, Perl's Prussian blue and Oil-Red O, and photographed. Relative Hounsfield units across the energies were entered into a linear algebraic material decomposition model to identify the unknown plaque components.

RESULTS

Lipid, calcium, iron and water-like components of plaque have distinguishable energy responses to X-ray, visible on spectral CT images. CT images of the plaque surface correlated very well with histological photographs. Calcium deposits (>1,000 μm) in plaque are larger than iron deposits (<100 μm), but could not be distinguished from each other within the same voxel using the energy range available.

CONCLUSIONS

Spectral CT displays energy information in image form at high spatial resolution, enhancing the intrinsic contrast of lipid, calcium and iron within atheroma.

KEY POINTS

Spectral computed tomography offers new insights into tissue characterisation. Components of vulnerable atherosclerotic plaque are spectrally distinct with intrinsic contrast. Spectral CT of excised atherosclerotic plaques can display iron, calcium and lipid. Calcium deposits are larger than iron deposits in atheroma. Spectral CT may help in the non-invasive detection of vulnerable plaques.

Assessment of angiogenesis in osseointegration of a silica-collagen biomaterial using 3D-nano-CT

Bony integration of biomaterials is a complex process in which angiogenesis plays a crucial role. We evaluated micro- and nano-CT imaging to demonstrate and quantify neovascularization in bony integration of a biomaterial and to give an image based estimation for the needed resolution for imaging angiogenesis in an animal model of femora defect healing. In 8 rats 5mm full-size defects were created at the left femur that was filled with silica-collagen bone substitute material and internally fixed with plate osteosynthesis. After 6 weeks the femora were infused in situ with Microfil, harvested and scanned for micro-CT (9 μm)(3) and nano-CT (3 μm)(3) imaging. Using those 3D images, the newly formed blood vessels in the area of the biomaterial were assessed and the total vascular volume fraction, the volume of the bone substitute material and the volume of the bone defect were quantitatively characterized. Results were complemented by histology. Differences were statistically assessed using (ANOVA). High-resolution nano-CT demonstrated new blood vessel formation surrounding the biomaterial in all animals at capillary level. Immunohistochemistry confirmed the newly formed blood vessels surrounding the bone substitute material. The mean vascular volume fraction (VVF) around the implant was calculated to be 3.01 ± 0.4%. The VVF was inversely correlated with the volume of the bone substitute material (r=0.8) but not with the dimension of the fracture zone (r=0.3). Nano-CT imaging is feasible for quantitative analysis of angiogenesis during bony integration of biomaterials and a promising tool in this context for the future.

Synchrotron radiation X-ray fluorescence microscopy reveals a spatial association of copper on elastic laminae in rat aortic media

Copper, an essential trace metal in humans, plays an important role in elastic formation. However, little is known about the spatial association between copper, elastin, and elastin producing cells. The aorta is the largest artery; the aortic media is primarily composed of the elastic lamellae and vascular smooth muscle cells, which makes it a good model to address this issue. Synchrotron radiation X-ray fluorescence microscopy (SRXRF) is a new generation technique to investigate the spatial topography of trace metals in biological samples. Recently, we utilized this technique to determine the topography of copper as well as other trace elements in aortic media of Sprague Dawley rats. A standard rat diet was used to feed Sprague Dawley rats, which contains the normal dietary requirements of copper and zinc. Paraffin embedded segments (4 μm of thickness) of thoracic aorta were analyzed using a 10 keV incident monochromatic X-ray beam focusing on a spot size of 0.3 μm × 0.2 μm (horizontal × vertical). The X-ray spectrum was measured using an energy-dispersive silicon drift detector for elemental topography. Our results showed that phosphorus, sulfur, and zinc are predominately distributed in the vascular smooth muscle cells, whereas copper is dramatically accumulated in elastic laminae, indicating a preferential spatial association of copper on elastic laminae in aortic media. This finding sheds new light on the role of copper in elastic formation. Our studies also demonstrate that SRXRF allows for the visualization of trace elements in tissues and cells of rodent aorta with high spatial resolution and provides an opportunity to study the role of trace elements in vasculature.

Dual- and multi-energy CT: approach to functional imaging

The energy spectrum of X-ray photons after passage through an absorber contains information about its elemental composition. Thus, tissue characterisation becomes feasible provided that absorption characteristics can be measured or differentiated. Dual-energy CT uses two X-ray spectra enabling material differentiation by analysing material-dependent photo-electric and Compton effects. Elemental concentrations can thereby be determined using three-material decomposition algorithms. In comparison to dual-energy CT used in clinical practice, recently developed energy-sensitive photon-counting detectors sample the material-specific attenuation curves at multiple energy levels and within narrow energy bands; the latter allows the detection of element-specific, k-edge discontinuities of the photo-electric cross section. Multi-energy CT imaging therefore is able to concurrently identify multiple materials with increased accuracy. These specific data on material distribution provide information beyond morphological CT, and approach functional imaging. This article reviews the principles of dual- and multi-energy CT imaging, hardware approaches and clinical applications.

Flat-panel versus 64-channel computed tomography for in vivo quantitative characterization of aortic atherosclerotic plaques

BACKGROUND

Flat-panel computed tomography (FpCT) provides better spatial resolution than 64-channel CT (64-CT) and may improve in vivo quantitative assessment of atherosclerotic plaques.

METHODS AND RESULTS

Lesions in 184 aortic histology sections from 6 Watanabe heritable hyperlipidemic rabbits were quantitatively compared with 64-CT (image thickness, 0.625 mm) and FpCT (image thickness, 0.150 mm) images. Images were re-oriented perpendicular to the vessel centerline. For detecting plaque, FpCT and 64-CT were not significantly different (sensitivity, 76% vs 66%; P=NS). Although FpCT was significantly more sensitive (42% vs 0%; P=<0.001) for detecting eccentric lesions, the area under the curve (AUC) for FpCT (0.6) was not significantly different from that for 64-CT (0.45; P=NS). In detecting plaques with ≤ 10% lipid (low attenuation foci), FpCT was significantly more sensitive than 64-CT (24% vs 0.7%; P<0.00) and had a significantly greater AUC (0.6 vs 0.5; P<0.006). Additionally, FpCT was more sensitive (65% vs 0%; P<0.00) in detecting plaques with ≤ 5% calcium (high attenuation foci) but not in detecting branch points. Both FpCT and histology allowed us to detect low-attenuation foci as small as 0.3mm in diameter, whereas 64-CT allowed us to detect only low-attenuation foci ≥ 1.5mm in diameter.

CONCLUSIONS

Flat-panel CT seemed to have more potential for quantitatively screening low-risk small atherosclerotic lesions, whereas 64-CT was apparently more useful when imaging established, well-characterized lesions, particularly when measuring the vascular wall thickness in a rabbit model of atherosclerosis.

Dual-source dual-energy CT with additional tin filtration: Dose and image quality evaluation in phantoms and in vivo

OBJECTIVE

The objective of this study was to investigate the effect on radiation dose and image quality of the use of additional spectral filtration for dual-energy CT using dual-source CT (DSCT).

MATERIALS AND METHODS

A commercial DSCT scanner was modified by adding tin filtration to the high-kV tube, and radiation output and noise were measured in water phantoms. Dose values for equivalent image noise were compared between the dual-energy mode with and without tin filtration and the single-energy mode. To evaluate dual-energy CT material discrimination, the material-specific dual-energy ratio for calcium and that for iodine were determined using images of anthropomorphic phantoms. Data were additionally acquired from imaging a 38-kg pig and an 87-kg pig, and the noise of the linearly mixed images and virtual noncontrast images was compared between dual-energy modes. Finally, abdominal dual-energy CT images of two patients of similar sizes undergoing clinically indicated CT were compared.

RESULTS

Adding tin filtration to the high-kV tube improved the dual-energy contrast between iodine and calcium as much as 290%. Data from our animal study showed that tin filtration had no effect on noise in the dual-energy CT mixed images but decreased noise by as much as 30% in the virtual noncontrast images. Virtual noncontrast images of patients acquired using 100 and 140 kV with added tin filtration had improved image quality relative to those generated using 80 and 140 kV without tin filtration.

CONCLUSION

Tin filtration of the high-kV tube of a DSCT scanner increases the ability of dual-energy CT to discriminate between calcium and iodine without increasing dose relative to single-energy CT. Furthermore, the use of 100- and 140-kV tube potentials allows improved dual-energy CT imaging of large patients.

Microcalcifications in atherosclerotic lesion of apolipoprotein E-deficient mouse

Evidence is accumulating that calcium-rich microdeposits in the vascular wall might play a crucial role in the onset and progression of atherosclerosis. Here we investigated an atherosclerotic lesion of the carotid artery in an established murine model, i.e. the apolipoprotein E-deficient (APOE(-/-) ) mouse to identify (i) the presence of microcalcifications, if any, (ii) the elemental composition of microcalcifications with special reference to calcium/phosphorus mass ratio and (iii) co-localization of increased concentrations of iron and zinc with microcalcifications. Atherosclerosis was induced by a flow-divider placed around the carotid artery resulting in low and high shear-stress regions. Element composition was assessed with a proton microprobe. Microcalcifications, predominantly present in the thickened intima of the low shear-stress region, were surrounded by areas with normal calcium levels, indicating that calcium-precipitation is a local event. The diameter of intimal microcalcifications varied from 6 to 70 μm. Calcium/phosphorus ratios of microcalcifications varied from 0.3 to 4.8, mainly corresponding to the ratio of amorphous calcium-phosphate. Increased iron and zinc concentrations commonly co-localized with microcalcifications. Our findings indicate that the atherosclerotic process in the murine carotid artery is associated with locally accumulated calcium, iron and zinc. The calcium-rich deposits resemble amorphous calcium phosphate rather than pure hydroxyapatite. We propose that the APOE(-/-) mouse, in which atherosclerosis was evoked by a flow-divider, offers a useful model to investigate the pathophysiological significance of accumulation of elements such as calcium, iron and zinc.

Quantitative CT imaging of the spatio-temporal distribution patterns of vasa vasorum in aortas of apoE-/-/LDL-/- double knockout mice

OBJECTIVE

To investigate the distribution of vasa vasorum (VV) relative to advanced atherosclerotic lesions (calcified, fibrotic or hemorrhaged) along the aortic wall of apoE-/-/LDL-/- mice at the age of 25 and 80 weeks using high-resolution nano-CT.

METHODS

Aortas from male apoE-/-/LDL-/- mice at the age of 25 weeks (n=4) and 80 weeks (n=7) were infused in situ with contrast agent and harvested for scanning with nano-CT. The spatial distribution of vasa vasorum [number and area/cross-section (mm2)] was compared to aortic luminal cross-sectional area and plaque cross-sectional area in the ascending aorta, aortic arch and descending aorta. Results were complemented with co-localized histology.

RESULTS

The number and total luminal cross-sectional area of VV showed a significant decrease in the ascending aorta and aortic arch from 25 to 80 weeks but not in the descending aorta. The number and cross-sectional area of VV showed significant local differences depending on whether it was near a fibrotic, and hemorrhaged or calcified plaque in animals at the age of 80 weeks. Area of VV progressively increased along the aorta from least in the ascending aorta<aortic arch<descending aorta in animals at the age of 80 weeks and is inverse in animals aged 25 weeks.

CONCLUSION

Atherosclerotic lesion type is correlated to the number and cross-sectional area of VV in different aortic segments in apoE-/-/LDL-/- mice. The chronological development of VV along the aorta proceeds distally from the ascending aorta and aortic arch.

Small-animal molecular imaging methods

The ability to trace or identify specific molecules within a specific anatomic location provides insight into metabolic pathways, tissue components, and tracing of solute transport mechanisms. With the increasing use of small animals for research, such imaging must have sufficiently high spatial resolution to allow anatomic localization as well as sufficient specificity and sensitivity to provide an accurate description of the molecular distribution and concentration.

METHODS

Imaging methods based on electromagnetic radiation, such as PET, SPECT, MRI, and CT, are increasingly applicable because of recent advances in novel scanner hardware and image reconstruction software and the availability of novel molecules that have enhanced sensitivity in these methodologies.

RESULTS

Small-animal PET has been advanced by the development of detector arrays that provide higher resolution and positron-emitting elements that allow new molecular tracers to be labeled. Micro-MRI has been improved in terms of spatial resolution and sensitivity through increased magnet field strength and the development of special-purpose coils and associated scan protocols. Of particular interest is the associated ability to image local mechanical function and solute transport processes, which can be directly related to the molecular information. This ability is further strengthened by the synergistic integration of PET with MRI. Micro-SPECT has been improved through the use of coded aperture imaging approaches as well as image reconstruction algorithms that can better deal with the photon-limited scan data. The limited spatial resolution can be partially overcome by integrating SPECT with CT. Micro-CT by itself provides exquisite spatial resolution of anatomy, but recent developments in high-spatial-resolution photon counting and spectrally sensitive imaging arrays, combined with x-ray optical devices, hold promise for actual molecular identification by virtue of the chemical bond lengths of molecules, especially biopolymers.

CONCLUSION

Given the increasing use of small animals for evaluating new clinical imaging techniques and providing more insight into pathophysiologic phenomena as well as the availability of improved detection systems, scanning protocols, and associated software, the sensitivity and specificity of molecular imaging are increasing.

Spectroscopic (multi-energy) CT distinguishes iodine and barium contrast material in MICE

OBJECTIVE

Spectral CT differs from dual-energy CT by using a conventional X-ray tube and a photon-counting detector. We wished to produce 3D spectroscopic images of mice that distinguished calcium, iodine and barium.

METHODS

We developed a desktop spectral CT, dubbed MARS, based around the Medipix2 photon-counting energy-discriminating detector. The single conventional X-ray tube operated at constant voltage (75 kVp) and constant current (150 microA). We anaesthetised with ketamine six black mice (C57BL/6). We introduced iodinated contrast material and barium sulphate into the vascular system, alimentary tract and respiratory tract as we euthanised them. The mice were preserved in resin and imaged at four detector energy levels from 12 keV to 42 keV to include the K-edges of iodine (33.0 keV) and barium (37.4 keV). Principal component analysis was applied to reconstructed images to identify components with independent energy response, then displayed in 2D and 3D.

RESULTS

Iodinated and barium contrast material was spectrally distinct from soft tissue and bone in all six mice. Calcium, iodine and barium were displayed as separate channels on 3D colour images at <55 microm isotropic voxels.

CONCLUSION

Spectral CT distinguishes contrast agents with K-edges only 4 keV apart. Multi-contrast imaging and molecular CT are potential future applications.

Soft tissue discrimination ex vivo by dual energy computed tomography

PURPOSE

Dual Energy Computed Tomography (DECT) may provide additional information about the chemical composition of tissues compared to examination with a single X-ray energy. The aim of this in vitro study was to test whether combining two energies may significantly improve the detection of soft tissue components commonly present in arterial plaques.

METHODS

Tissue samples of myocardial and psoas muscle, venous and arterial thrombus as well as fat from different locations were scanned using a SOMATOM Definition Dual Source CT system (Siemens AG, Medical Solutions, Forchheim, Germany) with simultaneous tube voltages of 140 and 80 kV. The attenuation (Hounsfield units, HU) at 80 and 140 kV was measured in representative regions of interest, and the association between measured HU values and tissue types was tested with logistic regression.

RESULTS

The combination of two energy levels (80 and 140 kV) significantly improved (p<0.001) the ability to correctly classify venous thrombus vs arterial thrombus, myocardium or psoas; arterial thrombus vs myocardium or psoas; myocardium vs psoas; as well as the differentiation between fat tissue from various locations. Single energy alone was sufficient for distinguishing fat from other tissues.

CONCLUSION

DECT offers significantly improved in vitro differentiation between soft tissues occurring in plaques. If this corresponds to better tissue discrimination in vivo needs to be clarified in future studies.

Segmental heterogeneity of vasa vasorum neovascularization in human coronary atherosclerosis

OBJECTIVES

Our aim was to investigate the role of coronary vasa vasorum (VV) neovascularization in the progression and complications of human coronary atherosclerotic plaques.

BACKGROUND

Accumulating evidence supports an important role of VV neovascularization in atherogenesis and lesion location determination in coronary artery disease. VV neovascularization can lead to intraplaque hemorrhage, which has been identified as a promoter of plaque progression and complications like plaque rupture. We hypothesized that distinctive patterns of VV neovascularization and associated plaque complications can be found in different stages of human coronary atherosclerosis.

METHODS

Hearts from 15 patients (age 52+/-5 years, mean+/-SEM) were obtained at autopsy, perfused with Microfil (Flow Tech, Inc., Carver, Massachusetts), and subsequently scanned with micro-computed tomography (CT). The 2-cm segments (n=50) were histologically classified as either normal (n=12), nonstenotic plaque (<50% stenosis, n=18), calcified (n=10) or noncalcified (n=10) stenotic plaque. Micro-CT images were analyzed for VV density (number/mm2), VV vascular area fraction (mm2/mm2), and VV endothelial surface fraction (mm2/mm3). Histological sections were stained for Mallory's (iron), von Kossa (calcium), and glycophorin-A (erythrocyte fragments) as well as endothelial nitric oxide synthase, vascular endothelial growth factor, and tumor necrosis factor-alpha.

RESULTS

VV density was higher in segments with nonstenotic and noncalcified stenotic plaques as compared with normal segments (3.36+/-0.45, 3.72+/-1.03 vs. 1.16+/-0.21, p<0.01). In calcified stenotic plaques, VV spatial density was lowest (0.95+/-0.21, p<0.05 vs. nonstenotic and noncalcified stenotic plaque). The amount of iron and glycophorin A was significantly higher in nonstenotic and stenotic plaques as compared with normal segments, and correlated with VV density (Kendall-Tau correlation coefficient 0.65 and 0.58, respectively, p<0.01). Moreover, relatively high amounts of iron and glycophorin A were found in calcified plaques. Further immunohistochemical characterization of VV revealed positive staining for endothelial nitric oxide synthase and tumor necrosis factor-alpha but not vascular endothelial growth factor.

CONCLUSIONS

Our results support a possible role of VV neovascularization, VV rupture, and intraplaque hemorrhage in the progression and complications of human coronary atherosclerosis.

Vascular metallomics: copper in the vasculature

Owing to recent progress in analytical techniques, metallomics are evolving from detecting distinct trace metals in a defined state to monitor the dynamic changes in the abundance and location of trace metals in vitro and in vivo. Vascular metallomics is an emerging field that studies the role of trace metals in vasculature. This review will introduce common metallomics techniques including atomic absorption spectrometry, inductively coupled plasma-atomic emission spectrometry, inductively coupled plasma-mass spectrometry and X-ray fluorescence spectrometry with a summary table to compare these techniques. Moreover, we will summarize recent research findings that have applied these techniques to human population studies in cardiovascular diseases, with a particular emphasis on the role of copper in these diseases. In order to address the issue of interdisciplinary studies between metallomics and vascular biology, we will review the progress of efforts to understand the role of copper in neovascularization. This recent advance in the metallomics field may be a powerful tool to elucidate the signaling pathways and specific biological functions of these trace metals. Finally, we summarize the evidence to support the notion that copper is a dynamic signaling molecule. As a future direction, vascular metallomics studies may lead to the identification of targets for diagnosis and therapy in cardiovascular disease.

Role of computed tomography voxel size in detection and discrimination of calcium and iron deposits in atherosclerotic human coronary artery specimens

OBJECTIVE

This study evaluated the influence of voxel size on its ability to discriminate calcium from iron deposits in ex vivo coronary arteries.

METHODS

Postmortem human coronary arteries underwent multislice computed tomographic scan at (600-microm) voxel size to provide an index of computed tomography (CT) image noise and synchrotron-based micro-CT at (4-microm) voxel size to provide data for generating a range of voxel sizes 4 to (600-microm) after grayscale noise was added to the projection images before reconstruction so as to mimic the effect of retaining the same radiation exposure involved in the multislice computed tomographic scan.

RESULTS

At voxel sizes of (20-microm) or smaller, iron deposits could be identified based on CT grayscale value. Voxels of (100-microm) or larger cannot resolve nor distinguish iron deposits from calcifications by virtue of CT grayscale value.

CONCLUSIONS

Clinical CT scanners cannot be expected to discriminate iron deposits from calcifications by their CT value alone in the arterial wall.

Relationship between coronary endothelial function and coronary calcification in early atherosclerosis

BACKGROUND

The relationship between coronary endothelial function and coronary calcification is not well established.

METHODS

Forty-six patients 17 men [37%]; age, 47.4+/-11.4 years prospectively underwent testing for coronary endothelial function and measurement of coronary artery calcification (CAC).

RESULTS

Log CAC scores were not significantly different between patients with normal (n=31) and abnormal (n=15) response of epicardial coronary artery diameter to acetylcholine (%CAD(Ach)) (median (25, 75 percentile) 1.1 (0.0, 3.7) vs. 0.3 (0.0, 2.4), P=.32) and with normal (n=28) and abnormal (n=18) response of coronary blood flow to acetylcholine (%CBF(Ach)) (0.5 (0.0, 3.6) vs. 0.5 (0.0, 3.2), P=.76). Log CAC scores did not correlate with %CAD(Ach) (r=0.08, P=.59), %CBF(Ach) (r=0.14, P=.35).

CONCLUSIONS

In patients without significant coronary artery disease, coronary endothelial dysfunction showed no apparent association with coronary calcification. Our findings suggest that these 2 markers may represent separate, independent processes in the progression of coronary atherosclerosis.

Improved dual-energy material discrimination for dual-source CT by means of additional spectral filtration

The use of additional spectral filtration for dual-energy (DE) imaging using a dual-source CT (DSCT) system was investigated and its effect on the material-specific DE(ratio) was evaluated for several clinically relevant materials. The x-ray spectra, data acquisition, and reconstruction processes for a DSCT system (Siemens Definition) were simulated using information provided by the system manufacturer, resulting in virtual DE images. The factory-installed filtration for the 80 kV spectrum was left unchanged to avoid any further reductions in tube output, and only the filtration for the high-energy spectrum was modified. Only practical single-element filter materials within the atomic number range of 40 < or = Z < or = 83 were evaluated, with the aim of maximizing the separation between the two spectra, while maintaining similar noise levels for high- and low-energy images acquired at the same tube current. The differences between mean energies and the ratio of the 140 and 80 kV detector signals, each integrated below 80 keV, were evaluated. The simulations were performed for three attenuation scenarios: Head, body, and large body. The large body scenario was evaluated for the DE acquisition mode using the 100 and 140 kV spectra. The DE(ratio) for calcium hydroxyapatite (simulating bone or calcifications), iodine, and iron were determined for CT images simulated using the modified and factory-installed filtration. Several filter materials were found to perform well at proper thicknesses, with tin being a good practical choice. When image noise was matched between the low- and high-energy images, the spectral difference in mean absorbed energy using tin was increased from 25.7 to 42.7 keV (head), from 28.6 to 44.1 keV (body), and from 20.2 to 30.2 keV (large body). The overlap of the signal spectra for energies below 80 keV was reduced from 78% to 31% (head), from 93% to 27% (body), and from 106% to 79% (large body). The DE(ratio) for the body attenuation scenario increased from 1.45 to 1.91 (calcium), from 1.84 to 3.39 (iodine), and from 1.73 to 2.93 (iron) with the additional tin filtration compared to the factory filtration. This use of additional filtration for one of the x-ray tubes used in dual-source DECT dramatically increased the difference between material-specific DE ratios, e.g., from 0.39 to 1.48 for calcium and iodine or from 0.28 to 1.02 for calcium and iron. Because the ability to discriminate between different materials in DE imaging depends primarily on the differences in DE ratios, this increase is expected to improve the performance of any material-specific DECT imaging task. Furthermore, for the large patient size and in conjunction with a 100/140 kV acquisition, the use of additional filtration decreased noise in the low-energy images and increased contrast in the DE image relative to that obtained with 80/140 kV and no additional filtration.

Quantitative assessment of arterial stiffness by multiphase analysis in retrospectively electrocardiogram-gated multidetector row computed tomography: comparison between patients under chronic hemodialysis and age-matched controls

PURPOSE

To determine the feasibility of assessment of arterial stiffness with multiphase analysis of data sets of retrospectively electrocardiogram (ECG)-gated multidetector row computed tomography (MDCT) coronary angiography by comparing wall stiffness of the descending aorta between patients under chronic hemodialysis and age-matched controls undergoing imaging for by-pass graft.

MATERIALS AND METHODS

We retrospectively assessed 33 patients composed of 10 hemodialysis patients and 23 age-matched control subjects, who underwent MDCT to evaluate the coronary arterial lesions and pulse wave velocity (PWV) measurement. Scan data were reconstructed at 25 phases between 0% and 96% of the R-R intervals with an increment of 4%. Pixel-based measurements of arterial dimensions were performed at 1 cross-section of the descending aorta in a transaxial plane including the aortic valve at its widest. Aortic distensibility (AD) was calculated as follows: AD = (maximal dimension -- minimal dimension)/minimal dimension x pulse pressure. Comparison in the AD was performed between the hemodialysis patients and control subjects. Correlation between the AD and PWV were assessed separately in the patients under hemodialysis and age-matched controls.

RESULTS

AD was significantly smaller in patients under hemodialysis than in age-matched controls. The square of PWV correlated better with the inverse of the AD in the control subjects compared to patients on hemodialysis.

CONCLUSION

Multiphase analysis in ECG-gated MDCT enables us to assess stiffness of the descending aorta objectively and noninvasively.

The dynamic vasa vasorum

The function of vasa vasorum is both to deliver nutrients and oxygen to arterial and venous walls and to remove "waste" products, either produced by cells in the wall or introduced by diffusional transport through the endothelium of the artery or vein. Although the relationship between changes in vasa vasorum characteristics and the development of atheromatous plaques is well documented, the role of vasa vasorum, especially in terms of their appearance and disappearance in disease processes such as atherosclerosis, are still not clearly understood in terms of their being causative or merely reactive. However, even if their proliferation is merely reactive, these new microvessels may be a source of disease progression by virtue of endothelial impairment and as a pathway for monocytic cells to migrate to sites of early disease. As both these features are aspects of the vasa vasorum function, this Review focuses on the following issues: 1) acute modulation of vasa vasorum patency due to surrounding compressive forces within vessel wall and due to variable tone in the smooth muscle within proximal vasa vasorum and 2) chronic angiogenic responses due to local cytokine accumulations such as occur in the wall of arteries in the presence of hypertension, hypercholesterolemia, accumulation of lipids, extravasated blood products (e.g., red blood cells, macrophages, inflammatory products) which attract monocytes, and response of vasa vasorum to pharmacological stimuli.