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Magnus L, Schwein A, Chinnadurai P, Fontaine K, Autry K, Shah DJ, Grande-Allen KJ, Chakfé N, Bismuth J. Experimental multiparametric magnetic resonance imaging characterization of iliocaval venous thrombosis pathological changes. J Vasc Surg Venous Lymphat Disord 2024; 12:101895. [PMID: 38679142 DOI: 10.1016/j.jvsv.2024.101895] [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: 12/19/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Iliocaval thrombotic obstruction is a challenging condition, especially because thrombus age and corresponding pathological remodeling at presentation are unknown, which directly impacts management. Our aim was to assess the ability of magnetic resonance imaging (MRI) in determining age thresholds of experimentally created inferior vena cava (IVC) thrombosis in pigs. METHODS We used a previously described swine model of IVC thrombosis. The animals underwent MRI at baseline, immediately after thrombosis creation, and after a follow-up period extending from 2 to 28 days. Thirteen pigs were divided into three groups according to disease chronicity: acute group (AG; n = 5), subacute group (SAG; n = 4), and chronic group (CG; n = 4), with a mean thrombosis age of 6.4 ± 2.5 days, 15.7 ± 2.8 days, and 28 ± 5.7 days, respectively. A T1-weighted volumetric interpolated breath-hold examination sequence was used to anatomically delineate IVC thrombus as a region of interest. Three other MRI sequences were used to assess the thrombus signal. RESULTS The Kruskal-Wallis test showed a statistically significant difference in T1 relaxation times after contrast injection (P = .026) between the three groups of chronicity. The AG (360.2 ± 102.5 ms) was significantly different from the CG (336.7 ± 55.2 ms; P = .003), and the SAG (354.1 ± 89.7 ms) was significantly different from the AG (P = .027). There was a statistically significant difference in native T2 relaxation times (P = .038) between the three groups. The AG (160 ± 86.7 ms) was significantly different from the SAG (142.3 ± 55.4 ms; P = .027), and the SAG was significantly different from the CG (178.4 ± 11.7 ms; P = .004). CONCLUSIONS This study highlighted MRI characteristics in a swine model that might have the potential to significantly differentiate subacute and chronic stages from an acute stage of deep vein thrombosis in humans. Further clinical studies in humans are warranted. CLINICAL RELEVANCE In addition to providing a better understanding of venous thrombosis remodeling over time, magnetic resonance imaging has the potential to be a tool that could allow us to characterize the composition of venous thrombus over an interval, allowing for a refined analysis of the local evolution of venous thrombosis. We propose a noninvasive and innovative method to characterize different thresholds of chronicity with magnetic resonance imaging features of central deep vein thrombosis of the inferior vena cava experimentally obtained using a totally endovascular in vivo swine model, mimicking human pathophysiology. Being able to determine these features noninvasively is critical for vascular specialists when it comes to choosing between fibrinolytic therapy, percutaneous thrombectomy, or surgical management.
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Affiliation(s)
- Louis Magnus
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Adeline Schwein
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Heart and Vascular Research Institute, Harry Perkins Medical Research Institute, Perth, Western Australia, Australia
| | | | - Killian Fontaine
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Kyle Autry
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
| | | | - Nabil Chakfé
- Department of Vascular Surgery, Kidney Transplantation and Innovation, University Hospital of Strasbourg, Strasbourg, France; GEPROMED, Strasbourg, France
| | - Jean Bismuth
- Division of Vascular Surgery, USF Health Morsani School of Medicine, Tampa, FL
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An Intermodal Correlation Study among Imaging, Histology, Procedural and Clinical Parameters in Cerebral Thrombi Retrieved from Anterior Circulation Ischemic Stroke Patients. J Clin Med 2022; 11:jcm11195976. [PMID: 36233842 PMCID: PMC9572771 DOI: 10.3390/jcm11195976] [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: 08/25/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
The precise characterization of cerebral thrombi prior to an interventional procedure can ease the procedure and increase its success. This study investigates how well cerebral thrombi can be characterized by computed tomography (CT), magnetic resonance (MR) and histology, and how parameters obtained by these methods correlate with each other as well as with the interventional procedure and clinical parameters. Cerebral thrombi of 25 patients diagnosed by CT with acute ischemic stroke were acquired by mechanical thrombectomy and, subsequently, scanned by a high spatial-resolution 3D MRI including T1-weighted imaging, apparent diffusion coefficient (ADC), T2 mapping and then finally analyzed by histology. Parameter pairs with Pearson correlation coefficient more than 0.5 were further considered by explaining a possible cause for the correlation and its impact on the difficulty of the interventional procedure and the treatment outcome. Significant correlations were found between the variability of ADC and the duration of the mechanical recanalization, the deviation in average Hounsfield units (HU) and the number of passes with the thrombectomy device, length of the thrombus, its RBC content and many others. This study also demonstrates the clinical potentials of high spatial resolution multiparametric MRI in characterization of thrombi and its use for interventional procedure planning.
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Wu G, Liu L, Wang T, Pan C. T1 mapping is useful for staging deep venous thrombosis in the lower extremities. Acta Radiol 2022; 63:489-496. [PMID: 33910379 DOI: 10.1177/02841851211004425] [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: 11/16/2022]
Abstract
BACKGROUND The discrimination of acute and chronic deep venous thrombosis (DVT) is of great importance. Quantitative imaging is an urgent requirement in reflecting intrinsic characteristics of thrombosis. PURPOSE To investigate the feasibility of T1 mapping in staging DVT in the lower extremities. MATERIAL AND METHODS A total of 57 patients with DVT in the lower extremities (26 men, 31 women; mean age = 53.3 years) underwent T1-weighted imaging and T1 mapping for obtaining T1 signal intensity (SI) and T1 time of thrombus. The relative SI (rSI) of DVT was obtained by calculating the ratio of thrombus SI to muscle SI. The Mann-Whitney U test was used to compare rSI and T1 time of DVT between acute group (patients with limb edema ≤ 2 weeks) and chronic group (patients with limb edema > 2 weeks). A receiver operator characteristic (ROC) curve was constructed for further evaluation. RESULTS DVT rSI was significantly higher in the acute group versus the chronic group (2.8 ± 1.2 vs. 1.4 ± 0.6; P<0.05). DVT T1 time was significantly lower in the acute group versus the chronic group (819.4 ± 223.7 ms vs. 1264.8 ± 270.7 ms; P<0.05). The area under the curve (AUC) was 0.93 for T1 time and 0.75 for rSI. When using 1015 ms as the cut-off, the sensitivity and specificity of T1 time were 91% (32/35) and 86% (19/22), respectively. CONCLUSION T1 mapping is a potential technique in discriminating acute from chronic DVT in the lower extremities and warrants further investigation.
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Affiliation(s)
- Gang Wu
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Liangjin Liu
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Ting Wang
- Department of Ultrasound, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Chu Pan
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
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Izquierdo-Garcia D, Désogère P, Philip AL, Mekkaoui C, Weiner RB, Catalano OA, Chen YCI, Yeh DD, Mansour M, Catana C, Caravan P, Sosnovik DE. Detection and Characterization of Thrombosis in Humans Using Fibrin-Targeted Positron Emission Tomography and Magnetic Resonance. JACC Cardiovasc Imaging 2022; 15:504-515. [PMID: 34656469 PMCID: PMC8917974 DOI: 10.1016/j.jcmg.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The authors present a novel technique to detect and characterize LAA thrombus in humans using combined positron emission tomography (PET)/cardiac magnetic resonance (CMR) of a fibrin-binding radiotracer, [64Cu]FBP8. BACKGROUND The detection of thrombus in the left atrial appendage (LAA) is vital in the prevention of stroke and is currently performed using transesophageal echocardiography (TEE). METHODS The metabolism and pharmacokinetics of [64Cu]FBP8 were studied in 8 healthy volunteers. Patients with atrial fibrillation and recent TEEs of the LAA (positive n = 12, negative n = 12) were injected with [64Cu]FBP8 and imaged with PET/CMR, including mapping the longitudinal magnetic relaxation time (T1) in the LAA. RESULTS [64Cu]FBP8 was stable to metabolism and was rapidly eliminated. The maximum standardized uptake value (SUVMax) in the LAA was significantly higher in the TEE-positive than TEE-negative subjects (median of 4.0 [interquartile range (IQR): 3.0-6.0] vs 2.3 [IQR: 2.1-2.5]; P < 0.001), with an area under the receiver-operating characteristic curve of 0.97. An SUVMax threshold of 2.6 provided a sensitivity of 100% and specificity of 84%. The minimum T1 (T1Min) in the LAA was 970 ms (IQR: 780-1,080 ms) vs 1,380 ms (IQR: 1,120-1,620 ms) (TEE positive vs TEE negative; P < 0.05), with some overlap between the groups. Logistic regression using SUVMax and T1Min allowed all TEE-positive and TEE-negative subjects to be classified with 100% accuracy. CONCLUSIONS PET/CMR of [64Cu]FBP8 is able to detect acute as well as older platelet-poor thrombi with excellent accuracy. Furthermore, the integrated PET/CMR approach provides useful information on the biological properties of thrombus such as fibrin and methemoglobin content. (Imaging of LAA Thrombosis; NCT03830320).
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Affiliation(s)
- David Izquierdo-Garcia
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA; Harvard-MIT Department of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
| | - Pauline Désogère
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA,Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital
| | - Anne L. Philip
- Cardiovascular Research Center, Cardiology Division, Dept. of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Choukri Mekkaoui
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Rory B. Weiner
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Onofrio A. Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Yin-Ching Iris Chen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Doreen DeFaria Yeh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Moussa Mansour
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA,Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA,Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital
| | - David E. Sosnovik
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA,Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital,Cardiovascular Research Center, Cardiology Division, Dept. of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA,Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Recent Trends in Fascinating Applications of Nanotechnology in Allied Health Sciences. CRYSTALS 2021. [DOI: 10.3390/cryst12010039] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The increased advancement in nanosciences in recent times has led to fascinating innovations. It has potential applications for altering the structural, surface, and physicochemical properties of nano-ranged metamaterials. The adaptable optical, structural, and surface characteristics of the nanoscopic regimes enhance the quality of integrated nanodevices and sensors. These are further used in optoelectronics, biomedicines, and catalysis. The use of nanomaterials for constructing nano-biosensors and various other organic and inorganic functional nanomaterials is quite promising. They have excellent electronic and surface-to-volume reactivity. Their various applications include metal and metal-oxides-based nanoparticles, clusters, wires, and 2D nanosheets as carbon nanotubes. More recently, hybrid nanomaterials are being developed to regulate sensing functionalities in the field of nanomedicine and the pharmaceutical industry. They are used as nano-markers, templates, and targeted agents. Moreover, the mechanical strength, chemical stability, durability, and flexibility of the hybrid nanomaterials make them appropriate for developing a healthy life for humans. This consists of a variety of applications, such as drug delivery, antimicrobial impacts, nutrition, orthopedics, dentistry, and fluorescence fabrics. This review article caters to the essential importance of nanoscience for biomedical applications and information for health science and research. The fundamental characteristics and functionalities of nanomaterials for particular biomedical uses are specifically addressed here.
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Kim SE, Parker DL, Roberts JA, Treiman GS, Alexander M, Baradaran H, de Havenon A, McNally JS. Differentiation of symptomatic and asymptomatic carotid intraplaque hemorrhage using 3D high-resolution diffusion-weighted stack of stars imaging. NMR IN BIOMEDICINE 2021; 34:e4582. [PMID: 34296793 DOI: 10.1002/nbm.4582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Ischemic events related to carotid disease are far more strongly associated with plaque instability than stenosis. 3D high-resolution diffusion-weighted (DW) imaging can provide quantitative diffusion measurements on carotid atherosclerosis and may improve detection of vulnerable intraplaque hemorrhage (IPH). The 3D DW-stack of stars (SOS) sequence was implemented with 3D SOS acquisition combined with DW preparation. After simulation of signals created from 3D DW-SOS, phantom studies were performed. Three healthy subjects and 20 patients with carotid disease were recruited. Apparent diffusion coefficient (ADC) values were statistically analyzed on three subgroups by using a two-group comparison Wilcoxon-Mann-Whitney U test with p values less than 0.05: symptomatic versus asymptomatic; IPH-positive versus IPH-negative; and IPH-positive symptomatic versus asymptomatic plaques to determine the relationship with plaque vulnerability. ADC values calculated by 3D DW-SOS provided values similar to those calculated from other techniques. Mean ADC of symptomatic plaque was significantly lower than asymptomatic plaque (0.68 ± 0.18 vs. 0.98 ± 0.16 x 10-3 mm2 /s, p < 0.001). ADC was also significantly lower in IPH-positive versus IPH-negative plaque (0.68 ± 0.13 vs. 1.04 ± 0.11 x 10-3 mm2 /s, p < 0.001). Additionally, ADC was significantly lower in symptomatic versus asymptomatic IPH-positive plaque (0.57 ± 0.09 vs. 0.75 ± 0.11 x 10-3 mm2 /s, p < 0.001). Our results provide strong evidence that ADC measurements from 3D DW-SOS correlate with the symptomatic status of extracranial internal carotid artery plaque. Further, ADC improved discrimination of symptomatic plaque in IPH. These data suggest that diffusion characteristics may improve detection of destabilized plaque leading to elevated stroke risk.
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Affiliation(s)
- Seong-Eun Kim
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - John A Roberts
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Gerald S Treiman
- Department of Veterans Affairs, VASLCHCS, Salt Lake City, Utah, USA
| | - Matthew Alexander
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Hediyeh Baradaran
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - J Scott McNally
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
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Shi WY, Xue HL, Chen L, Gu JP. Non-enhanced multimodal magnetic resonance imaging in assessment of iliac vein obstruction with or without thrombosis. Abdom Radiol (NY) 2021; 46:4432-4439. [PMID: 33866382 DOI: 10.1007/s00261-021-03079-8] [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: 12/21/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of a contrast-free multimodal magnetic resonance (MR) protocol (including M2DIPEAR, THRIVE, BTFE-SPAIR, and FLAIR sequences) in the detection of iliac vein obstruction with or without thrombosis. MATERIALS AND METHODS From May 1st, 2015, to May 1st, 2016, a total of 73 patients (aged 51.33 ± 4.21 years) who received both digital subtraction angiography (DSA) and the multimodal MR imaging were included. The protocol of the multimodal MR included M2DIPEAR and BTFE-SPAIR for presenting iliac vein obstruction, and THRIVE and FLAIR for revealing the co-existed thrombosis. Three observers who were blinded to clinical and DSA results independently analyzed all multimodal MR datasets. Per-patient evaluations on presence or absence of iliac vein obstruction were performed to calculate the diagnostic performance of MR imaging (DSA regarded as gold reference) in terms of overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Capability to display the co-existing venous thrombus was also evaluated per-MR sequence using a 3-point scale system. RESULTS Iliac vein obstruction was depicted with DSA in 64 patients. In per-patient evaluation, the multimodal MR imaging yielded accuracy of 95.9% (70/73), sensitivity of 96.9% (62/64), specificity of 88.9% (8/9), positive predictive value of 98.4% (62/63), and negative predictive value of 80% (8/10), respectively. In the multimodal MR sequences, balanced turbo field echo-spectral attenuated inversion recovery (BTFE-SPAIR) sequence was superior to other sequences in depicting the iliac vein configuration, but fluid attenuated inversion recovery (FLAIR) and T1 high-resolution isovolumetric examination (THRIVE) seemed superior in detecting co-existing venous thrombosis. CONCLUSIONS M2DIPEAR and BTFE-SPAIR sequence can reveal iliac vein obstruction while THRIVE and FLAIR can detect the co-existed thrombosis. The proposed multimodal MR protocol can accurately depict the iliac vein obstruction and accurately detect the co-existing venous thrombosis comparable with that of DSA.
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Affiliation(s)
- Wan-Yin Shi
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Hefei, 230022, China.
| | - Hai-Lin Xue
- Department of Medical Imaging, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing, 210006, China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing, 210006, China
| | - Jian-Ping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing, 210006, China
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Alkarithi G, Duval C, Shi Y, Macrae FL, Ariëns RAS. Thrombus Structural Composition in Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2021; 41:2370-2383. [PMID: 34261330 PMCID: PMC8384252 DOI: 10.1161/atvbaha.120.315754] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thrombosis is a major complication of cardiovascular disease, leading to myocardial infarction, acute ischemic stroke, or venous thromboembolism. Thrombosis occurs when a thrombus forms inside blood vessels disrupting blood flow. Developments in thrombectomy to remove thrombi from vessels have provided new opportunities to study thrombus composition which may help to understand mechanisms of disease and underpin improvements in treatments. We aimed to review thrombus compositions, roles of components in thrombus formation and stability, and methods to investigate thrombi. Also, we summarize studies on thrombus structure obtained from cardiovascular patients and animal models. Thrombi are composed of fibrin, red blood cells, platelets, leukocytes, and neutrophil extracellular traps. These components have been analyzed by several techniques, including scanning electron microscopy, laser scanning confocal microscopy, histochemistry, and immunohistochemistry; however, each technique has advantages and limitations. Thrombi are heterogenous in composition, but overall, thrombi obtained from myocardial infarction are composed of mainly fibrin and other components, including platelets, red blood cells, leukocytes, and cholesterol crystals. Thrombi from patients with acute ischemic stroke are characterized by red blood cell- and platelet-rich regions. Thrombi from patients with venous thromboembolism contain mainly red blood cells and fibrin with some platelets and leukocytes. Thrombus composition from patients with myocardial infarction is influenced by ischemic time. Animal thrombosis models are crucial to gain further mechanistic information about thrombosis and thrombus structure, with thrombi being similar in composition compared with those from patients. Further studies on thrombus composition and function are key to improve treatment and clinical outcome of thrombosis.
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Affiliation(s)
- Ghadir Alkarithi
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.).,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia (G.A.)
| | - Cédric Duval
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Yu Shi
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Fraser L Macrae
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
| | - Robert A S Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (G.A., C.D., Y.S., F.L.M., R.A.S.A.)
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Giannitto C, Mercante G, Spriano G, Natoli R, Gaino F, Lofino L, Esposito AA, Giannitto N, Vatteroni G, Fiamengo B, Vidiri A, Politi LS, Balzarini L. CT and MRI Findings of Head and Neck Masson’s Tumor: A Rare Case Report and Systematic Review of the Literature. REPORTS IN MEDICAL IMAGING 2021. [DOI: 10.2147/rmi.s292961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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10
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Hajhosseiny R, Prieto C, Qi H, Phinikaridou A, Botnar RM. Thrombosis and Embolism. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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López K, Neji R, Bustin A, Rashid I, Hajhosseiny R, Malik SJ, Teixeira RPAG, Razavi R, Prieto C, Roujol S, Botnar RM. Quantitative magnetization transfer imaging for non-contrast enhanced detection of myocardial fibrosis. Magn Reson Med 2020; 85:2069-2083. [PMID: 33201524 DOI: 10.1002/mrm.28577] [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: 02/06/2020] [Revised: 09/10/2020] [Accepted: 10/09/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE To develop a novel gadolinium-free model-based quantitative magnetization transfer (qMT) technique to assess macromolecular changes associated with myocardial fibrosis. METHODS The proposed sequence consists of a two-dimensional breath-held dual shot interleaved acquisition of five MT-weighted (MTw) spoiled gradient echo images, with variable MT flip angles (FAs) and off-resonance frequencies. A two-pool exchange model and dictionary matching were used to quantify the pool size ratio (PSR) and bound pool T2 relaxation ( T 2 B ). The signal model was developed and validated using 25 MTw images on a bovine serum albumin (BSA) phantom and in vivo human thigh muscle. A protocol with five MTw images was optimized for single breath-hold cardiac qMT imaging. The proposed sequence was tested in 10 healthy subjects and 5 patients with myocardial fibrosis and compared to late gadolinium enhancement (LGE). RESULTS PSR values in the BSA phantom were within the confidence interval of previously reported values (concentration 10% BSA = 5.9 ± 0.1%, 15% BSA = 9.4 ± 0.2%). PSR and T 2 B in thigh muscle were also in agreement with literature (PSR = 10.9 ± 0.3%, T 2 B = 6.4 ± 0.4 us). In 10 healthy subjects, global left ventricular PSR was 4.30 ± 0.65%. In patients, PSR was reduced in areas associated with LGE (remote: 4.68 ± 0.70% vs. fibrotic: 3.12 ± 0.78 %, n = 5, P < .002). CONCLUSION In vivo model-based qMT mapping of the heart was performed for the first time, with promising results for non-contrast enhanced assessment of myocardial fibrosis.
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Affiliation(s)
- Karina López
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,MR Research Collaboration, Siemens Healthcare Limited, Frimley, UK
| | - Aurelien Bustin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Imran Rashid
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shaihan J Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rui Pedro A G Teixeira
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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López K, Neji R, Mukherjee RK, Whitaker J, Phinikaridou A, Razavi R, Prieto C, Roujol S, Botnar R. Contrast-free high-resolution 3D magnetization transfer imaging for simultaneous myocardial scar and cardiac vein visualization. MAGMA (NEW YORK, N.Y.) 2020; 33:627-640. [PMID: 32078075 PMCID: PMC7502043 DOI: 10.1007/s10334-020-00833-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop a three-dimensional (3D) high-resolution free-breathing magnetization transfer ratio (MTR) sequence for contrast-free assessment of myocardial infarct and coronary vein anatomy. MATERIALS AND METHODS Two datasets with and without off-resonance magnetization transfer preparation were sequentially acquired to compute MTR. 2D image navigators enabled beat-to-beat translational and bin-to-bin non-rigid motion correction. Two different imaging sequences were explored. MTR scar localization was compared against 3D late gadolinium enhancement (LGE) in a porcine model of myocardial infarction. MTR variability across the left ventricle and vessel sharpness in the coronary veins were evaluated in healthy human subjects. RESULTS A decrease in MTR was observed in areas with LGE in all pigs (non-infarct: 25.1 ± 1.7% vs infarct: 16.8 ± 1.9%). The average infarct volume overlap on MTR and LGE was 62.5 ± 19.2%. In humans, mean MTR in myocardium was between 37 and 40%. Spatial variability was between 15 and 20% of the mean value. 3D whole heart MT-prepared datasets enabled coronary vein visualization with up to 8% improved vessel sharpness for non-rigid compared to translational motion correction. DISCUSSION MTR and LGE showed agreement in infarct detection and localization in a swine model. Free-breathing 3D MTR maps are feasible in humans but high spatial variability was observed. Further clinical studies are warranted.
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Affiliation(s)
- Karina López
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK.
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Rahul K Mukherjee
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
| | - Alkystis Phinikaridou
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
| | - René Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 3rd Floor Lambeth Wing, London, SE1 7EH, UK
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13
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Gi T, Kuroiwa Y, Yamashita A, Mizutani Y, Asanuma T, Miyati T, Maekawa K, Aman M, Imamura T, Asada Y. High Signal Intensity on Diffusion-Weighted Images Reflects Acute Phase of Deep Vein Thrombus. Thromb Haemost 2020; 120:1463-1473. [PMID: 32746467 PMCID: PMC7511261 DOI: 10.1055/s-0040-1714280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The effects of antithrombotic therapy on deep vein thrombosis (DVT) can be affected by thrombus age, which cannot be reliably determined by noninvasive imaging modalities. We investigated whether magnetic resonance (MR) diffusion-weighted imaging (DWI) can localize and determine the age of venous thrombus in patients with DVT, animal models, and human blood in vitro. Signal intensity (SI) on DWI and the apparent diffusion coefficient (ADC) of thrombi were assessed in eight patients with DVT using a 1.5-T MR imaging (MRI) system. We assessed the organizing processes as venous thrombus developed in the rabbit jugular vein using a 3.0-T MRI system over time. We also assessed MRI signals of human blood in vitro using the 1.5-T MRI system. Venous thrombi were detected by DWI as areas of high or mixed high and iso SI in all patients. The ADCs were lower in the proximal, than in the distal portion of the thrombi. The thrombi of rabbit jugular veins histologically organized in a time-dependent manner, with high SI on DWI at 4 hours, mixed high and iso SI at 1 and 2 weeks, and iso SI at 3 weeks. The ADC correlated negatively with erythrocyte content, and positively with smooth muscle cells, macrophages, hemosiderin, and collagen content. MRI signals of human blood in vitro showed that ADCs were affected by erythrocyte content, but not by blood clotting. MR-DWI can detect venous thrombus, and high SI on DWI accompanied by a low ADC might reflect erythrocyte-rich, acute-phase thrombi.
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Affiliation(s)
- Toshihiro Gi
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasuyoshi Kuroiwa
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.,Department of Radiological Technology, Koga General Hospital, Miyazaki, Japan
| | - Atsushi Yamashita
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuko Mizutani
- Division of Radiology, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Taketoshi Asanuma
- Development of Veterinary Medicine, Faculty of Veterinary Medicine, Imabari Campus, Okayama University of Science, Imabari, Japan
| | - Tosiaki Miyati
- Institute of Medical, Pharmaceutical and Health Sciences, Faculty of Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Kazunari Maekawa
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Murasaki Aman
- Department of Diagnostic Pathology, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takuroh Imamura
- Department of Internal Medicine, Koga General Hospital, Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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14
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Kao CC, Chen CW, Tseng YH, Tsai YH, Wang SC, Huang YK. Non-contrast-enhanced magnetic resonance imaging: Objective figures in differentiation between acute and chronic deep venous thrombosis in the lower extremities. Phlebology 2020; 35:777-783. [PMID: 32635819 DOI: 10.1177/0268355520939375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Deep vein thrombosis is a severe health problem. Treatment options may differ between acute and chronic deep vein thrombosis. Thus, distinguishing acute from chronic deep vein thrombosis is essential for patients with deep vein thrombosis.Triggered angiography non-contrast enhanced is an innovative magnetic resonance imaging protocol that may provide objective evidence in differentiating acute from chronic deep vein thrombosis. METHOD We prospectively collected information on consecutive patients who had been evaluated through triggered angiography non-contrast enhanced magnetic resonance imaging for venous pathology in their lower extremities at a vascular wound care center in a tertiary hospital between April 2017 and January 2020. Patients included were divided into two groups with the onset time cutoff point of 21 days. All were undergone non-contrast-enhanced magnetic resonance imaging evaluation. Non-contrast-enhanced magnetic resonance imaging images were evaluated by a radiologist, and lower extremity venous thrombosis, collateral-vein development, and subcutaneous honeycombing were emphasized. Cohen's kappa coefficient was used to measure interrater agreement between the development of collateral veins, subcutaneous honeycombing, and symptom onset over 21 days. RESULTS Interrater agreement analysis revealed that the development of collateral veins was substantially correlated with the onset of symptoms over 21 days (Table 1). Additionally, the development of subcutaneous honeycombing detected through triggered angiography non-contrast enhanced magnetic resonance imaging also substantially agreed with the onset of symptoms over 21 days (Table 2). CONCLUSION The diagnostic power of triggered angiography non-contrast enhanced magnetic resonance imaging in deep vein thrombosis is rival to current gold standard, color Doppler sonography. Triggered angiography non-contrast enhanced magnetic resonance imaging provides objective information on onset timing in patients with deep vein thrombosis that could differentiate acute from chronic deep vein thrombosis and provides guidance for treatment planning.
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Affiliation(s)
- Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan.,Institute of Medicine, Chung Shan Medical University, Taichung
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
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15
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Mallon D, Dixon L, Campion T, Dawe G, Bhatia K, Kachramanoglou C, Kirmi O. Beyond the brain: Extra-axial pathology on diffusion weighted imaging in neuroimaging. J Neurol Sci 2020; 415:116900. [PMID: 32464349 DOI: 10.1016/j.jns.2020.116900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 01/10/2023]
Abstract
Diffusion-weighted imaging (DWI) has a central role in the assessment of the brain parenchyma, particularly in the context of acute stroke. However, the applications of DWI extend far beyond the brain parenchyma and include the assessment of the extra-axial structures of the head and neck that are included in routine brain imaging. In this pictorial review, the added-value of DWI over other conventional sequences is illustrated through discussion of a broad range of disorders affecting the vasculature, skull, orbits, nasal cavity and salivary glands. This article highlights the requirement for all structures, both intra- and extra-axial, to be carefully reviewed on DWI.
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Affiliation(s)
- Dermot Mallon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Luke Dixon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Tom Campion
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Gemma Dawe
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Kunwar Bhatia
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Carolina Kachramanoglou
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Olga Kirmi
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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16
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Zhuang G, Tang C, He X, Liang J, He Z, Ye Y, Deng W, Liu D, Chen H. DANTE-SPACE: a new technical tool for DVT on 1.5T MRI. Int J Cardiovasc Imaging 2019; 35:2231-2237. [PMID: 31446527 PMCID: PMC6856036 DOI: 10.1007/s10554-019-01675-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 07/22/2019] [Indexed: 11/26/2022]
Abstract
The aim of the study was to compare CE-MRV with DANTE-SPACE on a 1.5T MRI system for the diagnosis of DVT. The patients were diagnosed with deep venous thrombosis of the lower extremities based on swelling, pain, and superficial varicose veins of the lower extremities. MRI examination confirmed the diagnosis. DANTE-SPACE images were obtained before the conventional contrast-enhanced MRV, which uses gadolinium. The scanning field started from the end of the inferior vena cava to the end of the ankle, divided into five observation segments, namely, the common iliac vein, external iliac vein, femoral vein, popliteal vein, and calf vein. The DANTE-SPACE and CE-MRV results were used for a consistency analysis. For the DANTE-SPACE and CE-MRV images, the signal intensity ratios of the thrombus/cavity and thrombus/muscle were calculated, and the ratio difference was compared using the paired t test. Twenty-six patients completed the examination; one of the patients underwent a right lower limb amputation, yielding a total of 255 lower limb vascular segments. The analysis of the DANTE-SPACE images showed that there were 14 iliac vein thromboses, 18 external iliac vein thromboses, 23 femoral vein thrombi, 21 popliteal vein thromboses, and 18 calf vein thromboses; these findings were consistent with the diagnostic results of CE-MRV. The ratio of the thrombus/cavity signal intensity measured in the DANTE-SPACE and CE-MRV images were as follows: 20.51 ± 12.96 vs. 0.51 ± 0.46; P < 0.05, n = 51; the difference was statistically significant. The ratio of the thrombus/muscle signal intensity measured on the DANTE-SPACE and CE-MRV images were as follows: 1.74 ± 0.57 vs. 0.99 ± 0.53; P < 0.05, n = 51; the difference was statistically significant. Compared with CE-MRV, DANTE-SPACE showed no significant difference in the ability to detect deep venous thrombosis of the lower extremities. DANTE-SPACE did not use contrast-enhancing agents and showed no evidence of inflammatory enhancement, and the display effect of small diameter veins was slightly poor. However, deep venous thrombosis of the lower extremities presents different levels of high signal in the DANTE-SPACE images, making it easy to identify and diagnose. It can also indicate the different components and age of the thrombus and help with the selection of a more accurate clinical treatment plan. MRI DANTE-SPACE is the preferred imaging modality for patients with deep venous thrombosis who are unable or unwilling to use gadolinium contrast agents.
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Affiliation(s)
- Gaoming Zhuang
- The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
| | - Caiyun Tang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
| | - Xueping He
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
| | - Jianke Liang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
| | - Zhuonan He
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
| | - Yufeng Ye
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
| | - Wei Deng
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China
| | - Dexiang Liu
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China.
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China.
| | - Hanwei Chen
- The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China.
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, 511400, Guangdong, China.
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17
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Wu G, Morelli J, Xiong Y, Liu X, Li X. Diffusion weighted cardiovascular magnetic resonance imaging for discriminating acute from non-acute deep venous Thrombus. J Cardiovasc Magn Reson 2019; 21:37. [PMID: 31286985 PMCID: PMC6615231 DOI: 10.1186/s12968-019-0552-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The importance of discriminating acute from non-acute thrombus is highlighted. The study aims to investigate the feasibility of readout-segmented diffusion weighted (DW) cardiovascular magnetic resonance (CMR) for discrimination of acute from non-acute deep venous thrombus (DVT). METHODS For this prospective study from December 2015 to December 2017, 85 participants (mean age = 53 years, age range = 34~74) with DVT of lower extremities underwent readout-segmented DW CMR. DVT of ≤14 days were defined as acute (n = 55) and > 14 days as non-acute (n = 30). DVT visualization on b = 0, b = 800, and apparent diffusion coefficient (ADC) images were assessed using a 4-point scale (0~3, poor~excellent). DW CMR parameters were measured using region of interest (ROI). Relative signal intensity (rSI) and ADC were compared between acute and non-acute DVT using a Mann Whitney test. Sensitivity and specificity for ADC and rSI were calculated. RESULTS ADC maps had higher visualization scores than b = 0 and b = 800 images (2.7 ± 0.5, 2.5 ± 0.6, and 2.4 ± 0.6 respectively, P<0.05). The mean ADC was higher in acute DVT than non-acute DVT (0.56 ± 0.17 × 10- 3 vs. 0.22 ± 0.12 × 10- 3 mm2/s, P<0.001). Using 0.32 × 10- 3 mm2/s as the cutoff, sensitivity and specificity for ADC to discriminate acute from non-acute DVT were 93 and 90% respectively. Sensitivity and specificity were 73 and 60% for rSI on b = 0, and 75 and 63% for rSI on b = 800. CONCLUSIONS Readout segmented diffusion-weighted CMR derived ADC distinguishes acute from non-acute DVT. TRIAL REGISTRATION This study is retrospectively registered. TRIAL REGISTRATION NUMBER HUST-TJH-2015-146 .
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Affiliation(s)
- Gang Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
| | - John Morelli
- Department of Radiology, St. John’s Medical Center, Tulsa, OK USA
| | - Yan Xiong
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Xuanlin Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
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18
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Janot K, Oliveira TR, Fromont-Hankard G, Annan M, Filipiak I, Barantin L, Guibon R, Duffy S, Gilvarry M, Cottier JP, Narata AP. Quantitative estimation of thrombus-erythrocytes using MRI. A phantom study with clot analogs and analysis by statistic regression models. J Neurointerv Surg 2019; 12:181-185. [PMID: 31273071 DOI: 10.1136/neurintsurg-2019-014950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thrombus composition has the potential to affect acute ischemic stroke (AIS) treatment. OBJECTIVE To evaluate in an in vitro test the correlation of clot composition, especially erythrocytes (red blood cells (RBCs)), with the variation of signal intensity ratio (SIR) obtained with MRI sequences used for AIS, and qualification of the susceptibility vessel sign effect using clot analogs. MATERIALS AND METHODS Nine ovine clots were fixed in a gelatin-manganese solution and studied by MRI (T2GE, T2-weighted gradient echo; SWI, susceptibility-weighted imaging; FLAIR, fluid attenuated inversion recovery). RBC concentration was estimated using regression models (SLR, single linear regression; MLR, multiple linear regression; RF, random Forest; and ANN, artificial neural networking), which combined the SIR-histology relationship of three MRI sequences. RESULTS Negative correlation was found between SIR and RBC concentration. T2GE SWI could not statistically distinguish clots with RBC content >54% and <23%. SLR was applied only to FLAIR images since T2GE and SWI demonstrated signal saturation. All four regression models showed a correlation between MRI and histology: SLR=0.981; MLR=0.986; RF=0.994, and ANN=0.971. One unknown clot was studied and agreement between SIR and histological analyses was found in all models. CONCLUSIONS We presented a method to quantify RBC concentration in clot analogs, combining SWI, T2GE, and FLAIR. This in vitro study has some limitations, so clot collection after thrombectomy with simultaneous imaging analysis is necessary to validate this model.
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Affiliation(s)
- Kevin Janot
- Neuroradiology, Regional University Hospital Centre Tours, Tours, France
| | - Tiago Ribeiro Oliveira
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of the ABC, Sao Bernardo do Campo, Brazil
| | | | - Mariam Annan
- Neurology, Regional University Hospital Centre Tours, Tours, France
| | - Isabelle Filipiak
- Inserm U1253 'Imaging and Brain: iBrain'', Regional University Hospital Centre Tours, Tours, France
| | - Laurent Barantin
- Inserm U1253 'Imaging and Brain: iBrain'', Regional University Hospital Centre Tours, Tours, France
| | - Roseline Guibon
- Pathology, Regional University Hospital Centre Tours, Tours, France
| | - Sharon Duffy
- Cerenovus, Galway Neuro Technology Centre, Galway, Ireland
| | | | | | - Ana Paula Narata
- Neuroradiology, Regional University Hospital Centre Tours, Tours, France
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19
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Lanza GM, Cui G, Schmieder AH, Zhang H, Allen JS, Scott MJ, Williams T, Yang X. An unmet clinical need: The history of thrombus imaging. J Nucl Cardiol 2019; 26:986-997. [PMID: 28608182 PMCID: PMC5741521 DOI: 10.1007/s12350-017-0942-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/24/2017] [Indexed: 11/24/2022]
Abstract
Robust thrombus imaging is an unresolved clinical unmet need dating back to the mid 1970s. While early molecular imaging approaches began with nuclear SPECT imaging, contrast agents for virtually all biomedical imaging modalities have been demonstrated in vivo with unique strengths and common weaknesses. Two primary molecular imaging targets have been pursued for thrombus imaging: platelets and fibrin. Some common issues noted over 40 years ago persist today. Acute thrombus is readily imaged with all probes and modalities, but aged thrombus remains a challenge. Similarly, anti-coagulation continues to interfere with and often negate thrombus imaging efficacy, but heparin is clinically required in patients suspected of pulmonary embolism, deep venous thrombosis or coronary ruptured plaque prior to confirmatory diagnostic studies have been executed and interpreted. These fundamental issues can be overcome, but an innovative departure from the prior approaches will be needed.
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Affiliation(s)
- Gregory M Lanza
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA.
| | - Grace Cui
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA
| | - Anne H Schmieder
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA
| | - Huiying Zhang
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA
| | - John S Allen
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA
| | - Michael J Scott
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA
| | - Todd Williams
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA
| | - Xiaoxia Yang
- Department of Medicine, Division of Cardiology, Washington University Medical School, St. Louis, MO, 63108, USA
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20
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Christiansen SD, Liu J, Boffa MB, Drangova M. Simultaneous R 2* and quantitative susceptibility mapping measurement enables differentiation of thrombus hematocrit and age: an in vitro study at 3 T. J Neurointerv Surg 2019; 11:1155-1161. [PMID: 31088940 DOI: 10.1136/neurintsurg-2019-014802] [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: 02/04/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The efficacy of acute ischemic stroke treatment is affected by thrombus composition and age, yet no diagnostic method capable of quantitative thrombus characterization currently exists. This in vitro study evaluates the use of R2* , quantitative susceptibility mapping (QSM), and proton density fat fraction (FF) maps derived from a single gradient echo (GRE) MRI acquisition for characterizing clot of various hematocrit, as well as added calcified and lipidic components, throughout aging. METHODS Two thrombus phantoms containing porcine clots (10-60% hematocrit, one with added calcium or lard) were scanned serially throughout 6 days of aging. Three-dimensional multi-echo GRE imaging was used to generate R2* , QSM, and FF maps, from which mean values for all clots at every time point were obtained. Receiver operating characteristic analysis was used to derive thresholds differentiating acute from chronic clot, and measured R2* and QSM were tested for their ability to estimate clot hematocrit. RESULTS R2* and QSM varied minimally over the first 6 hours of aging (acute), and QSM was found to linearly relate to clot hematocrit. Beyond 6 hours (chronic), R2* and QSM increased considerably over time and hematocrit could be estimated from the R2* /QSM ratio. R2* and QSM thresholds of 22 s-1 and 0.165 ppm differentiated acute from chronic clots with a sensitivity/specificity of 100%/100% and 85%/92%, respectively. QSM and FF maps definitively distinguished calcium and lipid, respectively, from clots of any hematocrit and age. CONCLUSIONS R2* , QSM, and FF from a single multi-echo GRE scan discriminated hematocrit and age, and distinguished calcification and lipid withinin vitro clot.
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Affiliation(s)
- Spencer D Christiansen
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Junmin Liu
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Michael B Boffa
- Department of Biochemistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Maria Drangova
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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Vargas Paris R, Skorpil M, Westerlund E, Lindholm P, Nyrén S. Diffusion-weighted imaging in acute pulmonary embolism: a feasibility study. Acta Radiol Open 2018; 7:2058460118783013. [PMID: 30013795 PMCID: PMC6039903 DOI: 10.1177/2058460118783013] [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: 02/13/2018] [Accepted: 05/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) can be an alternative method to computed tomography angiography (CTA) for pulmonary embolism. Purpose To evaluate the feasibility of diffusion-weighted imaging (DWI) detecting acute pulmonary embolism (PE) in free-breathing humans. Material and Methods Twenty patients with PE verified by CTA and 20 controls were investigated with MRI (1.5 Aera, Siemens Healthcare). All sequences were performed in the transversal plane using free-breathing without gating. The protocol consisted of a two-dimensional steady-state free precession (SSFP) and a single-shot DWI echo-planar imaging sequence with a voxel resolution of 2 × 2 × 5 mm. Three b values were used: 50, 400, and 800 s/mm2. Images were analyzed in two orders: an open source analysis (OSA); and a blinded only DWI analysis (BDA) simulating clinical work. Results OSA of corresponding images showed 370 findings on CTA (i.e. one elongated emboli could be represented in multiple images). SSFP identified 237 of those (64%). DWI with b values of 50, 400, and 800 identified 327 (88%), 245 (66%), and 138 (37%), respectively. In BDA we found 160 true emboli (according to CTA) on b50, 78 on b400, and 54 on b800. Fifty-two of these findings at the subsegmental level could be correlated to PE on CTA but were not visible on SSFP. Conclusions DWI has a high sensitivity for detecting PE but suffers from poor specificity. It could potentially be used as an eye catcher, i.e. where to look for PE in other MRI sequences.
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Affiliation(s)
- Roberto Vargas Paris
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Abdominal Radiology, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eli Westerlund
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Division of Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Thoracic Radiology, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Thoracic Radiology, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
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22
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Silickas J, Black SA, Phinikaridou A, Gwozdz AM, Smith A, Saha P. Use of Computed Tomography and Magnetic Resonance Imaging in Central Venous Disease. Methodist Debakey Cardiovasc J 2018; 14:188-195. [PMID: 30410648 DOI: 10.14797/mdcj-14-3-188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Successful management of acute deep vein thrombosis and post-thrombotic syndrome depends on careful patient selection and detailed investigation of thrombus extent, composition, and anatomy. This article reviews the use of computerized tomography and magnetic resonance imaging in the assessment of central deep veins of the pelvis and addresses new developments within the field. Despite drawbacks of each imaging modality, when contemplating deep venous reconstruction, cross-sectional imaging should be considered for preoperative planning and to compliment intraoperative imaging tools, including intravascular ultrasound and contrast venography.
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Affiliation(s)
- Justinas Silickas
- SCHOOL OF CARDIOVASCULAR MEDICINE AND SCIENCES, KING'S COLLEGE LONDON, LONDON, UK
| | - Stephen A Black
- SCHOOL OF CARDIOVASCULAR MEDICINE AND SCIENCES, KING'S COLLEGE LONDON, LONDON, UK.,GUY'S AND ST THOMAS' NHS FOUNDATION TRUST, ST THOMAS' HOSPITAL, LONDON, UK
| | | | - Adam M Gwozdz
- SCHOOL OF CARDIOVASCULAR MEDICINE AND SCIENCES, KING'S COLLEGE LONDON, LONDON, UK
| | - Alberto Smith
- SCHOOL OF CARDIOVASCULAR MEDICINE AND SCIENCES, KING'S COLLEGE LONDON, LONDON, UK
| | - Prakash Saha
- SCHOOL OF CARDIOVASCULAR MEDICINE AND SCIENCES, KING'S COLLEGE LONDON, LONDON, UK
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23
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Kuroiwa Y, Yamashita A, Imamura T, Asada Y. [7. Basic Research and Clinical Applications of Magnetic Resonance Imaging: Qualitative Assessment of Cardiovascular Diseases]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:599-605. [PMID: 29925755 DOI: 10.6009/jjrt.2018_jsrt_74.6.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Yasuyoshi Kuroiwa
- Department of Radiological Technology, Koga General Hospital
- Department of Pathology, Faculty of Medicine, University of Miyazaki
| | - Atsushi Yamashita
- Department of Pathology, Faculty of Medicine, University of Miyazaki
| | | | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, University of Miyazaki
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24
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In vivo characterization of the murine venous system before and during dobutamine stimulation: implications for preclinical models of venous disease. Ann Anat 2017; 214:43-52. [DOI: 10.1016/j.aanat.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/04/2017] [Accepted: 08/14/2017] [Indexed: 12/12/2022]
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25
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Germain P, El Ghannudi S, Labani A, Jeung MY, Gangi A, Ohlmann P, Roy C. A dual flip angle 3D bSSFP magnetization transfer-like method to differentiate between recent and old myocardial infarction. J Magn Reson Imaging 2017; 47:798-808. [PMID: 28727209 DOI: 10.1002/jmri.25821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/07/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) tissue signal is modulated by magnetization transfer (MT) phenomena, intrinsically induced by balanced steady-state free precession (bSSFP) imaging. PURPOSE To investigate the possible value of such a MT-like bSSFP approach in two clinical settings involving focal myocardial lesions highligthed by late gadolinium enhancement (LGE+): edema induced by recent myocardial infarction (MI) and fibrotic scar related to chronic infarction. MATERIALS AND METHODS Population: 48 LGE + patients were studied: 26 with recent MI, 22 with chronic MI. 20 LGE-normal subjects were considered the control group. Field strength/sequence: Navigator-based short axis 3D-bSSFP sequences with 20° and 90° excitation flip angles were acquired (1.5T). ASSESSMENT Pixel-wise normalized MT Ratio (nMTR) parametric images were calculated according to: nMTR = 100*(S20 -S90 *k)/S20 , with S20 and S90 signal intensity in 20° and 90° flip angle images and k = Blood20 /Blood90 as a normalization ratio. Statistical tests: analysis of variance (ANOVA), receiver operating characteristic (ROC) analysis. RESULTS Overall normal myocardial nMTR was 50.2 ± 3.6%. In recent MI, nMTR values were significantly reduced in LGE + regions (-22.3 ± 9.9%, P < 0.0001). In cases of chronic infarct, nMTR was significantly increased in LGE + regions (14.2 ± 11.4%, P < 0.0001). Comparison between observed results and theoretical values obtained with the Freeman-Hill formula showed that most variations observed in MI are related to MT effects instead of relaxation effects. CONCLUSION In contrast to LGE imaging, which may show a similar hyperenhancement in recent and old infarctions, nMTR imaging demonstrates an opposite pattern: decreased values for recent infarction and increased values for old infarction, thus allowing to discriminate between these two clinical conditions without gadolinium injection. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:798-808.
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Affiliation(s)
- Philippe Germain
- Department of Radiology, University Hospital, Strasbourg, France.,Department of Cardiology, University Hospital, Strasbourg, France
| | - Soraya El Ghannudi
- Department of Radiology, University Hospital, Strasbourg, France.,Department of Nuclear Medicine, University Hospital, Strasbourg, France
| | - Aissam Labani
- Department of Radiology, University Hospital, Strasbourg, France
| | - Mi Y Jeung
- Department of Radiology, University Hospital, Strasbourg, France
| | - Afshin Gangi
- Department of Radiology, University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Department of Cardiology, University Hospital, Strasbourg, France
| | - Catherine Roy
- Department of Radiology, University Hospital, Strasbourg, France
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26
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Benjamin P, Khan F, MacKinnon AD. The use of diffusion weighted imaging to evaluate pathology outside the brain parenchyma in neuroimaging studies. Br J Radiol 2017; 90:20160821. [PMID: 28195506 DOI: 10.1259/bjr.20160821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Diffusion-weighted imaging (DWI) has transformed the radiological assessment of a variety of cerebral pathologies, in particular acute stroke. In neuroimaging studies, DWI can also be used to evaluate pathology outside the brain parenchyma, although it is sometimes underutilized for this purpose. In this pictorial review, the principles of DWI are outlined, and 13 cases of abnormal diffusion outside the brain parenchyma are illustrated in order to show DWI as a useful sequence for the evaluation of the following recommended review areas: the dural venous sinuses, internal carotid arteries, meninges, ventricles, cavernous sinus and orbits, skull base and lymph nodes.
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Affiliation(s)
- Philip Benjamin
- 1 Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Faraan Khan
- 2 Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew D MacKinnon
- 2 Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
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27
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Karande GY, Hedgire SS, Sanchez Y, Baliyan V, Mishra V, Ganguli S, Prabhakar AM. Advanced imaging in acute and chronic deep vein thrombosis. Cardiovasc Diagn Ther 2016; 6:493-507. [PMID: 28123971 PMCID: PMC5220209 DOI: 10.21037/cdt.2016.12.06] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/28/2016] [Indexed: 11/06/2022]
Abstract
Deep venous thrombosis (DVT) affecting the extremities is a common clinical problem. Prompt imaging aids in rapid diagnosis and adequate treatment. While ultrasound (US) remains the workhorse of detection of extremity venous thrombosis, CT and MRI are commonly used as the problem-solving tools either to visualize the thrombosis in central veins like superior or inferior vena cava (IVC) or to test for the presence of complications like pulmonary embolism (PE). The cross-sectional modalities also offer improved visualization of venous collaterals. The purpose of this article is to review the established modalities used for characterization and diagnosis of DVT, and further explore promising innovations and recent advances in this field.
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Affiliation(s)
| | - Sandeep S. Hedgire
- Division of Cardiovascular Imaging, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Yadiel Sanchez
- Department of Radiology, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Vinit Baliyan
- Division of Abdominal Imaging and intervention, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Vishala Mishra
- Division of Abdominal Imaging and intervention, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Anand M. Prabhakar
- Division of Cardiovascular Imaging, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
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28
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Zhang YS, Davoudi F, Walch P, Manbachi A, Luo X, Dell'Erba V, Miri AK, Albadawi H, Arneri A, Li X, Wang X, Dokmeci MR, Khademhosseini A, Oklu R. Bioprinted thrombosis-on-a-chip. LAB ON A CHIP 2016; 16:4097-4105. [PMID: 27722710 PMCID: PMC5072176 DOI: 10.1039/c6lc00380j] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Pathologic thrombosis kills more people than cancer and trauma combined; it is associated with significant disability and morbidity, and represents a major healthcare burden. Despite advancements in medical therapies and imaging, there is often incomplete resolution of the thrombus. The residual thrombus can undergo fibrotic changes over time through infiltration of fibroblasts from the surrounding tissues and eventually transform into a permanent clot often associated with post-thrombotic syndrome. In order to understand the importance of cellular interactions and the impact of potential therapeutics to treat thrombosis, an in vitro platform using human cells and blood components would be beneficial. Towards achieving this aim, there have been studies utilizing the capabilities of microdevices to study the hemodynamics associated with thrombosis. In this work, we further exploited the utilization of 3D bioprinting technology, for the construction of a highly biomimetic thrombosis-on-a-chip model. The model consisted of microchannels coated with a layer of confluent human endothelium embedded in a gelatin methacryloyl (GelMA) hydrogel, where human whole blood was infused and induced to form thrombi. Continuous perfusion with tissue plasmin activator led to dissolution of non-fibrotic clots, revealing clinical relevance of the model. Further encapsulating fibroblasts in the GelMA matrix demonstrated the potential migration of these cells into the clot and subsequent deposition of collagen type I over time, facilitating fibrosis remodeling that resembled the in vivo scenario. Our study suggests that in vitro 3D bioprinted blood coagulation models can be used to study the pathology of fibrosis, and particularly, in thrombosis. This versatile platform may be conveniently extended to other vascularized fibrotic disease models.
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Affiliation(s)
- Yu Shrike Zhang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Farideh Davoudi
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Philipp Walch
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Institute of Pharmacy and Molecular Biotechnology, Heidelberg University, Im Neuenheimer Feld 364, D-69120, Germany
| | - Amir Manbachi
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xuan Luo
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Sorbonne Universités, Université de Technologie de Compiègne, UMR CNRS 7338, BMBI, Compiègne, France
| | - Valeria Dell'Erba
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Department of Biomedical Engineering, Politecnico di Torino, 10129 Torino, Italy
| | - Amir K Miri
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hassan Albadawi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Andrea Arneri
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xiaoyun Li
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and State Key Laboratory of Pulp and Paper Engineering, South China University of Technology, Guangzhou, 510640, PR China
| | - Xiaoying Wang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and State Key Laboratory of Pulp and Paper Engineering, South China University of Technology, Guangzhou, 510640, PR China
| | - Mehmet Remzi Dokmeci
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA and Department of Bioindustrial Technologies, College of Animal Bioscience and Technology, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea and Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
| | - Rahmi Oklu
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Division of Vascular & Interventional Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Kenkel D, Yamada Y, Weiger M, Jungraithmayr W, Wurnig MC, Boss A. Magnetization transfer as a potential tool for the early detection of acute graft rejection after lung transplantation in mice. J Magn Reson Imaging 2016; 44:1091-1098. [DOI: 10.1002/jmri.25266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/25/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- David Kenkel
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
| | - Yoshito Yamada
- Division of Thoracic Surgery; University Hospital Zurich; Switzerland
| | - Markus Weiger
- Institute for Biomedical Engineering, ETH Zurich and University of Zurich; Gloriastrasse 35 CH-8092 Zurich Switzerland
| | | | - Moritz C. Wurnig
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
| | - Andreas Boss
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
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30
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Saha P, Black S, Breen K, Patel A, Modarai B, Smith A. Contemporary management of acute and chronic deep venous thrombosis. Br Med Bull 2016; 117:107-20. [PMID: 26893407 DOI: 10.1093/bmb/ldw006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This review aims to provide an update on the management of deep vein thrombosis (DVT). SOURCES OF DATA A systematic search of PubMed, Google Scholar and Cochrane databases was carried out. AREAS OF AGREEMENT Direct oral anticoagulants (DOACs) are as effective and easier to use than vitamin K antagonists for the treatment of DVT. Catheter-directed thrombolysis can reduce post thrombotic syndrome in patients with iliofemoral DVT. Compression bandaging can help heal a venous ulcer. AREAS OF CONTROVERSY Compression hosiery to prevent post thrombotic syndrome. Long-term evidence to show clinical benefit of using endovenous therapies to restore deep vein patency. GROWING POINTS Developing imaging methods to identify patients who would benefit from venous thrombolysis. The evolution of dedicated venous stents. AREAS TIMELY FOR DEVELOPING RESEARCH Understanding the mechanisms that lead to stent occlusion and investigation into the appropriate treatments that could prevent in-stent thrombosis is required.
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Affiliation(s)
- Prakash Saha
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Stephen Black
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Karen Breen
- Department of Thrombosis and Haemostasis, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London SE1 7EH, UK
| | - Ashish Patel
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Bijan Modarai
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
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31
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Grover SP, Evans CE, Patel AS, Modarai B, Saha P, Smith A. Assessment of Venous Thrombosis in Animal Models. Arterioscler Thromb Vasc Biol 2015; 36:245-52. [PMID: 26681755 DOI: 10.1161/atvbaha.115.306255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/30/2015] [Indexed: 12/19/2022]
Abstract
Deep vein thrombosis and common complications, including pulmonary embolism and post-thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here, we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro-computed tomography, and high-frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition.
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Affiliation(s)
- Steven P Grover
- From the Cardiovascular Division, Academic Department of Vascular Surgery, Kings College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom
| | - Colin E Evans
- From the Cardiovascular Division, Academic Department of Vascular Surgery, Kings College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom
| | - Ashish S Patel
- From the Cardiovascular Division, Academic Department of Vascular Surgery, Kings College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom
| | - Bijan Modarai
- From the Cardiovascular Division, Academic Department of Vascular Surgery, Kings College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom
| | - Prakash Saha
- From the Cardiovascular Division, Academic Department of Vascular Surgery, Kings College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom.
| | - Alberto Smith
- From the Cardiovascular Division, Academic Department of Vascular Surgery, Kings College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom
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32
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Grover SP, Saha P, Jenkins J, Mukkavilli A, Lyons OT, Patel AS, Sunassee K, Modarai B, Smith A. Quantification of experimental venous thrombus resolution by longitudinal nanogold-enhanced micro-computed tomography. Thromb Res 2015; 136:1285-90. [PMID: 26489729 PMCID: PMC4697135 DOI: 10.1016/j.thromres.2015.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/23/2015] [Accepted: 10/04/2015] [Indexed: 01/10/2023]
Abstract
Introduction The assessment of thrombus size following treatments directed at preventing thrombosis or enhancing its resolution has generally relied on physical or histological methods. This cross-sectional design imposes the need for increased numbers of animals for experiments. Micro-computed tomography (microCT) has been used to detect the presence of venous thrombus in experimental models but has yet to be used in a quantitative manner. In this study, we investigate the use of contrast-enhanced microCT for the longitudinal assessment of experimental venous thrombus resolution. Materials and methods Thrombi induced by stenosis of the inferior vena cava in mice were imaged by contrast-enhanced microCT at 1, 7 and 14 days post-induction (n = 18). Thrombus volumes were determined longitudinally by segmentation and 3D volume reconstruction of microCT scans and by standard end-point histological analysis at day 14. An additional group of thrombi were analysed solely by histology at 1, 7 and 14 days post-induction (n = 15). Results IVC resident thrombus was readily detectable by contrast-enhanced microCT. MicroCT-derived measurements of thrombus volume correlated well with time-matched histological analyses (ICC = 0.75, P < 0.01). Thrombus volumes measured by microCT were significantly greater than those derived from histological analysis (P < 0.001). Intra- and inter-observer analyses were highly correlated (ICC = 0.99 and 0.91 respectively, P < 0.0001). Further histological analysis revealed noticeable levels of contrast agent extravasation into the thrombus that was associated with the presence of neovascular channels, macrophages and intracellular iron deposits. Conclusion Contrast-enhanced microCT represents a reliable and reproducible method for the longitudinal assessment of venous thrombus resolution providing powerful paired data. Contrast-enhanced microCT allows longitudinal measurements of experimental venous thrombi. Measurements of thrombus volume by microCT are highly reproducible. Aurovist nano-gold contrast accumulates in highly organised regions of the resolving thrombus.
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Affiliation(s)
- Steven P Grover
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK
| | - Prakash Saha
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK
| | - Julia Jenkins
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK
| | - Arun Mukkavilli
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK
| | - Oliver T Lyons
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK
| | - Ashish S Patel
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK
| | - Kavitha Sunassee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, UK
| | - Bijan Modarai
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St Thomas' Hospital, London, UK.
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Vidmar J, Serša I, Kralj E, Popovič P. Unsuccessful percutaneous mechanical thrombectomy in fibrin-rich high-risk pulmonary thromboembolism. Thromb J 2015; 13:30. [PMID: 26379477 PMCID: PMC4571107 DOI: 10.1186/s12959-015-0060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/09/2015] [Indexed: 12/02/2022] Open
Abstract
Background We report a case of unsuccessful percutaneous mechanical thrombectomy in treatment of a high-risk pulmonary embolism (PE). Pulmonary thromboemboli are commonly expected as a homogenous mass, rich with red blood cell content, which respond well to percutaneous mechanical thrombectomy (PMT). Catheter-based approach or surgical embolectomy are two treatment options that are usually considered for treatment of high-risk PE when the thrombolytic therapy fails or it is contraindicated due to a patient’s persisting hemodynamic compromise. Currently, selection criteria for PE treatment options are based mostly on the assessment of patient’s history. The aim of this report is to highlight a possible treatment complication in PMT of structurally heterogeneous thrombotic mass due to PMT inadequacy. Case presentation A 32 year-old male with polytrauma was admitted to an intensive care unit after a right-sided nephrectomy and evacuation of retroperitoneal hematoma. The patient initial haemostatic disorder was improved by administration of blood preparations, an anti-fibrinolytic agent and concentrates of fibrinogen. On the third day he presented sudden onset of hemodynamic instability and was incapable of standard CTA diagnostic procedure. Urgent and relevant investigations including transthoracic and transesophageal echocardiogram confirmed a high-risk PE. PMT was performed due to contraindications for systemic thrombolysis. Long-term PMT was attempted using aspiration with several devices. No major improvement was achieved in any of the treatments and the patient died. Autopsy confirmed a large heterogeneous thrombotic mass in the pulmonary trunk folding to the right main artery. Additional histological analysis revealed a high fibrin-rich content in the peripheral surroundings of the thrombus. Conclusion In the case, it was confirmed that the outcome of PMT was directly influenced by mechanical and histological features of the thromboembolus in high-risk PE. Formation of a rather complex thromboembolus in high-risk PE favors surgical embolectomy as the only life-saving treatment option. Current diagnostic imaging techniques do not enable precise assessment of thrombi structure and are therefore unable to identify patients who might benefit from PMT or open surgical embolectomy. Surgical backup treatment should be considered if there are no contraindications in the event of a failed catheter intervention.
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Affiliation(s)
- Jernej Vidmar
- Institute of Physiology, Medical Faculty, University of Ljubljana, Zaloska cesta 4, 1000 Ljubljana, Slovenia ; Jožef Stefan Institute, Ljubljana, Slovenia
| | - Igor Serša
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Eduard Kralj
- Institute of Forensic Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Popovič
- Institue of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Blasi F, Oliveira BL, Rietz TA, Rotile NJ, Naha PC, Cormode DP, Izquierdo-Garcia D, Catana C, Caravan P. Multisite Thrombus Imaging and Fibrin Content Estimation With a Single Whole-Body PET Scan in Rats. Arterioscler Thromb Vasc Biol 2015; 35:2114-21. [PMID: 26272938 DOI: 10.1161/atvbaha.115.306055] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/22/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Thrombosis is a leading cause of morbidity and mortality worldwide. Current diagnostic strategies rely on imaging modalities that are specific for distinct vascular territories, but a thrombus-specific whole-body imaging approach is still missing. Moreover, imaging techniques to assess thrombus composition are underdeveloped, although therapeutic strategies may benefit from such technology. Therefore, our goal was to test whether positron emission tomography (PET) with the fibrin-binding probe (64)Cu-FBP8 allows multisite thrombus detection and fibrin content estimation. APPROACH AND RESULTS Thrombosis was induced in Sprague-Dawley rats (n=32) by ferric chloride application on both carotid artery and femoral vein. (64)Cu-FBP8-PET/CT imaging was performed 1, 3, or 7 days after thrombosis to detect thrombus location and to evaluate age-dependent changes in target uptake. Ex vivo biodistribution, autoradiography, and histopathology were performed to validate imaging results. Arterial and venous thrombi were localized on fused PET/CT images with high accuracy (97.6%; 95% confidence interval, 92-100). A single whole-body PET/MR imaging session was sufficient to reveal the location of both arterial and venous thrombi after (64)Cu-FBP8 administration. PET imaging showed that probe uptake was greater in younger clots than in older ones for both arterial and venous thrombosis (P<0.0001). Quantitative histopathology revealed an age-dependent reduction of thrombus fibrin content (P<0.001), consistent with PET results. Biodistribution and autoradiography further confirmed the imaging findings. CONCLUSIONS We demonstrated that (64)Cu-FBP8-PET is a feasible approach for whole-body thrombus detection and that molecular imaging of fibrin can provide, noninvasively, insight into clot composition.
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Affiliation(s)
- Francesco Blasi
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - Bruno L Oliveira
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - Tyson A Rietz
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - Nicholas J Rotile
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - Pratap C Naha
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - David P Cormode
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - David Izquierdo-Garcia
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - Ciprian Catana
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.)
| | - Peter Caravan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown (F.B., B.L.O., T.A.R., N.J.R., D.I.-G., C.C., P.C.); Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (P.C.N., D.P.C.); and Institute for Innovation in Imaging, Massachusetts General Hospital, Boston (P.C.).
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35
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Magnetization transfer imaging to assess tumour response after chemoradiotherapy in rectal cancer. Eur Radiol 2015; 26:390-7. [PMID: 26065396 PMCID: PMC4712249 DOI: 10.1007/s00330-015-3856-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 05/10/2015] [Accepted: 05/20/2015] [Indexed: 01/28/2023]
Abstract
Purpose Single-slice magnetization transfer (MT) imaging has shown promising results for evaluating post-radiation fibrosis. The study aim was to evaluate the value of multislice MT imaging to assess tumour response after chemoradiotherapy by comparing magnetization transfer ratios (MTR) with histopathological tumour regression grade (TRG). Materials and Methods Thirty patients with locally advanced rectal cancer (cT3-4 and/or cN2) underwent routine restaging MRI 8 weeks post-chemoradiotherapy, including multislice MT-sequence, covering the entire tumour bed. Two independent readers delineated regions of interest on MTR maps, covering all potential remaining tumour and fibrotic areas. Mean MTR and histogram parameters (minimum, maximum, median, standard deviation, skewness, kurtosis, and 5-30-70-95th percentiles) were calculated. Reference standard was histological TRG1-2 (good response) and TRG3-5 (poor response). Results 24/30 patients were male; mean age was 67.7 ± 10.8 years. Mean MTR rendered AUCs of 0.65 (reader1) and 0.87 (reader2) to differentiate between TRG1-2 versus TRG3-5. Best results were obtained for 95th percentile (AUC 0.75- 0.88). Interobserver agreement was moderate (ICC 0.50) for mean MTR and good (ICC 0.80) for 95th percentile. Conclusions MT imaging is a promising tool to assess tumour response post-chemoradiotherapy in rectal cancer. Particularly, 95th percentile results in AUCs up to 0.88 to discriminate a good tumour response. Key Points • The mean MTR can differentiate between good and poor responders after chemoradiation. • In addition to measurement of the mean value, histogram analyses can be beneficial. • The histogram parameter 95thpercentile can reach AUCs of 0.75–0.88.
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Mani V, Alie N, Ramachandran S, Robson PM, Besa C, Piazza G, Mercuri M, Grosso M, Taouli B, Goldhaber SZ, Fayad ZA. A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis. J Vis Exp 2015:e52761. [PMID: 26065866 DOI: 10.3791/52761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We evaluated a magnetic resonance venography (MRV) approach with gadofosveset to quantify total thrombus volume changes as the principal criterion for treatment efficacy in a multicenter randomized study comparing edoxaban monotherapy with a heparin/warfarin regimen for acute, symptomatic lower extremities deep vein thrombosis (DVT) treatment. We also used a direct thrombus imaging approach (DTHI, without the use of a contrast agent) to quantify fresh thrombus. We then sought to evaluate the reproducibility of the analysis methodology and applicability of using 3D magnetic resonance venography and direct thrombus imaging for the quantification of DVT in a multicenter trial setting. From 10 randomly selected subjects participating in the edoxaban Thrombus Reduction Imaging Study (eTRIS), total thrombus volume in the entire lower extremity deep venous system was quantified bilaterally. Subjects were imaged using 3D-T1W gradient echo sequences before (direct thrombus imaging, DTHI) and 5 min after injection of 0.03 mmol/kg of gadofosveset trisodium (magnetic resonance venography, MRV). The margins of the DVT on corresponding axial, curved multi-planar reformatted images were manually delineated by two observers to obtain volumetric measurements of the venous thrombi. MRV was used to compute total DVT volume, whereas DTHI was used to compute volume of fresh thrombus. Intra-class correlation (ICC) and Bland Altman analysis were performed to compare inter and intra-observer variability of the analysis. The ICC for inter and intra-observer variability was excellent (0.99 and 0.98, p <0.001, respectively) with no bias on Bland-Altman analysis for MRV images. For DTHI images, the results were slightly lower (ICC = 0.88 and 0.95 respectively, p <0.001), with bias for inter-observer results on Bland-Altman plots. This study showed feasibility of thrombus volume estimation in DVT using MRV with gadofosveset trisodium, with good intra- and inter-observer reproducibility in a multicenter setting.
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Affiliation(s)
- Venkatesh Mani
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai;
| | - Nadia Alie
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | - Sarayu Ramachandran
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | - Philip M Robson
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | - Cecilia Besa
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | - Gregory Piazza
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School
| | | | | | - Bachir Taouli
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | - Samuel Z Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School
| | - Zahi A Fayad
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
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37
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Blasi F, Oliveira BL, Rietz TA, Rotile NJ, Day H, Naha PC, Cormode DP, Izquierdo-Garcia D, Catana C, Caravan P. Radiation Dosimetry of the Fibrin-Binding Probe ⁶⁴Cu-FBP8 and Its Feasibility for PET Imaging of Deep Vein Thrombosis and Pulmonary Embolism in Rats. J Nucl Med 2015; 56:1088-93. [PMID: 25977464 DOI: 10.2967/jnumed.115.157982] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/27/2015] [Indexed: 01/07/2023] Open
Abstract
UNLABELLED The diagnosis of deep venous thromboembolic disease is still challenging despite the progress of current thrombus imaging modalities and new diagnostic algorithms. We recently reported the high target uptake and thrombus imaging efficacy of the novel fibrin-specific PET probe (64)Cu-FBP8. Here, we tested the feasibility of (64)Cu-FBP8 PET to detect source thrombi and culprit emboli after deep vein thrombosis and pulmonary embolism (DVT-PE). To support clinical translation of (64)Cu-FBP8, we performed a human dosimetry estimation using time-dependent biodistribution in rats. METHODS Sprague-Dawley rats (n = 7) underwent ferric chloride application on the femoral vein to trigger thrombosis. Pulmonary embolism was induced 30 min or 2 d after DVT by intrajugular injection of a preformed blood clot labeled with (125)I-fibrinogen. PET imaging was performed to detect the clots, and SPECT was used to confirm in vivo the location of the pulmonary emboli. Ex vivo γ counting and histopathology were used to validate the imaging findings. Detailed biodistribution was performed in healthy rats (n = 30) at different time points after (64)Cu-FBP8 administration to estimate human radiation dosimetry. Longitudinal whole-body PET/MR imaging (n = 2) was performed after (64)Cu-FBP8 administration to further assess radioactivity clearance. RESULTS (64)Cu-FBP8 PET imaging detected the location of lung emboli and venous thrombi after DVT-PE, revealing significant differences in uptake between target and background tissues (P < 0.001). In vivo SPECT imaging and ex vivo γ counting confirmed the location of the lung emboli. PET quantification of the venous thrombi revealed that probe uptake was greater in younger clots than in older ones, a result confirmed by ex vivo analyses (P < 0.001). Histopathology revealed an age-dependent reduction of thrombus fibrin content (P = 0.006), further supporting the imaging findings. Biodistribution and whole-body PET/MR imaging showed a rapid, primarily renal, body clearance of (64)Cu-FBP8. The effective dose was 0.021 mSv/MBq for males and 0.027 mSv/MBq for females, supporting the feasibility of using (64)Cu-FBP8 in human trials. CONCLUSION We showed that (64)Cu-FBP8 PET is a feasible approach to image DVT-PE and that radiogenic adverse health effects should not limit the clinical translation of (64)Cu-FBP8.
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Affiliation(s)
- Francesco Blasi
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Bruno L Oliveira
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Tyson A Rietz
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Nicholas J Rotile
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Helen Day
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Pratap C Naha
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - David P Cormode
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - David Izquierdo-Garcia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Ciprian Catana
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Peter Caravan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts Institute for Innovation in Imaging, Massachusetts General Hospital, Boston, Massachusetts
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Lang KJ, Saha P, Roberts LN, Arya R. Changing paradigms in the management of deep vein thrombosis. Br J Haematol 2015; 170:162-74. [DOI: 10.1111/bjh.13431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn J. Lang
- King's Thrombosis Centre; King's College Hospital NHS Foundation Trust; London UK
| | - Prakash Saha
- Guy's Hospital; Guy's and St. Thomas’ NHS Foundation Trust; London UK
| | - Lara N. Roberts
- King's Thrombosis Centre; King's College Hospital NHS Foundation Trust; London UK
| | - Roopen Arya
- King's Thrombosis Centre; King's College Hospital NHS Foundation Trust; London UK
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Dharmarajah B, Sounderajah V, Rowland SP, Leen ELS, Davies AH. Aging techniques for deep vein thrombosis: a systematic review. Phlebology 2014; 30:77-84. [DOI: 10.1177/0268355514528691] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Deep vein thrombosis is common with an incidence of 1 in 1000. Acute thrombus removal for extensive proximal deep vein thrombosis using catheter-directed techniques highlights the need for accurate assessment of thrombus age. This systematic review summarises experimental and clinical evidence of imaging techniques for aging deep vein thrombosis. Ultrasound elastography and magnetic resonance imaging were highlighted as the most studied imaging modalities. Elastography was shown to distinguish between acute and chronic clots, despite demonstrating difficulty in accurate aging of clots older than 10 days in rat models. Elastography is noted as a feasible adjunct to current first-line imaging for deep vein thrombosis using duplex ultrasonography. Combinations of magnetic resonance imaging techniques can identify acute, sub-acute and chronic thrombi using endogenous contrast agents and provide objective standardisation of the diagnostic process, with reduced onus upon operator dependency. Further validation is required of these novel imaging techniques prior to clinical implementation for deep vein thrombosis aging.
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Affiliation(s)
- B Dharmarajah
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Experimental Medicine, Imperial College London, London, UK
| | - V Sounderajah
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - SP Rowland
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - ELS Leen
- Division of Experimental Medicine, Imperial College London, London, UK
| | - AH Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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40
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Saha P, Andia ME, Modarai B, Blume U, Humphries J, Patel AS, Phinikaridou A, Evans CE, Mattock K, Grover SP, Ahmad A, Lyons OT, Attia RQ, Renné T, Premaratne S, Wiethoff AJ, Botnar RM, Schaeffter T, Waltham M, Smith A. Magnetic resonance T1 relaxation time of venous thrombus is determined by iron processing and predicts susceptibility to lysis. Circulation 2013; 128:729-736. [PMID: 23820077 DOI: 10.1161/circulationaha.113.001371] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The magnetic resonance longitudinal relaxation time (T1) changes with thrombus age in humans. In this study, we investigate the possible mechanisms that give rise to the T1 signal in venous thrombi and whether changes in T1 relaxation time are informative of the susceptibility to lysis. METHODS AND RESULTS Venous thrombosis was induced in the vena cava of BALB/C mice, and temporal changes in T1 relaxation time correlated with thrombus composition. The mean T1 relaxation time of thrombus was shortest at 7 days following thrombus induction and returned to that of blood as the thrombus resolved. T1 relaxation time was related to thrombus methemoglobin formation and further processing. Studies in inducible nitric oxide synthase (iNOS(-/-))-deficient mice revealed that inducible nitric oxide synthase mediates oxidation of erythrocyte lysis-derived iron to paramagnetic Fe3+, which causes thrombus T1 relaxation time shortening. Studies using chemokine receptor-2-deficient mice (Ccr2(-/-)) revealed that the return of the T1 signal to that of blood is regulated by removal of Fe3+ by macrophages that accumulate in the thrombus during its resolution. Quantification of T1 relaxation time was a good predictor of successful thrombolysis with a cutoff point of <747 ms having a sensitivity and specificity to predict successful lysis of 83% and 94%, respectively. CONCLUSIONS The source of the T1 signal in the thrombus results from the oxidation of iron (released from the lysis of trapped erythrocytes in the thrombus) to its paramagnetic Fe3+ form. Quantification of T1 relaxation time appears to be a good predictor of the success of thrombolysis.
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Affiliation(s)
- Prakash Saha
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Marcelo E Andia
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Bijan Modarai
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Ulrike Blume
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Julia Humphries
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Ashish S Patel
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Alkystis Phinikaridou
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Colin E Evans
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Katherine Mattock
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Steven P Grover
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Anwar Ahmad
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Oliver T Lyons
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Rizwan Q Attia
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Thomas Renné
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Sobath Premaratne
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Andrea J Wiethoff
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - René M Botnar
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Tobias Schaeffter
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Matthew Waltham
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Alberto Smith
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
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