Techniques for high-resolution MR imaging of atherosclerotic plaque

Evaluation of Fibrous Cap Rupture of Atherosclerotic Carotid Plaque with Thin-Slice Source Images of Time-of-Flight MR Angiography

OBJECTIVE

To investigate the ability of source image of time-of-flight magnetic resonance angiography (TOF-MRA) in the detection of fibrous cap rupture of atherosclerotic carotid plaques.

MATERIALS AND METHODS

From the database of radiological information in our hospital, 35 patients who underwent carotid MR imaging and subsequent carotid endoarterectomy within 2 weeks were included in this retrospective study. MR imaging included thin-slice time-of-flight MR angiography, black-blood T1- and T2-weighted imaging. Sensitivity, specificity and accuracy were calculated for the detection of fibrous cap rupture with source image of TOF-MRA. The Cohen k coefficient was also calculated to quantify the degree of concordance of source image of TOF-MRA with histopathological data.

RESULTS

Sensitivity, specificity and accuracy in the detection of fibrous cap rupture were 90% (95%CI: 81-98), 69% (95%CI: 56-82) and 79% (95%CI: 71-87) with a k value of 0.59. The false positives (n = 15) were caused by partial-volume averaging between fibrous cap and lumen at the shoulder of carotid plaque. The false negatives (n = 5) were underestimated as partial thinning of fibrous cap.

CONCLUSION

Source image of TOF-MRA can be useful in the detection of fibrous cap rupture with high sensitivity, but further technical improvement should be necessary to overcome shortcomings causing image degradation.

Gray blood magnetic resonance for carotid wall imaging and visualization of deep-seated and superficial vascular calcifications

White blood and black blood magnetic resonance imaging methods are often used for lumenography and visualization of the arterial wall, respectively. However, the use of white blood imaging invariably obscures arterial wall boundaries, and thus, impedes precise measurement of arterial wall area. Conversely, black blood imaging imposes strict limits on sequence timing to suppress the arterial lumen, and by itself, precludes separation of superficial calcification from the hypointense arterial lumen. In this work, a three-dimensional arterial wall imaging methodology providing gray blood image contrast is described that remedies the above limitations. When applied to the carotid arteries, the described gray blood imaging method is found to clearly depict the inner and outer arterial wall boundaries as well as superficial and deep-seated vascular calcifications. A tailored phase-encoding schedule is also presented that enables concurrent gray and black blood, or "dual contrast," imaging of the arterial wall with no increase in the acquisition time. Taken together, presented data demonstrate that gray and dual blood contrast magnetic resonance imaging provide an efficient means for viewing and characterizing the composition of atherosclerotic plaques.

MR plaque imaging of the carotid artery

Atherosclerotic carotid plaque represents a major cause of cerebral ischemia. The detection of vulnerable plaque is important for preventing future cardiovascular events. The key factors in advanced plaque that are most likely to lead to patient complications are the condition of the fibrous cap, the size of the necrotic core and hemorrhage, and the extent of inflammatory activity within the plaque. Magnetic resonance (MR) imaging has excellent soft tissue contrast and can allow for a more accurate and objective estimation of carotid wall morphology and plaque composition. Recent advances in MR imaging techniques have permitted serial monitoring of atherosclerotic disease evolution and the identification of intraplaque risk factors for accelerated progression. The purpose of this review article is to review the current state of techniques of carotid wall MR imaging and the characterization of plaque components and surface morphology with MR imaging, and to describe the clinical practice of carotid wall MR imaging for the determination of treatment plan.

Atherosclerotic lesions rich in macrophages or smooth muscle cells discriminated in rabbit iliac arteries based on T1 relaxation time and lipid content

RATIONALE AND OBJECTIVES

Atherothrombosis usually occurs on macrophage- and lipid-rich unstable plaque, but rarely on smooth muscle cell (SMC)-rich stable plaque. Magnetic resonance imaging (MRI) has been extensively applied for noninvasive vascular imaging. We therefore investigated whether MRI provides valuable information about the characteristics of atherosclerotic vessels using rabbit models of macrophage-rich or SMC-rich atherosclerotic arteries.

MATERIALS AND METHODS

Rabbits were fed with a conventional (CD group, n = 3) or 0.5% cholesterol (ChD group, n = 3) diet for 1 week before and 3 weeks after balloon injury of the left iliac arteries. Three weeks later, these arteries were investigates by 1.5 T MRI and by conventional angiographic imaging, followed by histological and immunohistochemical analyses.

RESULTS

Three weeks after balloon injury, injured iliac arteries of both groups formed neointima with luminal stenosis. Conventional and MRI angiographic findings of the luminal diameter significantly and positively correlated. T1 relaxation time was significantly shorter and the lipid content was much higher in injured arteries from the ChD than from the CD group. The injured arteries from the ChD also contained more macrophages and less SMCs that those from the CD group. The T1 relaxation time and lipid content in injured arteries negatively and positively correlated with the degree of macrophage accumulation, respectively.

CONCLUSION

These results showed that MRI could provide valuable information about luminal stenosis and the characteristics of atherosclerotic vessels in rabbits.

Nanomedicine: perspective and promises with ligand-directed molecular imaging

Molecular imaging and targeted drug delivery play an important role toward personalized medicine, which is the future of patient management. Of late, nanoparticle-based molecular imaging has emerged as an interdisciplinary area, which shows promises to understand the components, processes, dynamics and therapies of a disease at a molecular level. The unprecedented potential of nanoplatforms for early detection, diagnosis and personalized treatment of diseases, have found application in every biomedical imaging modality. Biological and biophysical barriers are overcome by the integration of targeting ligands, imaging agents and therapeutics into the nanoplatform which allow for theranostic applications. In this article, we have discussed the opportunities and potential of targeted molecular imaging with various modalities putting a particular emphasis on perfluorocarbon nanoemulsion-based platform technology.

Atherosclerosis and thrombosis: identification of targets for magnetic resonance imaging

Imaging techniques are needed that will allow earlier and more refined diagnosis, guide targeted treatment in individual patients and monitor response to that treatment. Magnetic resonance imaging is well-suited to these tasks as it can provide anatomical, structural, and functional data on the arterial wall. Its capabilities are further enhanced by the use of a range of increasingly sophisticated contrast agents that target specific molecules, cells, and biological processes. This article will consider the pathogenesis of atherosclerosis and systematically identify biologically relevant targets for imaging at different stages of disease process.

A combined FEM/genetic algorithm for vascular soft tissue elasticity estimation

Tissue elasticity reconstruction is a parameter estimation effort combining imaging, elastography, and computational modeling to build maps of soft tissue mechanical properties. One application is in the characterization of atherosclerotic plaques in diseased arteries, wherein the distribution of elastic properties is required for stress analysis and plaque stability assessment. In this paper, a computational scheme is proposed for elasticity reconstruction in soft tissues, combining finite element modeling (FEM) for mechanical analysis of soft tissues and a genetic algorithm (GA) for parameter estimation. With a model reduction of the discrete elasticity values into lumped material regions, namely the plaque constituents, a robust, adaptive strategy can be used to solve inverse elasticity problems involving complex and inhomogeneous solution spaces. An advantage of utilizing a GA is its insistence on global convergence. The algorithm is easily implemented and adaptable to more complex material models and geometries. It is meant to provide either accurate initial guesses of low-resolution elasticity values in a multi-resolution scheme or as a replacement for failing traditional elasticity estimation efforts.

99mTc-interleukin-2 scintigraphy for the in vivo imaging of vulnerable atherosclerotic plaques

PURPOSE

Several histopathological studies have demonstrated that vulnerable plaques are enriched in inflammatory cells. The aims of this study were: (1a) to test the ability of 99mTc-labelled interleukin-2 (99mTc-IL2) to bind to IL2R-positive (IL2R+) cells in carotid plaques and (1b) to correlate the plaque uptake of 99mTc-IL2, measured in vivo, with the number of IL2R+ cells within the plaque, measured ex vivo by histology (transversal study, TS), and (2) to evaluate changes in 99mTc-IL2 uptake in plaques, before and after treatment with a statin or a hypocholesterolaemic diet (longitudinal study, LS).

METHODS

Ultrasound scan was performed for plaque characterisation and localisation. Fourteen patients (16 plaques) eligible for endoarterectomy were recruited for the TS and underwent 99mTc-IL2 scintigraphy before surgery. Nine patients (13 plaques) were recruited for the LS; these patients received atorvastatin or a standard hypocholesterolaemic diet and 99mTc-IL2 scintigraphy was performed before and after 3 months of treatment.

RESULTS

The degree of 99mTc-IL2 uptake was expressed as the plaque/background (T/B) ratio. In patients from TS, T/B ratios correlated with the percentage of IL2R+ cells at histology (r = 0.707; p = 0.002) and the number of IL2R+ cells at flow cytometry (r = 0.711; p = 0.006). No correlations were observed between ultrasound scores and either scintigraphic or histological findings. In patients from the LS, the mean 99mTc-IL2 uptake decreased in statin-treated patients (1.75+/-0.50 vs 2.16+/-0.44; p = 0.012), while it was unchanged in the patients on the hypocholesterolaemic diet (2.33+/-0.45 vs 2.34+/-0.5).

CONCLUSION

99mTc-IL2 accumulates in vulnerable carotid plaques; this accumulation is correlated with the amount of IL2R+ cells and is influenced by lipid-lowering treatment with a statin.

Mineral volume and morphology in carotid plaque specimens using high-resolution MRI and CT

OBJECTIVE

High-resolution MRI methods have been used to evaluate carotid artery atherosclerotic plaque content. The purpose of this study was to assess the performance of high-resolution MRI in evaluation of the quantity and pattern of mineral deposition in carotid endarterectomy (CEA) specimens, with quantitative micro-CT as the gold standard.

METHODS AND RESULTS

High-resolution MRI and CT were compared in 20 CEA specimens. Linear regression comparing mineral volumes generated from CT (VCT) and MRI (VMRI) data demonstrated good correlation using simple thresholding (VMRI=-0.01+0.98VCT; R2=0.90; threshold=4xnoise) and k-means clustering methods (VMRI=-0.005+1.38VCT; R2=0.93). Bone mineral density (BMD) and bone mineral content (BMC [mineral mass]) were calculated for CT data and BMC verified with ash weight. Patterns of mineralization like particles, granules, and sheets were more clearly depicted on CT.

CONCLUSIONS

Mineral volumes generated from MRI or CT data were highly correlated. CT provided a more detailed depiction of mineralization patterns and provided BMD and BMC in addition to mineral volume. The extent of mineralization as well as the morphology may ultimately be useful in assessing plaque stability.

Avaliação da aterosclerose carotídea por intermédio de ultra-sonografia e ressonância magnética

OBJETIVO: Identificar ateromas carotídeos em coronariopatas com indicação de terapia cirúrgica. Avaliar o grau de estenose das artérias carótidas internas por meio de ultra-sonografia com Doppler colorido (UDC) e angiografia por ressonância magnética (ARM). Comparar a ecogenicidade das placas visualizadas pela ultra-sonografia (US), com a intensidade de sinal nos exames de ressonância magnética (RM). Avaliar a qualidade de imagens e confiabilidade interobservadores nos exames de RM. MATERIAIS E MÉTODOS: Estudo prospectivo em 50 pacientes. Utilizamos US e RM em seqüências ponderadas em T1 e T2, ambas pelas técnicas "black-blood" (BB) e "fat sat black-blood" (FSBB), e ARM 3D TOF ("time-of-flight'') com e sem contraste paramagnético. RESULTADOS: Do total de 100 segmentos, 81% apresentaram estenose pela US. Em 72 placas com ecogenicidade tipo 4 houve aumento da intensidade de sinal em 59,7% em T1-BB, 65,3% em T1-FSBB, 62,5% em T2-BB e 66,7% em T2-FSBB. Nas placas tipo 2 houve aumento da intensidade de sinal em 71,4% em T1-BB e T1-FSBB, 85,7% em T2-BB e 71,4% em T2-FSBB. Nas placas tipo 1 houve aumento da intensidade de sinal em 50,0% em T1 e T2. Em 19 segmentos a US foi considerada normal. Quando estes segmentos foram avaliados pela RM, houve aumento da intensidade de sinal em 47,4% em T1-BB, 57,9% em T1-FSBB e 52,6% em T2-BB e T2-FSBB. CONCLUSÃO: Houve alta incidência de aterosclerose carotídea. Houve reprodutibilidade marginal na associação entre o grau de estenose visualizado pela UDC e ARM. Não houve correlação entre os tipos de ecogenicidade das placas visualizadas pela US com as alterações de intensidade de sinal pela RM. A qualidade de imagens dos exames de RM foi considerada ótima em T1 e T2 e muito boa em 3D TOF (axial). A qualidade de imagem dos exames de ARM foi excelente. Notou-se ótima reprodutibilidade interobservadores, com valores de índice kappa acima de 0,71.

Magnetic resonance imaging of atherosclerosis

Abundant data now link composition of the vascular wall, rather than the degree of luminal narrowing, with the risk for acute ischemic syndromes in the coronary, central nervous system, and peripheral arterial beds. Over the past few years, magnetic resonance angiography has evolved as a well-established method to determine the location and severity of advanced, lumen-encroaching atherosclerotic lesions. In addition, more recent studies have shown that high spatial resolution, multisequence MRI is also a promising tool for noninvasive, serial imaging of the aortic and carotid vessel wall, which potentially can be applied in the clinical setting. Because of the limited spatial resolution of current MRI techniques, characterization of coronary vessel wall atherosclerosis, however, is not yet possible and remains the holy grail of plaque imaging. Recent technical developments in MRI technology such as dedicated surface coils, the introduction of 3.0-T high-field systems and parallel imaging, as well as developments in the field of molecular imaging such as contrast agents targeted to specific plaque constituents, are likely to lead to the necessary improvements in signal to noise ratio, imaging speed, and specificity. These improvements will ultimately lead to more widespread application of this technology in clinical practice. In the present review, the current status and future role of MRI for plaque detection and characterization are summarized.

Segmentation of wall and plaque in in vitro vascular MR images

Atherosclerosis leads to heart attack and stroke, which are major killers in the western world. These cardiovascular events frequently result from local rupture of vulnerable atherosclerotic plaque. Non-invasive assessment of plaque vulnerability would dramatically change the way in which atherosclerotic disease is diagnosed, monitored, and treated. In this paper, we report a computerized method for segmentation of arterial wall layers and plaque from high-resolution volumetric MR images. The method uses dynamic programming to detect optimal borders in each MRI frame. The accuracy of the results was tested in 62 T1-weighted MR images from six vessel specimens in comparison to borders manually determined by an expert observer. The mean signed border positioning errors for the lumen, internal elastic lamina, and external elastic lamina borders were -0.1 +/- 0.1, 0.0 +/- 0.1, and -0.1 +/- 0.1 mm, respectively. The presented wall layer segmentation approach is one of the first steps towards non-invasive assessment of plaque vulnerability in atherosclerotic subjects.

Magnetic resonance imaging-guided coronary interventions

Magnetic resonance imaging (MRI) guidance for coronary interventions offers potential advantages over conventional x-ray angiography. Advantages include the use of nonionizing radiation, combined assessment of anatomy and function, and three-dimensional assessment of the coronary arteries leading to the myocardium. These advantages have prompted a series of recent studies in this field. Real-time coronary MR angiography, with low-dose catheter-directed intraarterial (IA) infusion of contrast media, has achieved in-plane spatial resolution as low as 0.8 x 0.8 mm2 and temporal resolution as short as 130 msec per image. Catheter-based IA injection of contrast agent has proven useful in the collection of multislice and three-dimensional images, not only for coronary intervention guidance, but also in the assessment of regional myocardial perfusion fed by the affected vessel. Actively visible guidewires and guiding catheters, based on the loopless antenna concept, have been effectively used to negotiate tortuous coronary vessels during catheterization, permitting placement of coronary angioplasty balloon catheters. Passive tracking approaches have been used to image contrast agent-filled coronary catheters and to place susceptibility-based endovascular stents. Although the field is in its infancy, these early results demonstrate the feasibility for performing MRI-guided coronary interventions. Although further methodological and technical developments are required before these methods become clinically applicable, we anticipate that MRI someday will be included in the armamentarium of techniques used to diagnose and treat coronary artery disease.

Triple contrast technique for black blood imaging with double inversion preparation

This work reports on the development of a pulse sequence to simultaneously acquire proton density, T(1), and T(2) weighted images in a single magnetization prepared fast spin echo acquisition. The technique is based upon the application of a magnetization preparation consisting of a global inversion followed by slice-selective 180 degrees and 90 degrees pulses to prepare the signal of specific slices. Slices are acquired in an interleaved manner with time delays appropriate for the desired image contrasts. Data acquisition is repeated for all combinations of slice interleaving covering the region of interest until images from all slice locations have been acquired with all desired image contrasts. The multiple image contrasts obtained with this technique should be useful in applications where discrimination between different types of tissue components is desired, such as in the analysis of plaque in cervical carotid artery disease.

Accuracy and uniqueness of three in vivo measurements of atherosclerotic carotid plaque morphology with black blood MRI

High-resolution MRI provides unique information about morphology of atherosclerotic carotid plaque. In this study, the accuracy and precision of measurements of carotid plaque burden and lumen narrowing were determined for in vivo black blood MRI assessment with respect to ex vivo MRI in a group of 37 atherosclerosis patients who underwent carotid endarterectomy (CEA). Three different plaque measures were compared between paired in vivo and ex vivo MR images: maximum wall area (MWA), minimum lumen area (mLA), and wall volume (WV). MWA and WV are measures of plaque burden, while mLA is a measure of lumen narrowing. The matched in vivo and ex vivo measurements showed good agreement (the correlation coefficients for in/ex vivo WV, MWA, and mLA were 0.92, 0.91, 0.90, respectively) with predictable bias. This study indicates that in vivo black blood MRI can be used to directly estimate the morphology of the plaque. Comparison of the three plaque measures showed that mLA and MWA or WV provide different information regarding the atherosclerotic lesions (the correlation coefficients between mLA and MWA or WV were less than 0.3). Black blood MRI technique is a potentially powerful clinical tool to characterize the severity of atherosclerotic plaque. It can provide accurate measurements on different aspects of the plaque, from plaque burden to lumen narrowing.

MRI-guided coronary catheterization and PTCA: A feasibility study on a dog model

The aim of this work was to demonstrate the feasibility of MRI-guided coronary artery catheterization and intervention in a dog model. Experiments were performed on 10 healthy dogs. A 9F introducer sheath was placed through a right carotid artery cutdown. A prototype 0.014-inch coronary MRI guidewire, a prototype 7 French MRI-guiding catheter, and two flexible surface coils were connected to a GE 1.5 T CV/i scanner for simultaneous visualization of the guidewire, guiding catheter, and chest anatomy. Images were displayed in real time on an in-room monitor. A nongated, single-slice fast gradient-echo sequence was used to obtain real-time images of the catheters and background anatomy during the intervention. Fifteen selective catheterizations were attempted in the coronary arteries, and all were successful. Selective injection of diluted gadolinium into the MRI-guiding catheter provided dynamic 2D projection coronary angiography in all cases, confirming successful catheterization. Percutaneous transluminal coronary angioplasty (PTCA) was attempted after two catheterizations, and all attempts were successful. Inflation of the balloon angioplasty catheter was performed successfully in the left anterior and circumflex arteries. Our results indicate that coronary artery catheterization and intracoronary balloon angioplasty are feasible with MRI guidance only. MRI guidance may be used as an alternative to X-ray guidance in coronary artery interventions in the future.

Evaluation of a dedicated dual phased-array surface coil using a black-blood FSE sequence for high resolution MRI of the carotid vessel wall

PURPOSE

To investigate the ability of magnetic resonance imaging (MRI) to visualize the carotid vessel wall using a phased-array coil and a black-blood (BB) fast spin-echo (FSE) sequence.

MATERIALS AND METHODS

The phased-array coil was compared with a three-inch coil. Images from volunteers were evaluated for artifacts, wall layers, and wall signal intensity. Signal intensity and homogeneity of atherosclerosis were assessed. Lumen diameter and vessel area were measured.

RESULTS

Comparison between the phased-array coil and the three-inch coil showed a 100% increase in signal-to-noise ratio. BB-FSE imaging resulted in good delineation between blood and vessel wall. Most volunteers had a two-layered vessel wall with a hyperintense inner layer. MRI showed both homogeneous hyperintense and heterogeneous plaques, which consisted of a main hyperintense part with hypointense spots and/or intermediate regions. MRI lumen and area measurements were performed easily.

CONCLUSION

High resolution MRI of carotid atherosclerosis is feasible with a phased-array coil and a BB-FSE sequence.

Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke

BACKGROUND

High-resolution MRI has been shown to be capable of distinguishing intact, thick fibrous caps from thin and ruptured caps in human carotid atherosclerosis in vivo. The aim of this study was to determine whether MRI identification of fibrous cap thinning or rupture is associated with a history of recent transient ischemic attack (TIA) or stroke.

METHODS AND RESULTS

Fifty-three consecutive patients (mean age, 71 years; 49 male) scheduled for carotid endarterectomy were recruited after obtaining informed consent. Twenty-eight subjects had a recent history of TIA or stroke on the side appropriate to the index carotid lesion, and 25 were asymptomatic. Preoperative carotid MRI was performed in a 1.5-T GE Signa scanner that generated T(1)-, PD-, and T(2)-weighted and three-dimensional time-of-flight images. Using previously reported MRI criteria, the fibrous cap was categorized as intact-thick, intact-thin, or ruptured for each carotid plaque by blinded review. There was a strong and statistically significant trend showing a higher percentage of symptomatic patients for ruptured caps (70%) compared with thick caps (9%) (P=0.001 Mann-Whitney test for cap status versus symptoms). Compared with patients with thick fibrous caps, patients with ruptured caps were 23 times more likely to have had a recent TIA or stroke (95% CI=3, 210).

CONCLUSIONS

MRI identification of a ruptured fibrous cap is highly associated with a recent history of TIA or stroke. Ongoing prospective studies will determine the predictive value fibrous cap characteristics, as visualized by MRI, for risk of subsequent ischemic events.

Contrast-enhanced high resolution MRI for atherosclerotic carotid artery tissue characterization

PURPOSE

To determine if a gadolinium-based contrast agent provides additional information for characterization of human plaque tissues, particularly neovasculature. Although high-resolution magnetic resonance imaging (MRI) has been used to identify plaque constituents in advanced atherosclerosis, some constituents, such as neovascularized tissue, defy detection.

MATERIALS AND METHODS

Non-contrast-enhanced carotid artery images from 18 patients scheduled for carotid endarterectomy and two normal volunteers were used to identify regions of fibrous tissue, necrotic core, or calcification, using established criteria. Then, the percent change in T1-weighted images after contrast enhancement was calculated for each region.

RESULTS

There were statistically significant differences in mean intensity change between tissues, with the largest increase for fibrous tissue (79.5%) and the smallest for necrotic core (28.6%). Additionally, histological analysis showed that a subset of fibrous regions rich in plaque neovascularization could be identified using a threshold of 80% enhancement (sensitivity = 76%, specificity = 79%).

CONCLUSION

The ability of contrast-enhanced MRI to identify neovascularization and potentially improve differentiation of necrotic core from fibrous tissue further establishes MRI as a viable tool for in vivo study of atherosclerotic plaque.

High-Resolution magnetic resonance imaging of normal and atherosclerotic human coronary arteries ex vivo: discrimination of plaque tissue components

BACKGROUND

Noninvasive detection of plaque lipid and calcium in human atherosclerosis may have clinical utility, because the presence of each may be associated with increased risk of plaque disruption. Magnetic resonance imaging (MRI) has the potential to detect both plaque lipid and calcium. However, no previous studies have: 1) used an MR coil with sufficient resolution to image the components of human coronary arteries, 2) evaluated the utility of a combination of different MR contrast weightings in discriminating plaque components in human coronary arteries, or 3) used sensitive and specific histological stains for lipid and calcium to determine their MR image characteristics in human atherosclerosis.

METHODS

Using a custom-made surface coil on a whole-body, 1.5T MRI scanner, high resolution MR images were obtained from 22 nonatherosclerotic and atherosclerotic human coronary artery segments and then compared with histological sections stained for neutral lipid, calcium, and ribrous and cellular components.

RESULTS

With a multicontrast protocol using T1-, proton density-, and T2-weighted images, statistically significant differences were found among MR image contrast values for regions identified by histological stains as containing lipid only, calcium only, mixed lipid and calcium, or fibrous tissue. All four of these histologically defined region types could be differentiated from one another by a multicontrast MRI protocol. Of the 22 segments, 10 (45%) contained areas with combined plaque lipid and calcium; calcium would not have been recognized histologically in these regions without the use of a specific calcium stain.

CONCLUSIONS

These results demonstrate that multicontrast MRI can produce remarkably high-resolution images and can discriminate between clinically relevant components of the atherosclerotic vessel wall.

In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques

BACKGROUND

High-resolution MRI has been shown to be capable of identifying plaque constituents, such as the necrotic core and intraplaque hemorrhage, in human carotid atherosclerosis. The purpose of this study was to evaluate differential contrast-weighted images, specifically a multispectral MR technique, to improve the accuracy of identifying the lipid-rich necrotic core and acute intraplaque hemorrhage in vivo.

METHODS AND RESULTS

Eighteen patients scheduled for carotid endarterectomy underwent a preoperative carotid MRI examination in a 1.5-T GE Signa scanner using a protocol that generated 4 contrast weightings (T1, T2, proton density, and 3D time of flight). MR images of the vessel wall were examined for the presence of a lipid-rich necrotic core and/or intraplaque hemorrhage. Ninety cross sections were compared with matched histological sections of the excised specimen in a double-blinded fashion. Overall accuracy (95% CI) of multispectral MRI was 87% (80% to 94%), sensitivity was 85% (78% to 92%), and specificity was 92% (86% to 98%). There was good agreement between MRI and histological findings, with a value of kappa=0.69 (0.53 to 0.85).

CONCLUSIONS

Multispectral MRI can identify the lipid-rich necrotic core in human carotid atherosclerosis in vivo with high sensitivity and specificity. This MRI technique provides a noninvasive tool to study the pathogenesis and natural history of carotid atherosclerosis. Furthermore, it will permit a direct assessment of the effect of pharmacological therapy, such as aggressive lipid lowering, on plaque lipid composition.

Comparison of carotid vessel wall area measurements using three different contrast-weighted black blood MR imaging techniques

Measuring carotid artery plaque burden from MRI is a reliable method for monitoring regression and progression of atherosclerosis. However, to measure all available images would be very time consuming, and in practice the image quality (IQ) of these images may be inconsistent, which can directly impact the quality of measurement. It is hypothesized that if IQ is comparable among different contrast weighted images, then carotid artery area measurements obtained from different contrast images of the same location will produce identical results. To test this, T1, proton density and T2 weighted images were acquired from ten patients (51 +/- 7 years old). Carotid lumen and vessel wall area was measured using a custom designed software program. The results showed strong agreement evidenced with only small differences on both lumen (mean: 40.5 mm(2)) and wall (mean: 52.6 mm(2)) area measurement among different weighted images. The maximum absolute mean differences are less than 2.7 mm(2) and 4.4 mm(2), and 90(th) percentile of the absolute differences are 5.6 mm(2) and 8.2 mm(2) respectively. In conclusion, different contrast weighted images with high and comparable IQ will yield similar results in lumen and vessel wall area measurement. At each matched location, it is recommended that the image with the highest IQ be used for area measurement.

The assessment of the vulnerable atherosclerotic plaque using MR imaging: a brief review

The study of atherosclerotic disease during its natural history and after therapeutic intervention may enhance our understanding of the progression and regression of this disease and will aid in selecting the appropriate medical treatments or surgical interventions. Several invasive and non-invasive imaging techniques are available to assess atherosclerotic disease vessels. Most of these techniques are strong in identifying the morphological features of the disease such as lumenal diameter and stenosis or wall thickness, and in some cases provide an assessment of the relative risk associated with the atherosclerotic disease. However, none of these techniques can fully characterize the composition of the atherosclerotic plaque in the vessel wall and therefore are incapable of identifying the vulnerable plaques. High-resolution, multi-contrast, magnetic resonance (MR) can non-invasively image vulnerable plaques and characterize plaques in terms of lipid and fibrous content and identify the presence of thrombus or calcium. Application of MR imaging opens up whole new areas for diagnosis, prevention, and treatment of atherosclerosis.

Atherosclerotic plaques: classification and characterization with T2-weighted high-spatial-resolution MR imaging-- an in vitro study

PURPOSE

To evaluate if T2-weighted high-spatial-resolution magnetic resonance (MR) imaging (117 microm per pixel) can help accurate classification of atherosclerotic plaques.

MATERIALS AND METHODS

Thirty human arteries and 11 carotid endarterectomy specimens from 31 patients underwent T2-weighted MR imaging (2-T magnet; repetition time, 2,000 msec; echo time, 50 msec) at room temperature. After imaging, Bouin fixative was used to fix 26 arteries, and the other 15 arteries were fixed by means of freezing. Specimens were stained with hematoxylin-eosin and safranin or Sudan lipid stain. MR images and histologic slices were classified independently by two radiologists and a pathologist, respectively, on the basis of the American Heart Association classification.

RESULTS

Results with MR imaging were the following: type I-II plaques, sensitivity of 67% and specificity of 100%; type IV-Va plaques, sensitivity of 74% and specificity of 85%; type Vb plaques, sensitivity of 90% and specificity of 100%; type Vc plaques, sensitivity of 80% and specificity of 90%. No type III plaque was diagnosed in the study. The overall kappa value was 0.68.

CONCLUSION

High-spatial-resolution MR imaging with T2 weighting alone can help accurate classification of fibrocalcic plaques (type Vb), but it is subject to limitations for the classification and analysis of other types of atherosclerotic plaques.

Characterization of atherosclerotic plaques by magnetic resonance imaging

The study of atherosclerotic disease during its natural history and after therapeutic intervention will enhance our understanding of the progression and regression of this disease and will aid in selecting the appropriate medical treatments or surgical interventions. Several invasive and noninvasive imaging techniques are available to assess atherosclerotic vessels. Most of these techniques are strong in identifying the morphological features of the disease, such as lumenal diameter and stenosis or wall thickness, and in some cases provide an assessment of the relative risk associated with the atherosclerosis. However, none of these techniques can fully characterize the composition of the atherosclerotic plaque in the vessel wall and, therefore, are incapable of identifying the vulnerable plaques. High-resolution, multi-contrast, magnetic resonance (MR) can non-invasively image vulnerable plaques, characterize plaques in terms of lipid and fibrous content, and identify the presence of thrombus or calcium. Application of MR imaging opens up whole new areas for diagnosis, prevention, and treatment (e.g., lipid-lowering drug regimens) of atherosclerosis.

High-resolution three-dimensional in vivo imaging of atherosclerotic plaque

The internal structure of atherosclerotic-plaque lesions may be a useful predictor of which lesions will rupture and cause sudden events such as heart attack or stroke. With lipid and flow suppression, we obtained high-resolution, three-dimensional (3D) images of atherosclerotic plaque in vivo that show the cap thickness and core size of the lesions. 3D GRASE was used because it provides flexible T(2) contrast and good resistance to off-resonance artifacts. While 2D RARE has similar properties, its resolution in the slice-select direction, which is important because of the irregular geometry of atherosclerotic lesions, is limited by achievable slice-excitation profiles. Also, 2D imaging generally achieves lower SNR than 3D imaging because, for SNR purposes, 3D image data is averaged over all the slices of a corresponding multislice 2D dataset. Although 3D RARE has many of the advantages of 3D GRASE, it requires a longer scan time because it uses more refocusing pulses to acquire the same amount of data. Finally, cardiac gating is an important part of our imaging sequence, but can make the imaging time quite long. To obtain reasonable scan times, a 2D excitation pulse was used to restrict the field of view. Magn Reson Med 42:762-771, 1999.

MRI of rabbit atherosclerosis in response to dietary cholesterol lowering

Direct imaging of the atherosclerotic plaque, rather than the angiographic lumen, may provide greater insight into the response of atherosclerosis to cholesterol-lowering therapy. Aortic plaque was studied in vivo by MRI in rabbits undergoing dietary cholesterol intervention. Thirty-one rabbits underwent aortic balloon injury and high-cholesterol diet for 4 months and then were assigned to low-cholesterol versus continued high-cholesterol diet for up to an additional 16 months. High-resolution (310 micrometer) fast spin-echo MRI of the abdominal aorta was performed at 4, 12, and 20 months and compared with histology. MRI demonstrated a significant reduction in % area stenosis in rabbits placed on low-cholesterol diet (44.6+/-2. 1% at 20 months versus 55.8+/-1.5% at 4 months, P=0.0002). In contrast, % area stenosis increased in rabbits maintained on high-cholesterol diet (69.8+/-3.8% at 20 months versus 55.8+/-1.5% at 4 months, P=0.001). Similarly, plaque thickness decreased significantly in the low-cholesterol group (0.60+/-0.05 mm at 20 months versus 0.85+/-0.06 mm at 4 months, P=0.006), with a trend toward increase in the high-cholesterol group (1.02+/-0.08 mm at 20 months versus 0.85+/-0.06 mm at 4 months, P=0.1). Thus, in rabbits undergoing dietary cholesterol lowering, MRI detected regression of aortic atherosclerotic plaque in vivo. Plaque progression was seen with maintenance of high-cholesterol diet. MRI is a promising noninvasive technology for directly imaging atherosclerosis and its response to therapeutic interventions.

Mild carotid artery atherosclerosis: assessment by 3-dimensional time-of-flight magnetic resonance angiography, with reference to intravascular ultrasound imaging and contrast angiography

BACKGROUND AND PURPOSE

Our aim was to evaluate the usefulness of 3-dimensional time-of-flight magnetic resonance angiography (3-D TOF MRA) in detection and quantification of mild atherosclerotic changes of carotid arteries with reference to intravascular ultrasound (IVUS) and contrast angiography.

METHODS

TOF MRA at 1.5 T, IVUS, and selective digital subtraction angiography were performed on 31 extracranial carotid arteries of 27 patients (mean age, 52 years; age range, 17 to 75 years) undergoing neuroendovascular interventions. The atherosclerotic lesions were registered, and quantitative measurements of plaque thickness, luminal diameters, and diameter stenosis were independently performed for the imaging modalities.

RESULTS

Among 170 arterial segments analyzed, IVUS revealed a total of 48 atherosclerotic lesions (mean diameter stenosis, 17%; range, 4% to 40%), only 25 of which were depicted on digital subtraction angiography. Analysis of the axial source images of TOF MRA resulted in sensitivity of 77% to 83% and specificity of 71% to 80% in lesion depiction for the 2 readers with reference to IVUS. The values of diameter stenosis measured from MRA and IVUS were closely interrelated (r=0.53 to 0.61, P<0.001).

CONCLUSIONS

Three-dimensional TOF MRA is feasible and moderately accurate for evaluation of mild atherosclerotic changes of carotid arteries.

Dynamic MR imaging of the carotid wall

The purpose of this study was to clarify temporal changes of carotid wall enhancement using dynamic magnetic resonance (MR) and to correlate its findings with pathological conditions. Cervical carotid arteries of 84 consecutive patients were studied with a 1.5 T MR imager using phased array coils. Axial spoiled gradient-echo (SPGR) images (30-58 second scan time) with fat saturation were repeated 4-8 times after the injection of contrast material. We evaluated the presence and thickness of hypointense inner rims and hyperintense outer rims of the carotid wall, temporal changes of outer rim enhancement, and their changes in relation to pathological conditions. Hypointense inner rims and enhanced outer rims were clearly visualized in 87% (73/84) of our subjects. Enhancement of the outer rim was minimal in early phases and gradually increased. Patient age had a significant correlation with outer rim thickness. In the portions with large atheromatous plaques, inner rims were disrupted or thickened. A marked thickening of the outer rim was observed in one patient with arteritis. The outer rims adjacent to malignant tumors were often obscured. Our study suggests that dynamic MR images of the cervical carotid artery can uniquely demonstrate angiogenesis of the wall itself. The outer rim of the artery shows relatively rapid enhancement, and its thickness correlates with age.

Measurement of atherosclerotic carotid plaque size in vivo using high resolution magnetic resonance imaging

BACKGROUND

Current imaging modalities, such as contrast angiography, accurately determine the degree of luminal narrowing but provide no direct information on plaque size. Magnetic resonance imaging (MRI), however, has potential for noninvasively determining arterial wall area (WA). This study was conducted to determine the accuracy of in vivo MRI for measuring the cross-sectional maximum wall area (MaxWA) of atherosclerotic carotid arteries in a group of patients undergoing carotid endarterectomy.

METHODS AND RESULTS

Fourteen patients scheduled for carotid endarterectomy underwent preoperative carotid MRI using a custom-made phased-array coil. The plaques were excised en bloc and scanned using similar imaging parameters. MaxWA measurements from the ex vivo MRI were used as the reference standard and compared with MaxWA measurements from the corresponding in vivo MR study. Agreement between the in vivo and ex vivo measurement was analyzed using the Bland-Altman method. The paired in vivo and ex vivo MaxWA measurements strongly agreed: the mean difference (in vivo minus ex vivo) in MaxWA was 13.1+/-6.5 mm2 for T1-weighted (T1W) imaging (mean MaxWA in vivo=94.7 mm2, ex vivo=81.6 mm2) and 14.1+/-11.7 mm2 for proton density-weighted (PDW) imaging (mean MaxWA in vivo=93.4 mm2, ex vivo=79.3 mm2). Intraobserver and interobserver variability was small, with intraclass correlation coefficients ranging from 0.90 to 0.98.

CONCLUSIONS

MRI is highly accurate for in vivo measurement of artery WA in atherosclerotic carotid lesions. This imaging technique has potential application monitoring lesion size in studies examining plaque progression and/or regression.

Characterization of atherosclerotic plaque components by high resolution quantitative MR and US imaging

High resolution MRI at 3 T and US imaging at 50 MHz were used for atherosclerotic plaque characterization. For 14 excised segments of human arteries, conventional MR and US images, quantitative MR T2 maps, US integrated attenuation (IA) maps, and histologic sections were produced and compared. The MR T2 and US attenuation mean values estimated in selected regions of interest were related with tissue type as identified on histologic sections. Significant distinction between media or collagen and lipid or collagen lipidic plaque was achieved with both techniques (MR: P < .001; US: P < .01). Significant distinction was obtained between media and collagen (P < .0001) and between iliac and aortic media (P < .05) with MR T2 but not with IA. MR and US native and parametric images, with different sensitivities to tissue type, provide complementary information useful for quantitative plaque characterization.

Biochemical composition of human peripheral arteries examined with near-infrared Raman spectroscopy

PURPOSE

Near-infrared Raman spectroscopy provides an important new means of analyzing the chemical composition of the arterial wall. The objective of this study was to show that Raman spectroscopy can be used to evaluate the lipid and calcium salt contents of human peripheral arteries. The results extend a recently developed Raman-based method for analyzing the chemical composition of coronary arteries.

METHODS AND RESULTS

We studied 167 segments of carotid and femoral artery wall in various pathologic states. The Raman spectra from these samples was accurately modeled. The resulting chemical concentrations were compared with the amounts of cholesterol and calcium mineral determined at histologic evaluation by an experienced cardiovascular pathologist. Strong correlations between spectroscopic measurements and morphologic findings were demonstrated and validated the applicability of the method to peripheral arteries.

CONCLUSIONS

Raman spectroscopy can provide reliable histochemical information about peripheral and coronary arteries. Such information may help identify rupture-prone plaques before the onset of symptoms and allow aggressive and directed intervention. Accurate knowledge of the chemical composition of a lesion may be useful in selecting the most appropriate treatment.

On the nature and reduction of plaque-mimicking flow artifacts in black blood MRI of the carotid bifurcation

Cardiac-gated black blood MRI of the carotid artery bifurcation in normal human subjects shows signal within the lumen suggesting wall thickening or atherosclerotic plaque. This signal was believed to be artifactual, arising from complex flow patterns present at the carotid bifurcation. Computer simulation of the hemodynamics and black blood multislice image acquisition in a model of the carotid bifurcation showed that these artifacts arise from spins recovering their signal within the slow, recirculating flow of the carotid bulb. The computed hemodynamics also suggested that these artifacts could be minimized or eliminated entirely by gating the acquisition of slices in the most artifact-prone region of the carotid bulb within a 250-ms window after peak systole. Application of these predictions to studies of normal volunteers showed that, in most cases, these flow artifacts in black blood MRI can be eliminated simply by altering the phase of the cardiac cycle to which the image acquisition is gated. The observation that the size and placement of the saturation slabs had little effect on these artifacts suggested that, in those cases in which recirculation persists throughout the cardiac cycle, either inversion-recovery or presaturation within the bulb itself would be required to suppress them.

US backscatter and attenuation 30 to 50 MHz and MR T2 at 3 Tesla for differentiation of atherosclerotic artery constituents in vitro

This study compares quantitative characterization of atherosclerotic artery constituents by high resolution estimates of ultrasonic attenuation, ultrasonic attenuation-compensated backscatter, and magnetic resonance transverse relaxation time. Atherosclerotic human arteries were studied in vitro at 37&deg;C. Backscattered radio frequency signals were acquired with a 50 MHz backscatter acoustic microscope. Ultrasonic parametric images were constructed from the integrated (30 to 50 MHz) backscatter and attenuation obtained using FFT methods with diffraction correction and a multinarrow-band attenuation algorithm. Parametric magnetic resonance images were constructed from calculated values of the transverse relaxation time T2 determined from an 8 echo-single-slice sequence at 3 Tesla. In a total of 54 regions of interest, average values of integrated attenuation, integrated backscatter compensated for the attenuation between the artery surface and the scattering volume, and the transverse relaxation time were correlated with local tissue composition as assessed by histology. Results show that ultrasound and magnetic resonance techniques offer complementary approaches for characterization of plaque composition.

Intravascular magnetic resonance imaging of aortic atherosclerotic plaque composition

Magnetic resonance imaging (MRI) may be an excellent tool to define atherosclerotic plaque composition, but surface MRI (SMRI) suffers from a low signal-to-noise ratio and low resolution of arterial images. Intravascular MRI (IVMRI) represents a potential solution for acquiring high-quality in vivo images of atherosclerotic plaques. Isolated segments of 11 thoracic human aortas obtained at autopsy were imaged by IVMRI using an intravascular receiver catheter coil designed and built at our institution. Images obtained by IVMRI were compared with corresponding images obtained by SMRI and with histopathological aortic cross sections. The intensity of intimal thickness and plaque components was graded by IVMRI and histopathology using a score of 1 for mild, 2 for moderate, and 3 for severe intensity. IVMRI had an agreement of 75% with histopathology in fibrous cap grading (37.5% expected, kappa = 0.60, P < 0.001) and of 74% in necrotic core grading (39% expected, kappa = 0.57, P < 0.001). Intraplaque calcification was correctly graded by IVMRI in six of the eight plaques in which histopathology recognized calcium. The analysis of intimal thickness showed 80% agreement between IVMRI and histopathology (52% expected, kappa = 0.59, P < 0.001). IVMRI image features were similar to those of SMRI. In addition, IVMRI accurately determined atherosclerotic plaque size in comparison with histopathology and SMRI (slope = 1.25 cm2, r = 0.99, P < 0.001 for luminal area by IVMRI vs histopathology; slope = 0.97 cm2, r = 0.996, P < 0.001 for luminal area by IVMRI vs SMRI). IVMRI has the potential to provide important prognostic information in patients with atherosclerosis because of its ability to accurately assess both plaque composition and size.

In vitro and in situ magnetic resonance imaging signal features of atherosclerotic plaque-associated lipids

The goal of this study was to evaluate magnetic resonance imaging (MRI) signal features of the different types of lipids found in human atherosclerotic plaques. A 1.5-T SIGNA scanner was used to acquire T1-, T2-, and proton density-weighted data at four different temperatures for individual lipids and lipid mixtures designed to replicate the proportions of lipids found in plaques. Individual lipids and lipid mixtures were scanned both in a test tube and after implantation in the media of normal porcine aortas. Each of the three broad classes of lipids (triglycerides, unesterified and esterified cholesterol, and phospholipids) had different and distinct MR signal patterns, which allowed discrimination of these classes of lipids in vitro. Further, lipid implantation studies demonstrated that these distinct MR signal patterns could be used to readily distinguish each lipid type from surrounding porcine aortic media. MR signals from lipid mixtures demonstrated marked regional heterogeneity, similar to the heterogeneous lipid distribution characteristic of human atherosclerotic plaques. In summary, MR signals from lipid mixtures that mimic plaque lipid proportions can be detected at body temperature, especially in those mixtures with an increased percentage of cholesteryl esters. These studies raise the possibility that with further advances in technology, MRI may become a useful tool for determining the lipid content and composition of human atherosclerotic plaques in vivo.

MRI and NMR spectroscopy of the lipids of atherosclerotic plaque in rabbits and humans

The early stages of atherosclerosis are characterized by the deposition of cholesteryl esters and triglycerides into the arterial wall. In the excised human atherosclerotic plaque these lipids are in a liquid-like state at body temperature and observable via MRI and NMR spectroscopy. To assess the ability of MRI to quantitatively image the lipids of atherosclerotic plaque in vivo, we have investigated eight New Zealand White rabbits fed atherogenic diets (2 weight (wt)% cholesterol, 1 wt% cholesterol + 6 wt% peanut oil, and 1 wt% cholesterol + 6 wt% com oil). Postmortem examination indicated that all rabbits developed atherosclerosis in the aorta. Except for one animal, magnetic resonance angiography showed no noticeable obstruction in the aorta. MRI was carried out in an attempt to image atherosclerotic plaque lipids directly, but no signal was detected in vivo. However, a plaque lipid signal was observed from excised tissue using a small diameter RF coil. 1H NMR spectroscopy of the atherosclerotic plaque from excised aortas indicated that the major fraction of plaque lipids in rabbits is not in a liquid state at physiological temperature and are only marginally MRI-visible compared to human plaque lipid. The differences in the MRI characteristics of rabbit and human plaque are due to differences in the fatty acid profile of the cholesteryl esters, chiefly a decrease of linoleic acid in rabbit lesions.

Contrast-enhanced magnetic resonance angiography of carotid arterial wall in pigs

This study was designed to investigate the effects of contrast agents on MR images of balloon-injured carotid arteries containing atherosclerotic-like lesions. We have evaluated an intravascular contrast agent, MS-325 (METASYN INC., Cambridge, MA) and an extravascular contrast agent, Optimark, (Mallinckrodt Medical Inc., St. Louis, MO) on MR angiograms obtained 4 weeks after balloon hyperinflation-induced injury of the left common carotid artery in 12 hypercholesterolemic minipigs. High in-plane resolution (.8 x .4 mm2), thin slice (1 mm) time-of-flight gradient echo sequences were used to acquire the MR angiographic images. Vascular lumen definition was compared before and after a single bolus intravenous injection of a contrast agent. Digital subtraction angiograms were obtained from all pigs after MR imaging. High grade stenosis developed in 1 of the 12 pigs and five pigs had complete occlusion of the injured vessel. The remaining pigs exhibited essentially no visible stenoses as assessed either by MR angiography or digital subtraction angiography. The vessel walls of the stenosed and occluded vessels were visible after the injection of either intravascular or extravascular contrast agent. Histologic analyses showed well developed neovascularization in the neointima or occlusive thrombosis. We conclude that the observed contrast-enhanced vessel wall is caused by an increased vascular supply associated with thrombosis and neointimal thickening that leads to an accumulation of contrast agent in the abnormal vessel walls after the injection of the T1-shortening paramagnetic contrast agent.

Carotid plaque morphology and clinical events

BACKGROUND AND PURPOSE

Studies have suggested that B-mode ultrasonography can be used to determine carotid plaque composition and that specific plaque characteristics are associated with a worse clinical outcome. However, histological studies examining the relationship between carotid plaque morphology and clinical outcome have reported conflicting findings. Furthermore, few investigators have described plaque morphology in quantifiable terms. This study examines the association between the volume of carotid plaque constituents and preoperative ischemic neurological symptoms. Constituents examined were chosen based on their potential for identification by current diagnostic imaging modalities such as ultrasound or MRI.

METHODS

Atherosclerotic plaques from 43 patients undergoing carotid endarterectomy were examined histologically, with sections obtained every 0.5 to 1 mm. The lesions were examined for the presence and quantity of fibrous intimal tissue, intraplaque hemorrhage, lipid core, necrotic plaque core, and calcification. The quantity of each constituent was compared in plaques removed from symptomatic patients with those excised from asymptomatic individuals. Differences were analyzed with a Kolmogorov-Smirnov statistic.

RESULTS

There was no difference between plaques removed from asymptomatic and symptomatic patients with regard to the presence and volume of fibrous intimal tissue, intraplaque hemorrhage, the lipid core, the necrotic core, or calcification.

CONCLUSIONS

In patients with highly stenotic carotid lesions who are undergoing carotid endarterectomy, gross plaque composition is similar regardless of preoperative symptom status. Given this similarity, it is unlikely that differences in the volume of intraplaque hemorrhage, lipid core, necrotic core, or calcification in atherosclerotic carotid plaques explain their embolic history.

Atherosclerotic plaque components in human aortas contrasted by ex vivo imaging using fast spin-echo magnetic resonance imaging and spiral computed tomography

RATIONALE AND OBJECTIVES

Imaging techniques that distinguish atherosclerotic plaque components may be useful in identifying the nature of the atherosclerotic lesion and determining the best method of treatment for obstructive vascular mining the best method of treatment for obstructive vascular disease. This study compares fast spin-echo (FSE) magnetic resonance (MR) and spiral computed tomography (CT) images of excised human atherosclerotic aortas to determine which imaging technique provides the best contrast between plaque components ex vivo.

METHODS

Aortas were imaged using four FSE sequences in MR with and without frequency-selective fat saturation, and using spiral CT without contrast. The average signal intensity of a region of calcification, thrombosis, fatty plaque, and normal vessel wall was measured on all images and compared.

RESULTS

The use of fat saturation pulses in MR did not significantly alter the signal from atherosclerotic plaque for the sequences used. Proton density-weighted FSE sequences that collected early echoes were better than other FSE sequences and CT at differentiating calcification from all soft tissues. T2-weighted FSE sequences that collected later echoes were best at soft-tissue discrimination.

CONCLUSIONS

The FSE techniques used were superior to nonenhanced spiral CT in discriminating plaque components ex vivo, including calcification.

High resolution intravascular MRI and MRS by using a catheter receiver coil

Potentially important diagnostic information about atherosclerosis can be obtained by using magnetic resonance imaging and spectroscopy techniques. Because critical vessels such as the aorta, coronary arteries, and renal arteries are not near the surface of the body, surface coils are not adequate to increase the data quality to desired levels. A few catheter MR receiver coil designs have been proposed for imaging the walls of large blood vessels such as the aorta. These coils have limited longitudinal coverage and they are too thick to be placed into small vessels. A flexible, long and narrow receiver coil that can be placed on the tip of a catheter and will enable multi-slice high resolution imaging of small vessels has been developed. The authors describe the theory of the coil design technique, derive formulae for the signal-to-noise ratio characteristics of the coil, and show examples of high resolution cross-sectional images from isolated human aortas acquired by using this catheter coil. In addition, high resolution in vivo rabbit aorta images were obtained as well as a set of spatially resolved chemical shift spectra from a dog circumflex coronary artery.

Magnetic resonance images lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo

BACKGROUND

Although MRI can discriminate the lipid core from the collagenous cap of atherosclerotic lesions in vitro with T2 contrast, it has not yet produced detailed in vivo images of these human plaque components.

METHODS AND RESULTS

We imaged seven lesions from six patients who required surgical carotid endarterectomy and calculated T2 in vivo before surgery in various plaque regions. Using the same acquisition parameters, we repeated these measurements in vitro on the resected fragment and compared MR images with histology. T2 values calculated in vivo correlate with in vitro measurements for each plaque component; the in vitro discrimination we demonstrated previously with T2 contrast can therefore be performed similarly in vivo.

CONCLUSIONS

MRI is the first noninvasive imaging technique that allows the discrimination of lipid cores, fibrous caps, calcifications, normal media, and adventitia in human atheromatous plaques in vivo. This technique also characterizes intraplaque hemorrhage and acute thrombosis. This result may support further investigations that include MRI of plaque progression, stabilization, and rupture in human atherosclerosis.

Atherosclerosis of the carotid artery: evaluation by magnetic resonance angiography

Carotid artery atherosclerotic plaques (APs) can lead to brain ischemia, an event shown to correlate with both the degree of stenosis and the composition of the AP. Currently, accurate estimates of stenosis can be obtained by either x-ray angiography or three-dimensional time-of-flight (TOF) magnetic resonance angiography (MRA). Our purpose was to determine whether three-dimensional TOF MRA images could also provide information on plaque location, morphology, and composition. Seven pre-endarterectomy patients underwent three-dimensional TOF MRA. After endarterectomy, plaque histology was evaluated. Three-dimensional TOF MRA images contained sufficient soft tissue contrast to differentiate the plaques from the surrounding tissues in all cases. Estimation of plaque morphology had 80% correlation with histology. Finally, intraplaque hemorrhage and calcification were deplicted as regions of moderately high and very low intensity, respectively. These preliminary results suggest that three-dimensional TOF MRA may be useful in studying the development and progression of carotid atherosclerosis.

Improved MR images of arterial specimens by submersion in trichlorotrifluoroethane

MR images of ex vivo arterial specimens immersed in 1,1,2-trichloro-1,2,2-trifluoroethane (R-113) have improved signal-to-noise ratio and contrast-to-noise ratio. R-113 has no hydrogen atoms, so it yields no proton signal; hence, the contrast between the specimen and its background is maximized. SNR is maximized because (i) R-113 is nonconductive so that coil loading and inductive noise are minimized, and (ii) the volume susceptibility of R-113 closely matches that of water and tissue so that T2* effects are minimized. Short-term submersion of porcine aortas in R-113 was found to have no significant effect on the artery's hydration level, relaxation time, tensile strength, and structure or quantity of elastin, collagen, or smooth muscle cells.